Inspection on 03/04/07 for The Brambles

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Brambles 14/12/05

The Brambles 23/08/05

The Brambles 28/10/04

The Brambles 25/05/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Brambles Suffolk Close Massetts Rd Horley Surrey RH6 7DU Lead Inspector Sarah MacLennan Unannounced Inspection 3rd April 2007 09:45 The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 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 The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address Suffolk Close Massetts Rd Horley Surrey RH6 7DU 01293 771644 01293 784478 kcroll@brambles.org.uk www.mssociety.org.uk Multiple Sclerosis Society 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) Ms Kay Croll Care Home 28 Category(ies) of Physical disability (28) registration, with number of places The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 6 persons for day care between 09.00 - 17.00 hours At no time may the number of residents accommodated overnight exceed 28 All persons admitted to the home may be those who require nursing care, or those who only require personal care. 14th December 2005 Date of last inspection Brief Description of the Service: The Brambles is a large purpose built property providing respite accommodation and personal and/or nursing care to up to 28 adults who have been diagnosed with Multiple Sclerosis. The home is owned and managed by the Multiple Sclerosis Society charity and is located in a quiet residential cul-de-sac, close to shops and other amenities of Horley Town Centre. There are pleasant, well-maintained gardens to the rear of the property and parking for several cars to the front. All bedrooms are single occupancy and have en-suite toilet and washbasin, electrical tracking hoists attached to the ceiling, TV and video and hands free telephones. The home is currently in the process of installing en-suite showers into all of the bedrooms. Communal areas consist of a large lounge which has a licensed bar enabling guests and visitors to purchase alcoholic and soft drinks. There is also a spacious dining room that has recently been refurbished, a garden room and a smoking lounge where guests and visitors may smoke. The home also has a physiotherapy department and a hydrotherapy pool for use by the guests. Fees range from £798 - £1281 per week. This fee does not include chiropody, hairdressing, meditation, yoga, aromatherapy, shiatsu, massage and reflexology. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit formed part of the key inspection process and took place over 7¼ hours commencing at 09:45 and ending at 17:00. Sarah MacLennan, Regulation Inspector, carried out the visit. Mrs Kay Croll, the Registered Manager, was present throughout the inspection. As part of the inspection process a partial tour of the premises took place. Various written records were examined, including three care plans and service user assessments, four staff personnel files, samples of staff training records, the complaints record, a sample of the required safety certificates, the medication storage facilities and a sample of the medication administration records. The inspector spoke to a number of service users and the Commission for Social Care Inspection also received written comments. Some staff members were spoken to during the course of the inspection. Some of the comments made to the inspector are quoted within this report. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the visit. What the service does well: What has improved since the last inspection? The premises are undergoing a period of extensive refurbishment that includes redecoration, new carpets and lighting to the corridors. The bedrooms are having en-suite accessible shower facilities, air conditioning and an accessible wardrobe fitted. Some rooms will also benefit from ‘high / low’ sinks. Service users spoken to were positive about the refurbishment and stated that the disruptions caused were a minor inconvenience compared to the benefits. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assessed prior to admission to the home to ensure that the home can meet their needs. EVIDENCE: The inspector was advised that a pre-admission questionnaire is sent to all prospective service users approximately six weeks prior to their planned admission. A respite booking is only confirmed upon receipt of this document, thus ensuring that the home is able to meet the service users needs. Service users are then telephoned one to two days prior to their admission to confirm that their needs had not changed. The three care plans sampled had a pre-admission needs assessment that had been completed by the service user. The assessment covered physical, medical, mental, and social needs. The service users spoken to during the inspection felt they had received enough information prior to their stay at the home. Written correspondence from a former service user stated that they had been admitted to a room that did not have vertical handrails. It was noted that The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 9 there was no section on the pre-admission assessment form for the provision of additional equipment, for example vertical handrails or ‘high / low’ sinks. This is recommended. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans are in place for some service users. Service users are encouraged to make decisions. Some of the risks to health and safety of service users are assessed. EVIDENCE: Three service users care plans and daily statements were looked at. Two service users had care plans that were detailed and comprehensive. The service users had signed them wherever possible to evidence their involvement in their care. They clearly demonstrated how the home meets the individual needs of the service users. One of the files sampled did not have a care plan. One service user commented that the staff were ‘very experienced and well aware of the limitation of the disease.’ The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 11 Conversation with staff and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they were encouraged to make their own decisions one service user replied ‘you bet you’, she also stated that she was very surprised that that there was any need to ask the question. Samples of risk assessments were seen and included topics such as, pressures sores and manual handling; however the three service user files sampled did not have the history / risk of falls section completed, this is required. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of activities is suitable for the service users. Service users participate in the local community. Contact with family and friends is unrestricted. Service users rights and responsibilities are promoted within the home. Meals are well balanced and varied, individual choices and preferences are catered for. EVIDENCE: Service users spoken to stated that the provision of activities were suitable for their needs. Activities included flower arranging, quizzes and art sessions. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 13 Service users participate in the local community. They attend local facilities including shopping centres and pubs. Staff stated that the pub lunch outing was very popular and often took place more than once a week due to high demand. The registered manager stated that as the purpose of the home is to provide respite care, many of the service users do not receive visitors during their stay. However visitors would be welcomed and the home has unrestricted visiting times. Conversation with staff and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. Staff were observed to treat the service users with respect and care was provided in an unobtrusive and dignified manner. The food and catering staff are provided by an external catering company. The menu is on a four weekly rota; there is different menu for summer and winter. A choice is available at all meals. Special diets, including soft diets, high calorie, low cholesterol, diabetic, vegetarian and all cultural diets can be catered for by prior arrangement. Service users were observed to eat lunch during the inspection; the food was present in an appealing manner and met with positive comments from service users. Comments included, ‘nice size portions’ and ‘the food is excellent’. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive the support they require. Service users health needs are met. The medication administration records and storage of medication were not satisfactory. EVIDENCE: Staff spoken to were aware of the support required by the service users. Service users stated that the staff were ‘very knowledgeable of their needs’ and ‘they can definitely meet my needs’. Service users were supported and facilitated to take control of their healthcare. All service users spoken to stated that their views and needs were definitely listened to. Due to the respite nature of the home an arrangement is in place with the local health centre to see the service users as temporary patients if required. Staff spoken to stated that this was a suitable arrangement in practice. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 15 The medication storage facilities were seen. The medication fridges temperature is monitored and recorded regularly. Examination of these records showed that the fridge had been above the required temperature on several occasions, there was no evidence of any action taken. The medication policy was seen and found to be satisfactory. The medication administration records were examined and it was noted that the records had not been sign to evidence the administration of the previous evenings medication. The inspector was informed that the trained nurse on duty had already begun an investigation into this shortfall. Requirements regarding medication have been made. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a simple and accessible complaints procedure. Several shortfalls were found in relation to the protection of vulnerable adults. EVIDENCE: The home had a simple and accessible complaints procedure. No formal complaints had been received since the last inspection; however some minor concerns had been raised. Following discussion in this regard with the registered manager, it is recommended that a record is maintained of any minor concerns raised as well as all complaints. Service users spoken to during the inspection were aware of the complaints procedure, and felt confident about using the process. The home had an up to date copy of Surreys Multi-Agency Procedure for Vulnerable Adults and it’s own organisational policy. The homes policy states that an incident of a non-serious nature may be handled in-house, it is required that this policy is clarified as the term ‘non-serious’ is open to individual interpretation. The homes policy is also required to be updated to state that all allegations or suspicions of abuse should be reported to Social Services. All staff had not received training in the protection of vulnerable adults and staff spoken to were not aware of vulnerable adults procedures. Three staff members, one of whom had had vulnerable adults training within The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 17 the last three months, did not mention that they would report the incident to social services and stated that they would conduct an investigation themselves. Following the inspection, the registered manager has informed the Commission for Social Care Inspection that all staff have been given advice on ‘how to safeguard a vulnerable adult’ based on the up to date information on Surrey County Councils website. Since the inspection the registered manager has also arranged for staff training to take place during April 2007 that will include 80 staff members. