CARE HOMES FOR OLDER PEOPLE
Bramwell Care Home Chilwell Lane Bramcote Nottingham NG9 3DU Lead Inspector
Richard Ramsden Unannounced Inspection 28th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bramwell Care Home Address Chilwell Lane Bramcote Nottingham NG9 3DU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 967 7571 0115 907 6114 paul.ward@nottscc.gov.uk Nottinghamshire County Council Mr Stephen Paul Ward Care Home 59 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (15), Mental disorder, excluding learning of places disability or dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14), Old age, not falling within any other category (30), Physical disability (20) Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Jasmin Wing will have a total number of beds of 14 MD(E) over 65 years to include up to 14 MD 55 years and over. Honeysuckle will have a total of 15 beds for DE(E) over 65 years to include up to 15 DE 55 years and over. Cinnamon will have 15 beds in total for OP aged over 65 years to include up to 5 PD 55 years and over. Lavender will have a total of 15 beds OP over 65 years to include up to 15 PD 55 years and over. No long-term residents to be admitted to Lavender. Total number of residents must not exceed 59 Date of last inspection 21st June 2006 Brief Description of the Service: Bramwell Care Home is owned and managed by Nottinghamshire County Council Social Services; it is a purpose-built care home for 59 older people. The home is divided into four units caring for different service user needs: older people (Cinnamon), older people with dementia (Honeysuckle), older people with mental health problems (Jasmine) and in intermediate care unit offering rehabilitation older people prior to returning home (Lavender). The accommodation is provided over two floors with two passenger lifts to assist independent access. All bedrooms are for single occupancy with ensuite toilet and shower facilities. There are well-maintained enclosed gardens, which are easily accessible by all service users living in the ground floor accommodation. The weekly accommodation charges for those residents who are self funding would be £377.00. A copy of the most recent inspection report is available in the home. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced visit over one day it took approximately 7 1/2 hours. It included the inspection of care and of the records, a discussion with the manager and a member of care staff. The inspector spoke with four residents and one visitor to the home. A partial tour of the building was also completed. Three residents were case tracked, which means that their care plans were examined against the actual care they receive. Before completing this visit the inspector assessed the home service history, the information provided by the registered manager and the last inspection report. The inspector also discussed the commission for social care inspections proposal to reduce some of the restrictions placed on the homes registration categories. What the service does well:
The people who were spoken with during this visit are very satisfied with the services provided at Bramwell Care Home. The residents said that staff are always friendly and respectful and ensure that their privacy and dignity is maintained at all times. The observed interaction between residents and staff was an excellent standard. The home is run in the best interests of the residents. There are regular residents meetings to ensure that the people living at Bramwell are able to express their opinions about the way in which the home is run. The manager has used the information gathered from the residents to produce an improvement plan for the home. (This is good practice). The residents spoken with during the inspection said they are very satisfied with their bedrooms and confirmed that they had been encouraged to personalise them with small items of furniture photographs etc. All areas of the home viewed during the inspection had been well maintained; they were comfortably furnished and pleasantly decorated. There pleasant gardens, which are accessible by all of the residents.
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 6 The residents said that the home is always kept beautifully clean. Individual residents records show that the home is providing a good range of activities and social stimulation. The home has good health and safety policies and procedures. What has improved since the last inspection? What they could do better:
The registered person must take steps to ensure that staff always answer residents emergency call bells promptly. Staff personal records should contain proof of identity as this helps to protect the residents’ safety and welfare. The homes fire risk assessment must be reviewed at least once each year to ensure that it remains pertinent and effective. It would be good practice to ensure that residents or their representatives always sign their terms and conditions of residence document, as evidence
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 7 that they have read and agree with the information contained in this document. Residents bathing records should be recorded in a format that can be viewed confidentially, and all residents care plans should contain a photograph of the resident so that staff and other professionals are always sure which resident the records refer to. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,6. Staff are ensuring that they can meet the assessed needs of prospective residents by obtaining comprehensive assessments prior to their admission to the home. Service users who are admitted for intermediate care are helped to maximise their independence and where possible return home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents records were assessed as part of this inspection. All the records contained preadmission assessments, which had been completed by a social worker.
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 10 The manager stated that residents are never admitted without a pre admission assessment. One of the residents who’s records were viewed during the inspection had been admitted for intermediate care. Although she had only been in the home for a few days her care plan contained individual goals set by the staff team to help the resident return home. The resident was eager to return to her home and expressed some concern that her rehabilitation at Bramwell Care Home was not been provided quickly enough. The inspector suggested that staff should constantly reminded the resident about how long the program of rehabilitation is likely to take. This will help to reassure her about the progress she is making. One resident could not remember if she had been provided with a Contract or Terms and Conditions of Residence Document. A copy of this document was available in the residents’ bedroom, however the resident nor their representative had signed it. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Residents care plans contain sufficient information and are reviewed regularly, to ensure that staff are always aware of what support and assistance each resident requires. The homes medication is well managed and residents believe they are treated with respect. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were viewed as part of this inspection, the care plans contain sufficient information and were reviewed regularly enough to ensure that staff are always aware of what support and assistance each resident requires.
