Inspection on 15/01/09 for Little Bramingham Farm

This inspection was carried out on 15th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Little Bramingham Farm Leamington Road Luton Bedfordshire LU3 3XF     The quality rating for this care home is:   two star good 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: Neil Fernando     Date: 1 5 0 1 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: Little Bramingham Farm Leamington Road Luton Bedfordshire LU3 3XF 01582582433 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Friends of the Elderly Name of registered manager (if applicable) Miss Emma Lawrance Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 25 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Little Bramingham Farm is a care home, which is owned and managed by the Friends of the Elderly, since 22 July 2008. It is registered to accommodate up to 25 older people. The property is a refurbished farmhouse with a large extension providing a total of 25 bedrooms, with en- suite facilities. The building has been upgraded to a high standard. Within the complex there are 18 sheltered housing bungalows, all overseen by the manager. The home is located in a pleasant residential area of the northern boundary of Luton. The home stands in its own grounds with ample car Care Homes for Older People Page 4 of 27 care home 25 Over 65 25 0 Brief description of the care home parking facilities. The home is close to a shopping precinct, large superstores, a pub and a church. A copy of the service users guide is available for residents and visitors to read. The fees for this service vary between £485 and £507 per resident per week; the exact fees are reflected in individual contracts for the residents. Care Homes for Older People Page 5 of 27 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection, undertook the first unannounced key inspection of this home on 15 January 2009. We spoke with 5 residents, 2 visiting relatives, the manager and deputy manager, and 3 members of staff including the activities coordinator. We spent some time observing staff care practices so we could assess how they interacted and assisted residents. We undertook a brief tour of the accommodation and viewed a range of records the home must keep. At the time of the visit, there were 23 people in residence with 2 vacancies. Care Homes for Older People Page 6 of 27 We have received the AQAA (Annual Quality Assurance Assessment - a document, which gives the manager the opportunity to tell us how the home is meeting the standards and regulations. We have also received surveys from 9 residents and 8 staff. The manager and deputy manager were present throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Older People Page 8 of 27 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed and they are able to visit the home, prior to moving in. This process ensures that the residents identified needs could be fully met on admission. Evidence: The AQAA indicates We conduct a thorough personal assessment of potential residents in their own homes or hospital prior to admission and request a GP Medical Report, to ensure that we are able to meet their needs. A copy of the statement of purpose and service users guide is offered to all new residents. Case files for three residents were viewed and they all contained comprehensive pre-admission assessments completed by the manager or deputy manager, prior to an offer of a placement being made. Each file provides a detailed profile of the residents needs and the level of support required. This includes pressure Care Homes for Older People Page 11 of 27 Evidence: care, mobility, nutrition, recreational activities, religion and personal preferences. All assessment records are dated and appropriately signed by the person undertaking the assessments. Information about the prospective resident is also sought from their representative, health and social care professionals. The prospective resident and their family are encouraged to visit the home and meet with staff and have a meal with the other residents. Evidence shows that overnight stays are arranged, if this is required. Positive examples from residents include: We were allowed to visit the home before making our decision. All our questions were fully answered and I was given loads of information before moving in and this I found very helpful, said a resident. Residents are admitted on a trial basis to give them the opportunity to decide if they wish to stay. A review meeting is held at the end of the trial period involving the resident, their representative and their care manager to assess if the placement could be finalised. Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed, thus ensuring staff are aware of residents needs and requirements, and this ensures that they are appropriately met. Evidence: The AQAA indicates Up to date care plans which are detailed and reflect each residents individual needs. All residents are allocated with a key worker and have an individual care plan. The care plan for three residents including the last person admitted to the home were examined. Each person has a very detailed care plan, which identifies how they would like their individual needs to be addressed. The care plan is developed with contribution from the resident, their representative and home staff. They have also signed the care plan, thus demonstrating their participation and agreement with its content. Care plans are being internally reviewed monthly to reflect the changing needs and Care Homes for Older People Page 13 of 27 Evidence: objectives for health and personal care. Monthly review notes should however be in greater details, in order to reasonably reflect the changing needs/requirements of each resident. Once the above issue is addressed, this standard would be fully met. Risk assessments are completed for each resident and these are reviewed as required. Care plans include evidence of the