Inspection on 20/04/06 for Branksome Care Home

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Branksome Care Home 02/08/07

Branksome Care Home 31/01/06

Branksome Care Home 12/07/05

Branksome Care Home 01/03/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Branksome Care Home 56 St John`s Road Buxton Derbyshire SK17 6XB Lead Inspector Ray Coonan Unannounced Inspection 20th April 2006 10:00 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 Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Branksome Care Home Address 56 St John`s Road Buxton Derbyshire SK17 6XB 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) 01298 26230 01298 72194 Not given www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mr Guilbert Ian A Magno Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: The Home, which is located close to Buxton town centre and a wide range of local amenities, provides nursing and residential care for up to 34 elderly service users. All accommodation is in single rooms and spread over 2 floors. The Home has extensive garden areas. There are 2 lounge areas and a dining room situated on the ground floor and a sitting area close to the main entrance. The Home is suitably resourced with bathroom and toilet facilities and 4 bedrooms are en suite. Support services are in place with a choice of G.P. and links are established with other community health professionals. The Home employs qualified nursing staff together with care workers. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection took place over a period of just over six hours on the 20th April. The manager of the Home, Ian Magno, was present throughout the visit. There was also the opportunity to talk to several residents on the day and have discussions with staff on duty at the time. A range of documentation was examined such as Care Plan files, policies and procedures, staffing information and Health and Safety records. Most parts of the premises were also viewed, including a sample of residents’ bedrooms. What the service does well: What has improved since the last inspection? What they could do better: Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 6 More defined measures to raise staff awareness of protection and abuse procedures are still required. A clear policy on resident privacy is also needed. 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. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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 Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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 good. This judgement has been made using available evidence including a visit to this service. Satisfactory comprehensive assessment information was obtained on prospective residents. EVIDENCE: Several individual care plans were examined and these demonstrated that a range of relevant assessment information was obtained by the Home prior to any admission such as hospital nursing assessments, including initial wound information and also relevant social care information from care managers. The Home also undertook their own admission assessments, which informed subsequent care plans. The manager explained that the Provider Organisation had recently introduced a new initial stage assessment process to be developed by the Home which contained set checklists relating to the physical and emotional health of new residents and focussed on daily living activities. A separate format was in place for social history and background information. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents had their overall health and social care systematically assessed and promoted. The Homes policy and practice regarding individual privacy was not clear. EVIDENCE: Each resident had an individual care plan and several of these were examined in detail. Plans were well - organised and kept up to date. There were clear risk assessments and signed consent forms for such areas as the use of bed rails. Personal care needs were identified with desired outcomes and short term and long term goals set out with clear guidance notes for staff. The plans dealt with a comprehensive range of needs relating to the physical and emotional health of residents and monthly evaluations of care were formally recorded and completed by the resident’s named nurse. There were regular up dates on residents’ skin integrity and detailed notes on fluid intake as necessary. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 10 Appropriate pressure relieving equipment was also in use. Overall dependency of individual residents was assessed and monitored on a regular basis, as well as a resident’s weight and appetite. Records of G.P. appointments and other health contacts were maintained with communication sheets in use for any specific issues. The manager has also put in place a system for more detailed records regarding wound/pressure sore treatment. Care plans also contained social care assessment information, which included notes on residents’ individual preferences and interests, and social and family history. It was noted that on more recent files this area was now being completed more fully. Records of activities undertaken were also kept on care plans, though these were not always up to date. Arrangements for the storage, handling and administration of medicines were also viewed and these were generally satisfactory. The Home has a treatment/storage room, which is kept locked. Stock levels were satisfactory and there were suitable arrangements for the storage of controlled drugs with specific recording procedures in place. Overall recording processes were satisfactory. No residents administered their own medication apart from one instance regarding eye drops. The Home has an identified lead nurse in charge of dressings for pressure sores. Staff were observed interacting with residents in a friendly and appropriate manner and residents generally had a good rapport with care staff. It was noted that the Home still continues to leave many residents bedroom doors open, whether residents were in their room or not. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The social and leisure interests of residents were well promoted at the Home. Residents’ dietary needs and preferences were appropriately assessed and a varied and nutritious menu was available. EVIDENCE: The Home has an activity coordinator (15 hours per week) who has developed recreational programmes with residents mostly with the Home. Several residents and staff mentioned that the Homes minibus had been out of action for some time and that they missed the opportunity to go on trips out of the Home. Residents confirmed that entertainers visit the home regularly. Some residents also mentioned going into town to visit local shops and luncheon clubs, though this was dependent on the availability of staff. The Home also Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 12 published its own newsletter, which contained lists of events and features on individual residents. Residents spoken to were happy with the standard of catering at the Home and it was mentioned that the cook consults with them regularly. Menus run on a 4 weekly cycle and indicated that residents receive a varied and nutritious diet. Any special dietary needs were assessed and catered for and there were a good number of residents who required a soft food diet, which was suitably presented. Residents were able to get alternatives to main meals, though as noted at the previous inspection, the menu for the day was not displayed. Most residents had their meals in the dining area, which has recently been renovated, though some also had their meals in their rooms out of choice. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. The Home has satisfactory systems in place for responding to formal complaints. However, staff training in the protection of vulnerable adults still does not have a high enough profile. EVIDENCE: The Home has a comprehensive complaints policy, which is included in the service user guide. It was stated that there had not been any formal complaints received since the last inspection. Systems are in place for recording any complaints. The Home has had recent experience of adult protection procedures and the manager has attended interagency case conferences as required. Relevant policies are in place, though it was noted that senior staff have still not attended local multi agency training on the Protection of Vulnerable Adults and that there had not been any recent input for care staff. The manager stated that he is arranging to attend a course, which will enable him to train staff within the Home. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Following a substantial programme of redecoration and refurbishment at the Home residents enjoy a pleasant, fresh and comfortable environment, which is hygienically maintained. EVIDENCE: The redecoration and refurbishment programme of the past six months has now been completed with the repainting of the office areas. However, the kitchen storage area was still in need of repainting. The work to repaint external window frames has also been completed and overall the Home was decorated and maintained to a good standard with suitable fixtures and fittings throughout. Regular checks are made for any environmental hazards. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 15 Corridor areas are of a good width and bathroom areas are appropriately equipped with aids and adaptations. There has been no progress in providing a loop system for those residents with hearing impairment. The large greenhouse at the rear has now been demolished though the area still needs to be made fully safe. Work to make the grounds at the front more accessible has yet to start. The Home was clean and hygienic and there were no offensive odours evident. The laundry areas though busy were well organised and equipped. Residents clothing and appearance was seen to be of a good standard, though there was one instance of a resident left with stained clothing after a meal. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 16 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents benefit from an overall satisfactory approach to staff recruitment and development. However, the level of qualified nursing hours available is in need of review. EVIDENCE: Staff training records and information has now been updated and a more systematic approach to training provision was evident. Records showed that a comprehensive range of courses are made available to staff and staff spoken to were positive about the opportunities for development, which has recently included input on dementia care for some staff. Up to 50 of care staff have undertaken NVQ training. There have not been any staff changes since the last inspection. Staffing rotas were seen and indicated that appropriate numbers for each shift were maintained, though there was some fluidity regarding care hours, depending on the number of residents. At the time of the inspection there were 29 residents of whom 25 were receiving nursing care. Currently, there was only one qualified nurse on each shift though the manager stated that dependency Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 17 levels were fairly stable. It was also explained that the Home were actively looking to increase nursing hours. A sample of staff records were viewed and these were generally well organised and showed that recruitment and employment practices were followed appropriately. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 18 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The Home is run in a systematic and structured manner with residents benefiting from services that are monitored on a regular basis. The safety of their surroundings is also appropriately checked regularly. EVIDENCE: The manager has relevant professional qualifications and several years of management experience. Staff were positive about the support they received and confirmed that they received 1:1 supervision time as well as annual appraisals. However, it was noted that regular supervision sessions and formal annual staff appraisal processes were not being kept up to date. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 19 There was a structured approach evident to measuring the quality of services at the Home with a system of annual audits undertaken by independent managers. Records of monthly visits by the Providers representative were also maintained. Questionnaires were used with residents. Comprehensive Health and Safety policies and procedures were in place and there was a systematic programme for checking safety at the Home, which has its own Health and Safety Committee that meets quarterly in order to address and monitor any issues. Records for servicing of utilities and checks on equipment were examined at the previous inspection and were satisfactorily maintained. Records for ongoing monitoring such as checks on water temperatures and the alarm system are also in place. The Fire Officer last visited on 12/8/05 and there were no outstanding requirements. Fire safety records were also up to date and a fire drills take place on a regular basis. fire safety training certificates were seen on this occasion and were up to date. The Home handles personal spending monies for many of their residents. A detailed and secure system is in place for recording any financial transactions with clear computerised records backed up with suitable manual records. The Home is not an appointee for any resident. Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 21 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 OP18 Regulation 13 Requirement The manager must develop and implement a programme for staff training in the Protection of Vulnerable Adults. The Home must review its policy for keeping bedroom doors open and residents’ wishes must be recorded on care files (Previous timescale of 31/03/06 has not been met). Staffing levels of qualified nursing staff must be reviewed Timescale for action 31/10/06 2. OP10 12 30/06/06 3. OP27 18 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP12 Good Practice Recommendations The menu for the day should be displayed. Records of activities arranged at the Home should be kept DS0000044486.V289080.R01.S.doc Version 5.1 Page 22 Branksome Care Home up to date. 3. 4. 5. OP19 OP19 OP22 The kitchen storage area should be repainted. Plans to improve access to garden areas should be followed through. An assessment for the fitting of a loop system in communal areas should be made in order to assist residents with hearing difficulties. Processes for individual staff supervision and annual appraisal should be kept up to date. 6. OP36 Branksome Care Home DS0000044486.V289080.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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