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 12 Where possible residents had been encouraged to sign their care plans to confirm their involvement in the planning and review process. It was noticed that residents bathing records are being kept in a central file and consequently cannot be viewed in a confidential format. There were photographs of the residents on two of the care plans, however there was no photograph on the care plan of the resident who had been admitted for intermediate care. As the residents on the intermediate care unit are only there for a short period of time and a number of different professional staff work with these residents it is particularly important that a photograph is provided. Records show that the residents’ health care needs are being appropriately met; this was confirmed by all of the residents and the visitor spoken with during the inspection. The homes medication systems have been well maintained. Risk assessments are available for residents who administer their own medication. The records of receipt and disposal of medication have all been well maintained, the medication is stored securely and an air-conditioning unit has been fitted to ensure that it is stored at an appropriate temperature. The records of controlled medication were checked for one of the residents who was Case tracked; these records had been well maintained. All of the residents spoken with said that the staff are friendly and respectful and ensure that their privacy and dignity is maintained at all times. The relative spoken with during the inspection also confirmed this. The observed interaction between staff and residents was of an excellent standard. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The lifestyle experienced in the home appears to match the residents’ expectations and preferences. People are encouraged to maintain contact with family and friends and residents are satisfied with the food provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was able to demonstrate that the home provides a good range of activities and entertainment to stimulate the residents. The programme of activities is displayed in each of the four units within the home. One resident said that she would like the home to provide more activities however when this was discussed with her it became apparent that she is receiving a significant amount of social stimulation. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 14 One person said that they are very satisfied with the activities and entertainment in the home but that they would like to spend more time at the Salvation Army, which they have belonged to, all of their life. The manager agreed to discuss this with the resident and her family to see how the home could facilitate more contact with the Salvation Army for this resident. Residents and one visitor confirmed that visitors are made welcome, in the home; at any time and that refreshments are always provided. Individual residents care plans give details of how residents can be encouraged to make decisions about their daily lives. (This is good practice). There are also regular residents meetings where people are encouraged to express their opinions about the way in which the home is run. All of the residents’ spoken with said that they are satisfied with the meals provided by the home. They said that there is always a choice of food and that alternatives will be provided if they do not want the meal suggested on the menu. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The home has a robust, accessible complaints procedure and staff are ensuring that residents are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The literature supplied to all prospective residents contains a copy of the complaints procedure. The homes complaints records show that there have been four complaints received in the last 12 months. These were all informal complaints and were appropriately dealt with by the homes manager. None were referred to the Commission for Social Care Inspection. The residents spoken with confirmed that they would speak to a senior member of staff if they had any concerns or complaints. They believe that their concerns would be dealt with appropriately. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 16 Staff have received basic training in safeguarding adults and the home has an appropriate Whistle Blowing Policy. There have been no allegations of abuse in the home in the last 12 months. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. The purpose-built accommodation has been maintained to a very good standard it was pleasant and hygienic at the time of this inspection. Staff do not always answer the call bell system quickly enough to ensure the health, safety and comfort of the residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the premises was completed as part of this visit. The purpose-built accommodation has been maintained to a very good standard. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 18 The residents bedrooms viewed during the visit were comfortably furnished and people had clearly been encouraged to personalise their rooms with photographs, ornaments and small items of furniture. All of the residents spoken with, stated that they like their bedrooms and confirmed that they can use them at any time. The call bell was tested in one resident’s bedroom, the staff did not respond to the call bell. After 10 minutes the inspector located the member of staff to ascertain why she had not responded. The member of staff stated that she had not heard the call bell. It is essential the all call bells be answered promptly to ensure the health, safety and comfort of the residents. Note the inspector had observed staff responding to call bells promptly at other times during the inspection. All of the residents and the visitor confirmed that the home is always clean and hygienic. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,10. Sufficient staff are being employed to meet the assessed needs of the residents, the homes recruitment policies and practices are supporting and protecting residents. The registered person was able to demonstrate a commitment to staff training and development. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents spoken with said that although staff are always busy they are always available when you need them. One resident said that the staff are always friendly, helpful and caring and that they will do anything that you asked them to. All new members of staff complete an appropriate induction training programme. The information provided by the manager prior to the inspection states that out of a total of 45 care staff 25 people have NVQ level 2 or above and 14
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 20 people were completing the training at the time of this inspection. (This is good practice). The home follows Nottinghamshire County Councils recruitment policies and procedures, which include aspects of equal opportunities to ensure that there is no discrimination. The personal records of one recently recruited member of staff was assessed as part of this visit. The records contained all the required information except proof of identity. The manager confirmed that staff do not commence employment until all the required information has been obtained. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. The home is well managed and run in the best interests of residents. Where checked the health and safety of residents and staff are generally promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is well qualified and experienced. Residents and staff stated that the manager is very approachable and that he seeks their views about the way in which the home is run.
Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 22 Quality monitoring systems are in place and the manager has used the information gathered to produce a development plan, which addresses the individual issues highlighted by residents in the quality review process. (This is good practice). Staff do manage some residents personal allowances, the records were checked and had generally been well maintained. The manager was reminded that where possible residents should sign to witness their own financial transactions. If residents are unable to sign, two members of staff should sign the records. The aspects of health and safety, assessed as part of this visit, had generally been well maintained. Fire tests were being completed on a regular basis and appropriate records maintained. However it was noted that the homes Fire Risk Assessment had not been reviewed since January 2006. This should be reviewed each year to ensure the procedure remains appropriate and effective. Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 (2)(c) Requirement The registered person must ensure that the homes call system is always fully operational and that it is answered promptly by staff to ensure the health, safety and comfort of the residents. Staff’s individual records must include proof of the people’s identity. The homes Fire risk assessment must be reviewed at least once each year to ensure it remains appropriate & effective Timescale for action 28/06/07 2. OP29 Schedule 2 (1) 23 (4) (c) 06/08/07 3. OP38 06/08/07 Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations It is recommended that residents or where appropriate their representatives sing to confirm that they have read & agree to the individual Terms & Conditions of Residence Documents. It is recommended that residents bathing records be recorded in a format that can be viewed confidentially. It is recommended that there is always a photograph of the resident in their individual care plans. 2. 3. OP7 OP7 Bramwell Care Home DS0000043196.V336226.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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