Inspection on 09/10/08 for Branwell Lodge Nursing Home

This inspection was carried out on 9th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Branwell Lodge Nursing Home 04/06/09

Branwell Lodge Nursing Home 22/04/08

Branwell Lodge Nursing Home 25/04/07

Branwell Lodge Nursing Home 16/05/06

Branwell Lodge Nursing Home 20/10/05

Branwell Lodge Nursing Home 24/01/05

Branwell Lodge Nursing Home 15/09/04

Branwell Lodge Nursing Home 28/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Branwell Lodge Nursing Home Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Caroline Long     Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Branwell Lodge Nursing Home Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ 01274521731 01274523279 andrew.moran@bdct.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Rushworth Type of registration: Number of places registered: Brunel & Family Housing Association Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning disability - Code LD Date of last inspection Brief description of the care home Branwell Lodge is a 20 bedded registered care home providing nursing care for people with varying degrees of learning disabilities and challenging behaviour situated approximately 3 miles from Bradford city centre. The shops and local community facilities are within walking distance. The home is a purpose built property originally registered in 1980. There is a garden with a patio area and ample car parking space. The accommodation compromises of eight flats with single bedrooms, communal living Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 22 Brief description of the care home and kitchen areas, and bathrooms. Brunel Support Works, who are responsible for the ancillary staff at the home and general maintenance, have been merged with Yorkshire Housing Association. The Bradford District Care Trust provides all the care and nursing staff. Copies of the inspection report are available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The basic cost of services are dependent on local authority funding and benefit entitlement. This is what we used to write this report. We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual quality assessment questionnaire. Care Homes for Adults (18-65 years) Page 6 of 31 We sent surveys to people living in the home, to staff and to health professionals. Two inspectors visited the home unannounced. This visit lasted over six hours and included talking to the staff and the manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home and a relative who was visiting. We looked at four peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: To be sure that peoples health care needs are fully met. Staff must review peoples health care needs to make sure they are receiving the support and health care they need. To provide people with a fuller and more active lifestyle of their choice. A review of every ones daily life and activities must be carried out to make sure any activities are tailored to reflect peoples individual needs. People should have a choice about and be compatible with whom they share their flat. Care Homes for Adults (18-65 years) Page 8 of 31 Care plans need to be person centred and reflect what people want now and in the future and how the care and support the staff have to offer enable them to do this. Also risk assessments need to identify any possible risk and should be relevant to the individual. In order to keep an accurate record of the medicines the way medication is recorded needs to be improved. To provide people with a comfortable place to meet the communal areas should be less institutional. People should be provided with a sensory room to be able to relax in. When reviewing the number of staff on duty the manager should always take into consideration peoples needs and the layout of the building. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will only be admitted to Branwell Lodge when it is clear that the home is the best place for them to live. Evidence: There have been no new admissions to the home since 2006. In 2007 everyone living in the home had an assessment of their needs to establish whether Branwell Lodge was best place for them to live. Some people have now moved out of the home and it is our understanding that the staff are working with other people to find them the most suitable place to live and until this is completed there will be no admissions. Branwell Lodge consists of eight flats with either two or three bedrooms, a bathroom and living space; there is also a communal lounge and dining room for everyone. When we visited in April the manager explained that people do not have a choice about whom they share with because of availability of rooms. However some people have now left the home and there is some room for movement but we found evidence Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the staff are still failing to look at whether people are sharing with someone they are fully compatible with. When we visited in April we asked that people were made aware of their rights and their the contracts should be in a format which they can understand and efforts made by the home or the advocacy service to explain them. We asked the manager if there had been any changes to the contracts she told us there is now a easy read guide to the contracts and these have been explained to people living in the home. We were provided with a copy of the new service user guide which is clear and easily followed, this has a photograph of a person on the front, the manager said they had given their permission for their photograph to be used. However we must ask whether this compromises their confidentiality, privacy and dignity and when agreeing to their photograph being used were they fully able to understand who would have access to this document and what it is to be used for. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now have care plans and risk assessments in place which meet their basic needs, however further work needs to be carried out to make sure they are person centered and offer people the opportunity to make the most of their lives. Evidence: At our last visit we asked Branwell Lodge to make sure everyone had a up to date care plan which would help staff provide support to people according to their needs and wishes and we asked the home to provide us with an improvement plan telling us how they were going to carry this out. The improvement plan told us they were going to introduce new records which were person centered and introduce a named worker system to help them identify peoples needs better. We found improvements had been made, new care records had been introduced and overall the information was detailed and contained peoples personal preferences and choices and there was evidence of peoples involvement. Where risks were identified, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: risk assessments were carried out which provided staff with the actions they needed to take to minimise any risk. However we were able to find gaps and these showed us the staff are not taking a person centered approach to the care they offer. Being person centered is about listening to and learning about what people want from their lives and helping people to think about what they want now and in the future and providing the care and support to enable this to happen. When we talked with the manager and staff we found they were often relying upon old and historical knowledge to inform them about people needs and were not looking at how the person had changed or what improvements they could make. The manager told us the home is going to seek the advice of Mencap about reviewing the care plans to make them more person centered. Also the risk assessments included risks for areas such as the use of gas and electricity appliances, although it is unlikely that everyone would be using gas appliances. Risk assessments must be relevant to the individual. If some of them are not then they crowd out the ones that are meaningful. We found staff are supporting people to make limited choices such as what time to go to bed and get up, and people have now been introduced to the advocacy service. Evidence from the manager, staff and a person living in the home confirmed the reviews of peoples care are carried out regularly. Everyone has a named nurse who updates the care plan and a key worker who is a support worker who will spend more time with the person and get to know them better, so making sure people receive the care and support in the way they prefer. However one staff in their survey did comment that some named nurses are failing to pass on information to the support workers. The home has regular meetings where people living in the home can make their views known. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements need to be made to make sure everyone is leading a full and active life. Evidence: At the last visit and at previous inspections we have asked the home to make sure people are provide with and supported to enjoy a full range of opportunities and activities in the community. When we visited we found a full time activities organiser has been recruited and some people were being given the opportunity to join in activities and go out in the community. Also one person was now being offered one to one staff support to help them mix with others. The activities organiser has started a swimming group and people have been supported to go on holiday to Blackpool. There are also sufficient staff on duty to give staff time to spend with people. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: However this was spasmodic and not always tailored to peoples individual needs. Examples of this are One person liked to go for walks in the countryside but we found they spent most of their time in the home where staff acknowledged they appeared frustrated and unhappy. Where the activities organiser had taken a person out and they had enjoyed it this had not been repeated. The advocate told us where a person had cultural needs the home had not been proactive in finding ways to make sure these were met. Although there is now an activities organiser she has only limited experience of working with people with learning disabilities. When we visited there was a group activity where a person was giving a demonstration of how to make truffles and selling them, this was not appropriate to peoples needs and one person was seen to be very frustrated by it. One person liked to go out for a drive, however the staff mainly offered them a drive in the bus when they were taking other people to day centers rather than to a destination of their choice. Although there is now a activities organiser and the staff have more time, staff need to review how they can make sure activities are tailored to peoples individual needs. However a relative told us how they were able to visit people regularly, and how the staff were always welcoming. To try to make the home less institutional people are now encouraged to remain in their flats for lunch, to enable this to happen staff are allocated to the flats and to sit with them and eat. When we visited only one person sat in the lounge area to eat, this was their choice, staff told us the rest preferred to stay in their flats. All the staff said this new development was far better and people appeared to like it. For lunch when we visit people had tuna or cheese and tomato toastie or jacket potatoes with cheese and beans and salad. For the evening there was poached fish in parsley and vegetables or cauliflower cheese. We saw the food looked fresh and appealing and the person eating it said it was very good. Care Homes for Adults (18-65 years) Page 16 of 31 Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health services to enable them to remain in good physical health, however improvements need to be made to make sure people are accessing the health care they need and want. The administration of medication needs to be improved to make sure mistakes are not made. Evidence: The care plans included a comprehensive list of health checks for each person, which showed that people were able to access local health care facilities such as the general practitioner, specialist nurses and the psychiatric services. However due to a lack of person centred planning we found one person was receiving examinations by outside professionals which caused them distress when the examination