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an environment suitable for the needs of it’s service users. The home is clean and hygienic. EVIDENCE: The inspector toured areas of the home. The premises were undergoing a period of extensive refurbishment that includes redecoration, new carpets and lighting to the corridors. The bedrooms are having en-suite accessible shower facilities, air conditioning and an accessible wardrobe fitted. Some rooms will also benefit from ‘high / low’ sinks. Service users spoken to were positive about the refurbishment and stated that the disruptions caused were a minor inconvenience compared to the benefits. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 19 Service users are able to access all areas of the home and grounds, one service user stated how ‘lovely the gardens were in summer’. The home was seen to be clean, tidy and free from offensive odours. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff. Service users are protected by the homes recruitment policy and practices. EVIDENCE: The staff training files were seen. Shortfalls were noted in the provision of protection of vulnerable adults training. 37 of staff have completed NVQ level 2 or above and a further four staff members have just started their NVQ training. Four staff files were seen and found to contain the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000(Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 21 Service users stated that the staff were appropriately trained and competent. One service user commented that the staff were ‘very experienced and well aware of the limitation of the disease.’ The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefit from an open, positive and inclusive atmosphere. The home has effective systems in place to monitor the quality of care and services provided. Service users could potentially be put at risk due to shortfalls in procedures. EVIDENCE: The registered manager demonstrated a thorough knowledge and awareness of the service users needs. Service users were seen to interact readily with the registered manager. An open and inclusive atmosphere was evident within the home. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 23 An annual service user survey is carried out and monthly audits take place. Any issues identified in the monthly audits lead to an improvement suggestion then an action plan. . All service users spoken with felt that their views were listened to and taken seriously. Staff have received training in ‘improving customer care’ The registered manager is aware of the need to maintain a safe environment for service users and staff. Required policies, procedures and safety checks were in place; however shortfalls were noted which could potentially put service users at risk. The medication fridges temperature is monitored and recorded regularly. Examination of these records showed that the fridge had been above the required temperature on several occasions, there was no evidence of any action taken. The medication administration records were examined and it was noted that the records had not been sign to evidence the administration of the previous evenings medication. Staff spoken to, including the registered manager, were not aware of vulnerable adults procedures. The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 1 x The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 2 Standard YA6 YA9 Regulation 15 (1) 13 (4)(c) Requirement The registered person must ensure that all service users have a written care plan. The registered person must ensure that risks to the health and safety of service users, specifically risk of falls, are identified and so far as possible eliminated. The registered person must ensure that all medication is stored in accordance with the manufactures instructions. The registered person must ensure that all medication administered to service users is recorded. The registered person must ensure that the homes policy to ensure the protection of vulnerable adults is updated to include clarification of the term ‘non-serious’ and to state that all allegations or suspicions of abuse should be reported to Social Services. The registered person must ensure that all staff received training in the protection of vulnerable adults. DS0000013356.V333401.R01.S.doc Timescale for action 03/05/07 03/05/07 3 YA20 13 (2) 03/04/07 4 YA20 13 (2) 03/04/07 5 YA23 13 (6) 03/07/07 6 YA23 13 (6) 03/07/07 The Brambles Version 5.2 Page 26 7 YA23 13 (6) The registered person must ensure that all staff are aware of vulnerable adults procedures. 03/04/07 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 Refer to Standard YA2 Good Practice Recommendations It is recommended that the pre-admission assessment form is updated to include a section for the provision of additional equipment, for example vertical handrails or ‘high / low’ sinks. It is recommended that a record is kept of all issue raised, including concerns, by service users. 2 YA22 The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House, 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 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 © 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 The Brambles DS0000013356.V333401.R01.S.doc Version 5.2 Page 28 - 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!