CARE HOMES FOR OLDER PEOPLE
Bramwell Care Home Chilwell Lane Bramcote Nottingham NG9 3DU Lead Inspector
Richard Ramsden Unannounced Inspection 8th December 2005 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.V269632.R01.S.doc Version 5.0 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.V269632.R01.S.doc Version 5.0 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 9677571 0115 9076114 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.V269632.R01.S.doc Version 5.0 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 21/07/05 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. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Inspector completed this announced inspection over a period of approximately 5 hours. It included the inspection of care and of the records, a discussion with the manager, two members of staff, as well as speaking with five residents. A partial tour of the building was also completed. What the service does well: What has improved since the last inspection?
Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 6 Residents care plans are being reviewed each month in consultation with the individual residents and where appropriate to their representatives. This is helping to ensure that staff always has up-to-date information on what assistance and support each resident requires. Staff are now signing the medication records, each time medication is given to the person for whom it is prescribed. A lock has now been fitted to the laundry door and all hazardous substances are kept in a locked cupboard when staff are not using them. The new part-time cook has been employed and the home does no longer have to use meals on wheels when the main cook is not on duty. What they could do better: 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. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 7 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.V269632.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. The literature supplied to prospective residents does not contain sufficient information to enable people to make an informed choice, as to whether the home will meet their individual needs. EVIDENCE: The registered person has produced an information pack, which is supplied to all residents. The information pack contains a considerable amount of information, however some of the information was out of date. The literature must include the resident’s views of the home and must be updated to show that the Commission for Social Care Inspection is the organisation, which people can contact, if they believed that their concerns/complaints are not being dealt with appropriately by the home. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10. Not all of the residents care plans contain sufficient information to ensure that their social and health care needs are being met. Further improvements must be made to the way in which medication is managed to ensure the health and safety of the residents. Residents do feel they are treated with respect and that their privacy is upheld. EVIDENCE: On superficial inspection the care plans appeared to contain appropriate information to ensure that staff are aware what support and assistance each resident requires. However when the records of one resident was checked in more detail, it was noted that she was receiving anticonvulsant medication and that her preadmission assessment stated that she has “minor fits”. This person’s epilepsy was not mentioned in her care plan or any of her risk assessment. This could significantly affect the support and assistance this resident requires. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 10 The inspector noted that the care plans are being reviewed at least once a month and that there was written evidence that residents and where appropriate to their representatives have been involved in the review process. (This is good practice). There has been a considerable improvement in the way in which the home managers the residents medication. However it was noted that staff are still not recording the temperature in the room in which medication is stored. When the inspector spoke with one of the senior care staff it became apparent that she was administering medication to residents even though she had not received any external/accredited training. The manager was advised that no staff should administer medication until they have completed an appropriate training course. All of the residents spoken with during the inspection said that staff are always friendly and respectful and that they ensure that their privacy and dignity is promoted at all times. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15. More formalised activities need to be provided to meet the residents expectations. Residents are helped to exercise choice and control over their lives but must be informed how they can have access to their personal records. The meals provided for residents appear wholesome and nutritious. EVIDENCE: All of the residents spoken with during the inspection said that they do not believe that there are sufficient activities provided within the home. One person said that some extra stimulation might stop people falling asleep all the time. Each unit within the home displays a list of the activities available but it does not indicate when, or how frequently, the activities will be provided. The residents spoken with during the inspection stated that they are encouraged to make decisions about their life within the home. Everyone stated that they had been able to bring personal possession including photographs, ornaments and small items of furniture into the home. The information packs provided to all residents’ gives details of how they can contact independent advocates. (This is good practice).
Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 12 The residents have not been provided with any information on how they can gain access to their personal records. This information must be provided in a format suitable for the individual residents. Since the last inspection a new part-time cook has been appointed and the home no longer uses meals on wheels provide the residents lunches. All of the residents spoken with said that they enjoy the food provided and confirmed that they will be offered an alternative if they do not want the food suggested on the menu. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. The home has appropriate policies and procedures to protect residents from abuse. EVIDENCE: A copy of Nottinghamshire County Councils Whistle Blowing Procedure could not be located during the inspection. The manager stated that copies had been available but that they must have been taken by staff who are completing their NVQ training. A copy of the procedure was downloaded from the Internet during the inspection. The manager was advised that a copy of this procedure must be available in the home, at all times. A member of staff who was spoken with during the inspection was able to demonstrate a clear understanding of her responsibilities with regard to the Whistle blowing procedure. (This is good practice). The home has a copy of the local Vulnerable Adults Procedure and a summary has been produced informing staff of their responsibilities and of the reporting procedure. The summary also gives telephone numbers of people who can be contacted if staff does not wish to report issues to the homes management staff. (This is good practice). The manager stated that there have been no allegations of abuse in the home in the last 12 months.
Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home was appropriately clean and tidy at the time of this inspection. EVIDENCE: All of the residents spoken with during the inspection said that they are very satisfied with their bedrooms and confirmed that the home is always kept very clean and tidy. Since the last inspection a digital lock has been provided to the laundry door and all cleaning products are now stored in a locked cupboard, when there are no staff in the laundry. Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30. Residents are supported and protected by the homes recruitment policies and practices. Staff are well trained and competent to do their jobs. EVIDENCE: The records of the two most recently recruited members of staff were checked as part of this inspection. The records contain all the required information except written references. These references were faxed through to the home during the inspection and were satisfactory. The manager was reminded that staff should only commence employment once a satisfactory Criminal Records Bureau check has been received, except in exceptional circumstances when staff can commence employment if a POVA first check has been completed and the member of staff supervised at all times. Written confirmation of the POVA check including the reference number must be kept in the home. All staff complete appropriate induction training. This was confirmed by one of the staff spoken with during the inspection. 61 of the staff have completed NVQ training and a significant number of staff were completing the training at the time of this inspection. (This is good practice).
Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38. The manager has recently has recently attended an interview and was assessed a suitable to be registered by the Commission for Social Care Inspection. The aspects of health and safety assessed as part of this inspection were all satisfactory. EVIDENCE: The manager has considerable experience of managing care homes for older people. He was recently interviewed by the inspector of the commission for social care inspection and was assessed is suitable to be the registered manager at Bramwell Care Home. The homes Fire records were checked and had all been well maintained.
Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 17 Evidence was provided that 37 members of staff have up-to-date first aid qualifications. The manager confirmed that there is always a qualified first aider on duty, in the home. (This is good practice). The environmental health officer carried out in the inspection of the home on 25th of March 2003. There is no work outstanding from this inspection. All staff have received training in basic food hygiene and they all complete moving and handling training before they assist residents with their mobility. (This is good practice). Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 18 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 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5 Requirement It is required that the written information provided to prospective residents includes the following information. 1.The resident’s views of the home. 2.Details showing that the Commission for Social Care Inspection is now the organisation with responsibility for monitoring standards within the home. It is required that the registered person ensures that individual residents care plans cover all aspects of there assessed health & social care needs. It is required that the home records, each day, the temperature in the room in which the medication is stored. The room temperature must not exceed 25 C. (This requirement is outstanding from 21/07/05). It is required that staff do not administer medication until they have completed appropriate accredited training.
DS0000043196.V269632.R01.S.doc Timescale for action 16/01/06 2. OP7 12 08/12/05 3. OP9 13 08/12/05 4. OP9 13 08/12/05 Bramwell Care Home Version 5.0 Page 20 5. OP12 16 (2) 6. OP14 15 It is required that more social activities are provided preferably after consultation with the residents. It is required that the registered person ensures that residents are aware of how they can have access to there personal records. 30/01/06 16/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bramwell Care Home DS0000043196.V269632.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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