involvement of health care professionals such as district nurses, chiropodist, optician, dentist and GP. A GP visits every week to see any residents requiring medical attention. Good evidence is available to demonstrate that staff support residents to access health care professionals as and when required. The procedure on medication is comprehensive and this ensures that staff members administer medication in a safe and satisfactory manner. Only staff who have received appropriate training are authorised to administer medication. Residents who are able to administer their own medication are encouraged to do so; evidence of risk assessments is available. The medication administration records for seven residents were examined and these are noted to be in order. Staff members were observed to be maintaining the privacy and dignity of residents. All residents spoken with said they are being treated with respect and their privacy and dignity, always maintained. Staff are gentle and they always knock before coming in, said a resident. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. The social, cultural, religious and recreational interests of residents are being addressed satisfactorily. The quality and and variety of food offered is of a high standard. Evidence: The AQAA tells us We take the views, rights and choices of our individual residents very seriously and act accordingly, particularly with personal and social relationships. Varied and new activities daily, taking into account residents differing capabilities. These are based on residents suggestions and ideas. An activities coordinator is available for 15 hours per week and she facilitates a range of activities to suit residents taste and preference. The care staff also provide some activities during the weekends. Residents spoken with expressed a good deal of satisfaction in respect of activities being facilitated. Examples of comments include Always plenty to do and Never a dull moment, if you ask me, said two residents. The care plans for three residents were examined; they show that residents are being assisted to follow the lifestyle of their choice as agreed at the time of their Care Homes for Older People Page 15 of 27 Evidence: assessment. Four residents spoken with said they are satisfied with their lifestyle at this home. Two visiting relatives spoken to were very positive about the choice their relatives are able to make. He is able to continue with many of the activities he liked before coming here said a relative and I am pleasantly surprised with my mums lifestyle, said another. Residents told us their relatives and friends are able to visit them at any time and they are always made welcome. They are able to entertain their visitors in the dining room, lounge or the privacy of their own bedroom, if they so wish. Staff training and recruitment policy encourages equality and diversity. Residents are encouraged and they are able to practice their religion and their culture, as they wish. The local vicar visits monthly and offers communion; other members of the church also visit as appropriate. Members of staff are available to assist any residents if they wish to attend the local church or other cultural/religious activities. The menu seen provided for a nutritious and varied diet. Large windows pleasantly enhance the congenial setting of the dining room. Provision is made for residents to take their meal in their own room if they so wish. Residents are consulted daily regarding the menu and their taste and preference. Evidence indicates that alternative meals are provided if a resident does not like the meals on the menu. Those spoken to commented highly on the quality and variety of food offered to them. Excellent food said three residents. Any dietary requirements of the individual resident are well catered for. Snacks and beverages are readily available. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. The effective implementation of the homes complaints and safeguarding procedures ensures that residents accommodated are protected from harm. Evidence: The AQAA tells us that All mandatory training provided to ensure that all staff have the knowledge they need to care properly and so avoid abuse in any form. We were informed that information on how to raise a concern is provided to everyone living at the home. Evidence shows that a copy of the complaints procedure is displayed in the main entrance of the accommodation. Residents and visitors spoken to expressed confidence in that staff would respond appropriately if they had any concerns. Happy with the service, no complaints whatsoever, commented a resident in their survey. There was one minor complaint recorded since the home started operating in July 2008. The matter was resolved immediately; the Commission has not received any complaints about this service. All four staff interviewed demonstrated a knowledge of the complaints procedure. The home has policies and procedures on whistle blowing and safeguarding of vulnerable adults, which are available and accessible to staff. All staff bar two, have received training on safeguarding of vulnerable adults; the manager is arranging for the two members to complete their training by the end of February 2009. There have Care Homes for Older People Page 17 of 27 Evidence: been no safeguarding matters arising since the home started operating. There are a number of systems in place, which should adequately protect a resident from harm. Care Homes for Older People Page 18 of 27 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a high standard of physical environment, which is homely,comfortable, clean and well maintained. Evidence: The AQAA tells us that We provide a warm welcoming and comfortable homely surroundings. Some aspect of the home has been upgraded, which includes the lounge and activities room. Toilet facilities in proximity of the lounge and also seating in the conservatory have been made available. Communal