may not have been necessary. For others we found the staff had not fully considered or reviewed peoples health needs, for instance one persons plan gave conflicting information about the amount of support they needed with one aspect of their personal hygiene. Also when staff were asked why a person behaved in a certain way, they all answered because they always Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: have, no one had found out the reason so they could make sure this person was recieving the care and support they needed. Staff were aware of how to maintain peoples dignity when providing personal care and were treating people with respect but there were areas where staff had not considered how some actions had an effect on peoples dignity. The medicines are kept safe and secure and the Medicines Administration Record charts are securely stored. Most of the medicines are supplied by the pharmacy in a monitored dosage system, but some are kept in the original packaging. The MAR charts, which must show clearly the quantities of medicines received and in stock for each person, were examined. The medicines supplied in the monitored dosage system appeared to be administered and recorded accurately. There were signatures to confirm that staff had administered the medicine, although some signatures were missing. Most people have some medicines that they take only when needed. There is clear guidance in place to help staff make a decision about when someone requires this type of medication. The care plans include detailed information about all the medicine the person takes. Each of these medicines has its own record sheet, which includes a running total of the quantities received, administered and amounts remaining. These were completed but were not always accurate. In order to keep an accurate record of the medicines that are supplied in their original packaging, a brought forward system should be put in place for all medication. This would show the quantity of any medicines that are carried forward from one four week MAR chart to the next, in addition to any new supply of the medicine. None of the nurses have had any recent medication administration training. Since the last inspection visit a portable air conditioning unit has been installed in the medication room, making it a more comfortable temperature to work in and store medicines. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the support and information they need to raise concerns about the service. Evidence: Following our visit we asked the home to make sure they had a complaints policy which people living in the home can understand and is clearly displayed throughout the home and where the necessary advocacy support is available. Also for Brunel to be ultimately responsible for investigating, responding to and resolving all the concerns and complaints. We found the complaints policy has been reviewed and people have been made aware of how to complain and staff are now aware of who is responsible for investigating and responding to complaints. The home has recieved one complaint following the last inspection about a member of staff. The manager explained this has been referred initially to Brunels District Manager who had then consulted with Bradford District Care Trust who is their employer. We found staff are completing incident forms, this is required so the staff can identify any patterns and can be sent to the behavioural support team so they can provide the staff with advice about how to manage peoples behaviour better. These are now sent to Brunel who collate them and provide the manager with a comprehensive review, Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: which identifies any possible patterns or possibilities of re-occurrence. Most staff have had training about how to protect vulnerable people and how to calm a situation when a person exhibits behaviour which is challenging. The manager has shown us they are managing safeguarding issues well. People are now provided with a independent advocate or a independent mental capacity advocate. People are supported to manage their own finances. Each person has a bank account and detailed records are kept of all financial transactions carried out by the individual or by staff on their behalf. Peoples money is securely stored and is available to them at any time they want cash. The accounts are very well organised, clear and accurate. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and well maintained home however the furnishings may not always suit their needs. Evidence: Branwell Lodge provides accommodation for people in eight flats, as well as having a shared sitting and dining room. The home is clean and fresh and has recently been redecorated. The manager explained she will walk around the home weekly and make a list of any maintenance that needs to be carried out. We were invited into one persons flat. They have a single bedroom and share a lounge kitchen diner and the bathroom with their flatmates. We found there was some personalisation of the rooms, but more could be done to make the rooms more attractive and homely. The shared lounge dining room was large, bright and airy and had recently had new furniture. Although they are light and airy, the shared areas of the home are not warm and welcoming. They have a clinical appearance with all hard, wipe able surfaces Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: softened only by a few scatter cushions. The sofas in the shared lounge are uncomfortable and the television is still hidden behind safety glass, which we were told distorts the picture. As this glass screen is no longer needed it should be removed and the furniture should be changed to make it more homely and less institutional. People have keys for their rooms and one person was seen walking with a key hanging from a cord around their neck. To promote peoples dignity and protects them from risk an alternative should be found to hanging keys around peoples necks. When we visited the home was clean and fresh. Staff have received training in infection control and there were ample supplies of gloves, aprons and hand wash around the home to help prevent the spread of infections. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from staff that are properly recruited and who are appropriately trained and supervised. Evidence: Fourteen people currently live at Branwell Lodge. When we visited the home there was the manager, a staff nurse and six support workers for a day shift from 7 am to 9 pm and at night there is a nurse and two support workers. The rotas and staff confirmed these are the normal numbers. Requirements have been made at the previous inspections for staffing levels to be reviewed to make sure there are sufficient staff on duty to meet the needs of people using the service. We found staff told us there was enough staff on duty to meet peoples needs and they were now able to support people to carry out social activities. We were also able to see that staff did have the time to talk to people. However the staff were concerned that due to the people moving out of the home the numbers may be reduced. If the staff numbers are reduced the provider needs to take into consideration the level of support needed by people and the size of the building and the ability of the staff to keep everyone safe. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Staff are employed by Bradford District Care Trust and the recruitment procedures follow the Trusts policies. However Brunel is the responsible organisation and therefore takes responsibility for the staffs actions whilst working at Branwell Lodge. At the previous inspection we found staff were working in the home without the agreement of the provider and Brunel hope to become the employer for the staff. However we found that staff are checked to a very safe standard. Prospective staff complete an application form and attend formal interviews, which the manager takes part in . Written references and Protection of Vulnerable Adults First checks are made and staff are not permitted to work in the home until a Criminal Records Bureau check has been obtained. Staff training records showed a comprehensive training programme. All staff complete a home specific induction programme. A range of other training including health and safety training is provided. Specialist training such as break away, conflict resolution and the mental capacity act has been completed to ensure peoples specific needs are met. This provides staff with the knowledge and skills to perform their duties in a competent manner. Staff thought that the training provided is good and that the staff team are very supportive. However this inspection has shown all the staff need to be provided with training about person centered care. The staff said records confirmed that they receive supervision every four to six weeks and staff meetings are held regularly. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements need to be made to enable the home to be managed in peoples best interests. Evidence: The organisation registered with us as the provider is Brunel Housing, although Bradford District Care Trust employ most of the nursing and care staff. At the last inspection this was shown to be difficult liaison, with staff trying to follow direction from both Bradford District Care Trust and Brunel Housing, which had resulted in difficulty in resolving issues quickly and poor outcomes for people living in the home. The manager told us this has now resolved and she was fully supported by the District Manager from Brunel who was clear about Brunels role as the registered provider. The manager is a qualified nurse who tells us she is planning to register with us. The staff told us they find her approachable and supportive. Although the home has made some improvements since the last inspection, the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: outcomes in this report shows the provider and manager need to continue to make further improvements to enable them to provide better outcomes for people living at Branwell Lodge. The AQAA contains, clear, relevant information this supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. The data section of the AQAA is accurately and fully completed. Quality assurance surveys are sent to the relatives of the people who live at the home. The last survey was in July 2008 and we were able to see the manager had tried to respond to some of the issues raised. The District Manager from Brunel carries out regular quality monitoring visits. We did not look at a sample of the health and safety documents but the manager showed us she has now received up to date copies of all the certificates and she assured us they are all up to date. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 You must carry out a review of everyones daily life and activities to make sure any activities are tailored to reflect peoples individual needs. This will provide people with a fuller and more active lifestyle of their choice. 01/01/2009 2 19 12 You must review peoples 01/01/2009 health care needs to make sure they are recieving the support and health care they need. To be sure that peoples health care needs are fully met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 People should have a choice about and be compatable with whom they share their flat. Care Homes for Adults (18-65 years) Page 29 of 31 2 6 Care plans and risk assessments need to be person centered and reflect what they want now and in the future and how the care and support the staff have to offer to enable them to do this. To be sure risk assessments are meaningful and identify any possible risk they should be person centered and relevant to the individual. In order to keep an accurate record of the medicines that are supplied in their original packaging, a brought forward system should be put in place for all medication. This would show the quantity of any medicines that are carried forward from one four-week MAR chart to the next, in addition to any new supply of the medicine. None of the nurses have had any recent medication administration training. The communal areas should be less institutional and provide people with a comfortable place to meet. People should be provided with a sensory room to be able to relax in. 3 9 4 20 5 6 24 28 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - 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!