Inspection on 05/07/06 for Brandon House

This inspection was carried out on 5th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brandon House 16/12/05

Brandon House 26/07/05

Brandon House 11/11/04

Brandon House 12/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brandon 29 Douglas Avenue Exmouth Devon EX8 2HE Lead Inspector Stephen Spratling Key Unannounced Inspection 5th July 2006 09:00 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 Brandon DS0000021891.V292127.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. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brandon Address 29 Douglas Avenue Exmouth Devon EX8 2HE 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) 01395 267581 01395 270806 brandonhouse29@aol.com Mrs Wendy Pamela Marsh Mr John Howard Marsh Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35) of places Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2005 Brief Description of the Service: Brandon is registered to provide personal care for up to 35 older people who may or may not have a physical disability. The detached property is situated in a residential area of Exmouth with large gardens and patio areas. There is a dining room and three lounges. Bedrooms are large and all have en suite facilities. Current fees charged are between £375 and £525 per week. The summary of inspection reports is available to every resident in a folder in their rooms and to others on request. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over seven and a half hours on Wednesday 5th July 2006. During the course of the inspection the inspector spoke with nine residents, three members of care staff, one of the members of domestic staff and the owner/manager. He looked closely (case tracked) the care of three residents. He also looked at other documents/records e.g. policies, maintenance records and recruitment records. The inspector also walked around the shared areas of the home, looked in some private rooms and around the grounds. Before the inspection site visit the inspector sent out a total of 33 questionnaires, seeking peoples views about the home. Questionnaires from nine residents, six care staff and six from visiting professionals (care managers, Doctors and Nurses) were returned. What the service does well: This home provides an excellent service to its residents. To help make sure Brandon is the right place for potential residents, time is taken to talk with them about what help they need and about the service offered at the home. They are given opportunity to visit the home and stay for a short period before they decide to move in long term. Residents say they are treated with respect, consulted about their care and supported to live their lives how they wish, spending time as and with whom they choose. A variety of activities and outings are offered. Good attention is paid to residents’ health care needs and medications are managed safely and in a way that helps residents to keep their independence. A good varied menu is provided and drinks are regularly and freely available. Staff are employed in sufficient numbers to ensure residents receive care and support at the pace they want. Staff receive regular training and report being well supported. One resident described staff at the home as “wonderful”. The home is managed in the best interests of residents by the owner/manger who is trusted and respected by staff and residents. One resident described Mr & Mrs Marsh (owners/manager) as “two of the kindest people you could come across”. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 6 The home is comfortably furnished, in good decorative order and provides a variety of shared areas. Most bedrooms are large and all are en-suite. The gardens are attractively maintained and accessible to residents. What has improved since the last inspection? 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. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 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 Brandon DS0000021891.V292127.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents can be confident that the home’s good assessment and admissions practice will help to ensure that the their needs can and will be met. EVIDENCE: In every room a copy of the home’s statement of purpose, complaints procedure and the summary of the last inspection report were available in a file. Residents completing questionnaires (nine) report having enough information about what to expect from the service. Resident records read (three) contained detailed assessment information about residents’ physical, psychological and social needs. New residents spoken with confirmed that they had met the manager before moving in and talked through the help they would need. Assessment information about a resident who had come from many miles away had been gathered from social services before the person moved in. Residents Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 9 confirmed that they have opportunity to visit the home and stay for a trial period before committing to stay longer term. This home does not offer an intermediate care service. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 10 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, 8, 9 & 10 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be treated with respect and that they receive the personal care and health care they need. Robust systems help to ensure that residents receive the medications they need safely. EVIDENCE: Throughout the inspection staff were heard speaking with residents warmly and politely, knocking on doors before entering and offering residents choices. Every resident spoken with described the staff in very positive terms, one person described the staff as “wonderful” and another, who was quite hard of hearing, said they were particularly pleased as staff always made sure they spoke clearly and loudly enough to be heard. Residents confirmed that they are supported to spend time where and as they wish. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 11 The manager reported that care plans are kept in residents’ rooms to allow them and staff open access. Several were seen in residents’ rooms by the inspector. Care plans read (three) reflected residents’ needs as identified during the assessments. They contained adequate description of how residents needs in relation to personal care, health care, social and psychological care should be met. Those seen had been regularly reviewed and some residents confirmed that that they are invited to be take part in their development and review. Health care professionals returning questionnaires (six) reported favourably on the home, confirming that they believe they are informed of changing health needs of residents appropriately and that their advice is acted upon. Residents spoken with confirmed they can contact their GPs directly if they wish or that the home staff will request appointments for them as required. The visitor of one resident was very grateful to staff who had noticed and acted upon a subtle symptom observed in their relative helping to ensure they receive treatment they need. A variety of professionally recognised assessment tools were seen in use to help monitor residents’ health; for example their nutritional status and their susceptibility to devloping presure ulcers. Where these tools indicated it was necessary care plans had been developed with the intention of keeping residents as healthy as possible. Medication storage arrangements are secure and approriate. The manager reported that only staff trained to administer medication are permitted to do so and this was confirmed by staff spoken with. Some record of staff attending medications training was seen. Medication charts seen were all pre-printed by the supplying pharmacy, no hand written charts were seen. Medications received into the home had been checked in and signed for. Medication administration charts looked at (six) were properly completed. Two residents said that they manage their own medication. A formal risk assessment in relation to one of these residents managing their own medication was seen. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 12 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, 13, 14 & 15 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents at this home are supported to be as independent and active as they want/are able to be and their visitors are made to feel welcome. Residents are provided with the food they need and individual preferences are taken into account and mostly catered for. EVIDENCE: All residents completing commission questionnaires indicated that they are happy with the activities available in the home. On the morning of the inspection a group of ten residents were seen enjoying an exercise class. This is run three days a week. Residents mentioned other activities such as outings to the sea, a local garden centre, parties and a regular crafts group. Staff spoken with said that staffing levels are high enough to allow them to spend time individually with residents and to take them out of the home if they wish and need help. Residents confirmed that they are free to come and go as they please and spend time where and with whom they wish. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 13 One visitor indicated that they are very happy to see that their relative is treated with respect indicating that the staff approach encourages them to retain their independence. Many residents go out of the home unaccompanied as they wish. Residents confirmed that their visitors are made welcome at the home and that friends and relatives are welcome to attend parties and events held at the home. Six residents completing the questionnaire confirmed that they always like the food provided and the other three indicated that they usually do. All but one of the nine residents spoken with were positive about the food with several people describing it as excellent. Though the main meal of the day is set, the manager said alternatives are available; for example on the day of the inspection most residents had pork, though one had chicken and another a salad instead. Several residents have facilities to make hot drinks in their rooms, and all asked said they were regularly offered drinks by staff. Drinks with cake was being offered to all during the afternoon of the inspection. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents can be confident that concerns and complaints will be listened to and acted upon and that staff would act to protect them if they were being mistreated. EVIDENCE: Every resident completing a questionnaire confirmed that they would know who to speak to if they were not happy. Every resident who spoke with the inspector confirmed that they would speak with the manager if they had a concern or complaint and expressed great confidence that she would listen and act. The complaints procedure is available to each resident in a folder in their rooms. The procedure provides clear information including contact details of the Commission. The manager said there had been no formal complaints logged since the last inspection. Staff completing the Commission questionnaire (six) all indicated that they are “aware” of “adult protection procedures”. All three spoken with were clear that they should report any concerns to the manager, who is in the home every day. They also indicated that consistently good staffing levels mean they rarely feel pressured/stressed at work. The manager was clear about reporting procedures for adult protection concerns. The inspector read the home’s procedure for responding to concerns about abuse, which provided adequate information. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 15 On the pre-inspection questionnaire completed by the home manager she indicates that Protection of Vulnerable Adults training is provided for care staff at the home. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 16 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): 19 & 26 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home provides an attractive, well-maintained, clean, homely and comfortable environment for residents. EVIDENCE: The home is surrounded by well-maintained gardens full of flowers and shrubs. There are a good variety of outside seated areas and most of the garden would be accessible to wheelchair users. All residents spoken with confirmed that they think the home is kept clean and well maintained. All of the eleven bedrooms visited were comfortable, personalised, with resident soft furnishings, pictures etc, and most were large; all have ensuite facilities. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 17 The shared areas of the home were clean, comfortably and attractively furnished. All furnishings seen were in a good state of repair and the home is in excellent decorative order. One of the cleaning staff spoken with confirmed that she receives enough time and support to do her job properly. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 & 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Kind, suitably skilled care staff, employed in sufficient numbers ensure that residents are treated with respect and get the care they want and need. Though not completely robust the procedures followed for vetting and recruiting care staff help to protect residents from people unsuitable to care for them. EVIDENCE: Residents spoken with all said staff are available when needed. Seven residents returning Commission questionnaires confirmed that there are always staff available when needed and two said that usually there are. Residents confirmed that staff are always polite, listen to them and seem to know their jobs. One person described them as “wonderful” and another said they are extremely “good” and “efficient”. Staff spoken with (three) confirmed that staffing numbers are good and that they never feel pressured to rush when providing care to residents. Two residents commented that new care staff work with an experienced member of staff when first at the home. All three staff spoken with said new carers “shadow” colleagues before working alone. A new member of staff said that they feel well supported, confirmed that they were working through an induction process and that they had received instruction about moving and Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 19 handling, fire safety, food hygiene and health and safety. Induction records were available on files. Care staff spoken with made it clear to the inspector that they are encouraged to respect residents’ choices and to make the most of their abilities to be independent. All three care staff spoken with and all those completing questionnaires indicated they like working at the home and feel well supported. One person said described it as a “brilliant” place to work. The manager reports that 82 of care staff have NVQ2 or above. A senior care spoken with said that they were now doing NVQ4, which was being paid for by the homeowner. Another staff member confirmed that training paid for and generally provided in paid time. The home’s system for monitoring staff attendance at training was seen and showed that most staff were up to date with basics such as infection control and manual handling. The inspector looked at the recruitment files of three care staff employed within the past 12 months, all contained the required checks. However the Criminal Records Bureau (CRB) check for one person had not been received until after they had started in post and CRBs for the other two staff members had been completed by their previous employers. Current guidance says that new checks should be done on all new employees. The manager showed a list of CRB checks done on other care staff at the home, indicating that when a carer is not already know to the manager a full CRB is required before they start work. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 20 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, 33, 35 & 38 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. This home is well managed, run in the best interests of residents and has a systematic approach to health & safety which helps to protect them from harm. EVIDENCE: The home manager provides strong leadership in the home and is both an experienced Nurse and environmental health inspector. She is supported by her husband who is also co-owner of the home. She has completed the Registered Managers award. Residents speak very highly of the owners/manager, one resident described them as “two of the kindest people you could come across” and others described how the manager listens to them and acts on their requests. Care Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 21 staff were equally positive about the support they receive from the owner/manager, confirming that they are in the home seven days a week and easy to talk to. Anonymous questionnaires about the quality of the service are given to residents and staff annually. The outcome of a recent staff questionnaire had been drawn together to produce a report outlining action to be taken to address issues or ideas raised. The manager talked the inspector through how she is changing/improving arrangements around staff manual handling, to improve the safety. The home manager reported that neither she nor care staff have any involvement with residents’ finances. Though not all hot surfaces are guarded and some upper floor windows openings are not restricted, the manager could produce risk assessments which indicated these were in low risk areas. Guards and restrictors had been fitted where a raised risk had been identified. A positive report dated 22/06/06, with no requirements, from an environmental health officer’s inspection of the kitchens was seen. Receipt confirming that the fire alarms had been serviced was seen dated 30/06/06 and a maintenance receipt for the Gas boilers was seen dated 25/01/06. As mentioned earlier staff receive routine and regular training on basic health and safety topics. Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 22 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 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 4 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 4 X 3 X 3 X X 3 Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement The registered person must not employ a person to work in the care home unless…he has obtained in respect of that person all the information and documents specified in paragraphs 1 to 7 of schedule 2. A protection of vulnerable adults check (POVA) check should be made prior to the appointment of a new care worker. Ref paragraph 26 & 27 Protection of Vulnerable Adults Scheme- A Practical Guide (produced by the Department of Health and updated 16/05/06; www.dh.gov.uk). A check against the POVA list cannot yet be made without making a new full CRB application. Therefore CRB checks are not transferable from one employer to another. Timescale for action 05/09/06 Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 24 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 Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Brandon DS0000021891.V292127.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!