furniture, carpets and curtains have been replaced. Bedrooms are well personalised to reflect the taste and interests of the occupants. The lounges and dining rooms are spacious and decorated to a high standard. The gardens are well maintained. Residents expressed a high level of satisfaction with their physical environment. Responding to a survey question on the standard of cleanliness one resident commented Always as you would have at home, very good. The home is able to meet the individual needs of the residents with physical disabilities. The manager ensures the availability of suitable specialist equipment, Care Homes for Older People Page 19 of 27 Evidence: which is maintained to good order. There were no areas, which were in need of repair. A high standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. Records show that staff members have received training in hygiene and infection control. No health hazards are noted. Care Homes for Older People Page 20 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The numbers and skills of staff are adequate to provide a good standard of care but an ancillary person must be available to carry laundry tasks. The recruitment and training processes ensure that residents are protected from harm. Evidence: There were adequate numbers of care staff on duty on the day of the inspection to meet residents needs. Staff duty roster for a period of one month was scrutinised, which indicates that the day and night staffing levels are adequate to meet the assess needs of the residents accommodated. However, care staff members also undertake laundry tasks, which results in them spending less time with residents on some occasion. A laundry person must be employed to enable care staff focus on the care of residents. Once a laundry person is in post, this standard will be fully met. We looked at the recruitment files for 3 staff including a new member who had joined the team. They all contain appropriate documentation including application form, references and Criminal Record Bureau checks. One staff indicated in their survey The checks made were good, as one of my references was late coming back and I was not allowed to start until it did. Staff interviewed and their training files evidenced that mandatory training has been Care Homes for Older People Page 21 of 27 Evidence: completed by all staff. Other specific courses attended include medication, dementia, interpersonal skills, bereavement, palliative care, diabetes and oral health. Of the current 29 care staff, 20 hold an NVQ level 2 or equivalent and another 3 members are undertaking this course. This means that a high ratio (68.9 ) of care staff hold an NVQ Level 2 or equivalent qualification. This is indicative that the organisation is giving NVQ training a high profile and this will have a positive impact on the quality of service offered to residents. Feedback from residents is very positive. Examples of comments include Very very good, couldnt wish for better, They are very good at their job and This is a friendly and competent staff team. Residents spoken with said that the staff were knowledgeable and felt confident in their abilities to meet their needs. Care Homes for Older People Page 22 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Residents benefit from living in a well managed home where procedures for maintaining records, promoting safety and supervising staff ensure the welfare and protection of residents. Evidence: The registered manager holds an NVQ level 4, Registered Managers Award and a Foundation Degree in Care Management. She has significant experience and knowledge in the management of a home for older people. Staff members spoken with said that the manager and deputy manager operate an open door policy, describing management support as very good. Responding to a question in the survey, a staff commented The manager always has time to support her staff - as does the deputy manager and I think I have their backing at all times reported a senior care staff. Evidence of recorded supervision sessions is available. Staff members spoken with confirmed that they receive formal 1 to 1 supervision once Care Homes for Older People Page 23 of 27 Evidence: every month. Each staff member also has had their annual appraisal completed in November and December 2008. There is good evidence to demonstrate that quality assurance systems are in place to seek the views of residents, representatives and significant others. The responsible person has carried out monthly visits to the home, in order to ensure that appropriate standards are being maintained; reports on these visits for the months between October and December 2009 were viewed and noted to be in order. The manager retains a small amount of pocket money on behalf of nine residents who are not able to do so for themselves. Appropriate records are maintained. Other records viewed were in good order, except that the daily records of relevant occurrences should include the name and signature of the staff making the entries. Health and safety matters are being attended to. Care Homes for Older People Page 24 of 27 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 Older People Page 25 of 27 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 27 18 Given the number of residents this home accommodates, a person must be employed to undetake the laundry tasks. This would enable care staff to focus on the care of residents. 29/03/2009 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 7 The monthly review notes should be in greater details, in order to reasonably reflect the changing needs and requirements of each resident. The daily record of relevant occurrences maintained for each resident should include the name and signature of the staff making the entries. 2 37 Care Homes for Older People Page 26 of 27 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. 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