Inspection on 05/06/07 for The Brambles

This inspection was carried out on 5th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Brambles 08/01/07

The Brambles 25/09/06

The Brambles 18/11/05

The Brambles 24/05/05

The Brambles 22/11/04

The Brambles 02/06/04

The Brambles 05/08/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Brambles 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 5th June 2007 07:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA 01384 379034 01384 396892 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) Mr Boota Singh Khangoure Mrs Melanie Nickolls Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 35 service users in the category of OP 14 can be PD(E). Date of last inspection 8th January 2007 Brief Description of the Service: The Brambles is a residential home providing 24-hour care and support for up to 35 people over the age of 65, 14 of which can have a primary diagnosis of physical disability. The home is located in a residential area of Amblecote opposite Corbett Outpatients Department and close to Stourbridge town centre. It is easily accessible by local public transport networks and there are a few parking spaces at the front and attractive gardens to the rear. A major refurbishment and extension has been undertaken to improve the homes environment and increase the occupancy. This has increased communal space and enhanced bedrooms. Thirty bedrooms now have en-suite facilities. The weekly fees for this home range from £343- £363. Additional charges are applicable for services from the hairdresser and private chiropody. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on one day. It commenced at 07.10 and finished at 16.20 hours. A Commission pharmacist was also involved in the inspection and examined medication systems and safety. Much of the inspection was carried out in living areas where observations could be made about staff contact with service users’, daily routines and meal provision. Prior to the inspection questionnaires were sent to service users’ and relatives, feedback and comments from which are detailed in sections throughout this report. During the inspection I spoke with six service users’, four staff and five relatives to gain their views on the service provided. I partly observed both the breakfast and lunch time meals. I looked at care records and staff files to assess training and recruitment practices. I looked at service records and safety processes and quality monitoring systems. I randomly looked at the premises which included; the kitchen, laundry, bathrooms, toilets, four bedrooms, communal areas and the garden. What the service does well: When I asked about the service provided by the home, one service user said; “ Put it this way, the cook has just asked me what I want for breakfast from a range of choices or a full cooked one, what I would like for lunch out of two choices or anything else I would like and gave me my daily newspaper, I didn’t get that service at home ! The home is 100 and the food is 101 ”. Medication systems are efficient and safe. The home has an extremely positive, friendly, welcoming atmosphere. Generally staffing levels are good. Cleaning, catering and laundry staff are provided every day in addition to management and care staff. Activity provision is varied, interesting, stimulating and offered at least four times a week. The premises offer a large lounge, small lounge, dining room and conservatory. There is an attractive garden to the rear for the service users’ to enjoy. Thirty bedrooms have en-suite facilities. The home is well-maintained, clean, free from odour and provides nice furniture, fittings and floor coverings. Meal provision offers a wide range of choices for each service user at each meal to include; a full cooked breakfast each day for anyone who wants this. The majority of staff employed by the home have achieved NVQ awards. A number of seniors have NVQ level 3. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 6 The manager is registered with the Commission and has achieved her Registered Managers Award. The home actively encourages visitors and for service users to maintain contact with family and friends. The staff are kind, caring and friendly. Positive comments about the home were received from service users’ and relatives and included the following; “ I have been very happy with the level of care they have given to my mother”. “ I feel that they treat the residents really well. They are all kind and helpful”. “ The home itself has a nice homely feel to it.” “ They always appear to be well mannered and polite to their residents”. “ Oh its good here. The food and the atmosphere, couldn’t ask for better”. “ It is very nice, staff nice and kind”. “ Been here for six weeks. Came from another home that I did not want to stay in any longer, what impressed me was the layout of the building and the amenities”. “ Lots of activities”. What has improved since the last inspection? What they could do better: The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 7 The home needs to address the lack of reporting concerning any medication errors. Staff need to be trained in aspects of violence and aggression to enable them to identify triggers for concerning behaviours and defuse any concerning situations that may arise. A system of quality assurance auditing must take place across all areas of the service to maintain improvements in the home and be able to identify at an early stage any non- compliance with systems, processes and practices. An electrician to prevent any hazards must test electrical appliances brought into the home by service users’. Access to the laundry must be suitable restricted to prevent risk of injury to service users’. 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 DS0000024978.V333347.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. New service users’ are being issued with a new style terms and conditions document, which is clear and accurate. Admissions to the home are not made until an assessment of need has been carried out. Better adherence to conditions of registration has meant that the home can fully evidence that new service users’ needs can be met, and are being met, resulting in happier service users’ , less stress on the staff team and a positive, happy atmosphere. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I spoke with four new service users’ and where possible their families. They all told me that either they or their family had been to look at the home before they were offered a placement. One relative told me; “ We came to look around”. Another said; “ She wanted a home with a conservatory or a garden, here she has both, I was pleased when I saw that”. One relative said; “ Some of the homes I looked at I would not put a cat in”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 10 I looked at two new service user’ files and saw that there was a new type terms and conditions document on file which had been signed and dated by the service user. The manager told me; “All service users’ will be issued with this new terms and conditions once Social Services have agreed the new fee rates for this year”. This is good, as service users’ will all then have an accurate document informing them of the terms and conditions of their residency. On the new service user files I saw evidence to confirm that the home had assessed their needs before they were offered a placement. The manager told me that they had been very careful not to offer places to people with dementia. This change has had such a positive impact on the home. Staff are far less stressed, service user needs are being better met and they are happier. Many positive comments were received about the home and included the following; “ She is well looked after”. “ Everyone seems to be happy. We have had a few new ones, they are settled and happy”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. The delivery of personal care is reliable and consistent. People who use the service have access to health care services. staff ensure that those who are fit and well are encouraged to be independent. The home has an efficient medication policy that staff understand and follow which, ensures medication safety .Service users’ who want to and are able are given the support to manage their own medication. Staff respect the privacy and dignity of the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Considerable improvements have been made across all areas in this section to include care planning and medications, which has had a positive impact on the service and the safety of service users.. New care plans have been produced using the new care plan format. I checked the care plans of two new service users’ and was pleased to see that a completed care plan was in place. I found that this was the same for existing service users’. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 12 The content of the care plans has also improved although; need expanding for dementia care to show possible triggers for behaviour and ways to improve orientation. These overall improvements concerning care plans are good in that it shows that service user needs have been identified and that instruction is available for staff on how to meet needs. I looked at four service user files to assess healthcare provision and was pleased to see that risk assessments concerning tissue viability, nutrition and falls as examples had been carried out for each with the aim of reducing risk to service users’. A comment was made about the lack of appropriate service user weight monitoring . I followed this up and found that a set of sit on scales were available within the home. The manager told me; “ We have had those scales for over 12 months know”. I looked at four service user records and saw that all are being weighed regularly, the two new ones, when they were admitted. I did not find any concerns on these weight records such as significant weight loss. Another comment was made about the concern of dehydration and lack of record keeping. I looked into this issue. From my arrival at the home at 07.10 I saw that service users’ either had or were being offered a warm drink. During the day I saw that drinks were offered frequently. I was very pleased to see that new recording systems have been put into use to record the food and fluid input of each service user where a concern had been identified about their food or fluid intake. If there were shortfalls previously this evidence shows that more attention is now being paid to the prevention of dehydration. However, further improvements should be made in recording of any food and fluids taken between the hours of 7.30 pm and 9am next morning, as records between these hours were limited. The manager and deputy told me that service users’ are always given drinks between these hours and gave assurance that night staff would make records in the future. The doctor visits the home once a week as a matter of course. But also comes when needed in between visits. During the inspection the chiropodist was at the home. At 07.30 a service user told me; “ The chiropodist is coming today”. Which is good as it shows that service users’ are being informed about pending appointments. A relative told me; “ She has seen the dentist since she has been here. She has had new glasses from the optician and has been referred to the hearing aid centre for assessment”. That the home accesses external medical services was confirmed by a relative who commented; “ When my mother was poorly all of a sudden they did not hesitate in calling an ambulance and contacting us to let us know”. Another commented; “ If my.. has a fall or is ill we are informed immediately”. Two service users’ confirmed when asked, that they do care for themselves. One said; “ They let me do what I can, I wash and dress myself”. “ Another said; “ I can look after myself”. This is positive as it shows that the home encourages service users’ who are able to remain independent. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 13 Medications During the inspection the manager was spoken with who was very helpful. All service users medicine charts and two care plans were seen. A medicine policy was available which was easily accessible to staff. It included details on administration, receipt and disposal of medication. Eight members of staff had dated and signed a list stating they had read the policy. There was a homely remedies policy available, which had been agreed and signed by a doctor in order to ensure that service users could have treatment for simple ailments such as a headache or cold. Medication storage was seen within two locked medicine trolleys attached to a solid wall. Eye preparations were stored separately in a dedicated plastic container to prevent contamination. A lockable refrigerator was available to store medication requiring cold storage. A separate secure safe was available for storing controlled drug medication, which requires special storage. The temperatures of all storage areas were recorded, which was seen to be within the recommended temperature range for safe medication storage. Staff who administer medication had completed a ‘Safe Handling of Medication’ course. A document was seen which had been signed by members of staff agreeing to administer medication to service users. Two service users managed their own medicines and stored them safely in their own bedrooms. Completed risk assessments were seen, which assessed the risk of the service user looking after their own medicines. The documents seen reflected the individual needs and wishes of the service users. One service user said ‘I am very happy looking after my own medicines, which I have done for the last 15 years. I just need to request my medicines to Mel and she orders them for me’. The current months medicine charts were seen, which were pre-printed by the pharmacy. The medicine charts were all recorded with a staff signature to document administration of medication or an appropriate code documented to indicate a reason for not administering the medication. The medicine records seen were accurate. Records of weekly checks were seen which demonstrated that the service undertook a medication audit on all service users medication. The checks made ensured that the manager dealt with any discrepancies or errors immediately. The receipt of medicine was recorded onto the medicine charts. A disposal record was available at the inspection, which showed that unwanted medication was safely returned to the pharmacy. It was pleasing to see that there had been a reduction in the amount of medication returned to the pharmacy due to the improved monitoring and checks undertaken. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 14 The care plans for two service user’s were seen together with their medicine charts. The service users healthcare information for medication were recorded and up to date, for example there were records for ‘Health and GP Records’ which detailed any visits made by a healthcare professional and any changes or alterations made to medication were recorded directly into the service users care plan. I saw on service user files a record of the preferred form of address for each. During the day I heard staff using these preferred forms of address. One service user told me; “ I like to be called.. and that’s what they call me”. During the inspection I heard staff speaking politely to service users’ and relatives, giving them choices and reassurance. A relative made the following comment; “ They always appear to be well mannered and polite to their residents”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is excellent. Activity provision within the home has improved 100 since the last inspection. People who use the service are now able to enjoy a fuller and more stimulating lifestyle with activity options to choose from. Visiting times are open and flexible. The home encourages service users’ to maintain contact with family and friends. Meal provision within the home is excellent. The home offers choices at every meal. Food is of a very good quality and is presented nicely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some comments were made in questionnaires received, about the lack of activities and stimulation. I can only deduce that these were about previous provision not present. I have never seen such major improvements in activity provision in a home from one inspection to another, as with this home. A carer has been allocated ‘dedicated’ activity hours every Monday, Tuesday and Friday morning. From speaking to this carer it was clear that she has such an interest in providing a good activity service. This was confirmed by both service users’, staff and relatives who made the following comments; “ ..is excellent. She gets them all doing something. People have gone out that have The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 16 not gone out before”. “ They organise parties for birthdays and special events”. “ Activities are arranged to stimulate the residents”. “.. does a good job with activities”. “ There are activities I like the prayer meetings every two weeks”. “ Activities, skittles, bingo and other things. The recording of activity provision now is also excellent, not only are the names of service users’ involved recorded but photos of most events are also taken and displayed in the activities folder. I saw lots of evidence of recent activity provision, from birthday tea parties, to craft sessions, to activities to celebrate Mothers Day and Easter. All service users’ have been offered the opportunity to go out on a pub lunch, two went to a market and two have been on the toning tables at a local fitness centre. The activities co-ordinator told me; “ It is difficult to motivate everyone, although I do try and they are all given the choice. I am pleased that one person who refused in the past has started doing sketching. Others, I got them tomato plants that they can tend in their rooms. They are enjoying this”. One service user who has complex needs told me; “ I enjoyed listening to the piano”. The home also has external activity providers come to the home on a very regular basis such as; singers and other performing acts. During the inspection a exercise provider came to do a music to movement session with a large group of service users’. I saw that they all enjoying this. All bedrooms seen held a range of service user’ personal possessions demonstrating that the home allows these to be brought in to personalise their bedrooms. Two service users’ told me that they have brought televisions into the home and another his own orthopaedic bed. The manager confirmed annually she ensures that service user information is updated and provided to the local council in order for service users’ who wish to, vote. The home has an open visiting policy. One service user told me; “There are no restrictions”. A relative told me, “ There are no visiting restrictions”. I saw a number of relatives and visitors coming into and going out of the home at different times. One service user said; “ My son and granddaughter come and visit me. I go out twice a week with a friend. I went to the pub with my son on Sunday”. Another service user said; “ Yes my family come and see me and I go home to see my husband”. Visitors are welcomed by the home. One relative said; “ Yes, they are always friendly- make me feel welcome”. “ Made to feel welcome”. Meals provided by the home are excellent in terms of quality and choice. All service users’ spoken to complimented the food as follows; “ They ask you want you want for every meal. If you don’t like what’s on the menu you can ask for something else, anything”. “ The food is very good”. “ Food very good, nice”. “ The food is really lovely, she has eaten well since she has been in here”. One service user is vegetarian. She chose vegetable lattice pie and vegetables for her lunch. She said, “ I don’t like meat, they do other things for me. I like the food”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 17 It was interesting that all service users’ spoken to knew the cooks name. They were very complementary about her and her cooking. I indirectly observed both the breakfast and main meal times. I saw that the tables were nicely laid and that staff were on hand to give assistance. I saw that plate guards were available to ensure that service users’ can eat more independently. I heard staff asking service users’ what they would like to eat and drink. The breakfast offered a range of options, cereals, hot options or a full cooked breakfast. Service users’ had different things. I saw that most of the male service users’ did have a hot option and enjoyed this. The main meal was gammon or fish and parsley sauce, with peas and potatoes. Followed by treacle sponge and other options. I saw that food portions were of a good size and well presented. I looked at the kitchen and saw that home made cakes were being made by the evening cook. These looked and smelt very nice. There was plenty of food stocks, fresh fruit, vegetables and choices of types of milk for instance, skimmed and semi skimmed. The owner told me that there is no budget for food. “The staff can buy exactly what is needed and wanted. There are no restrictions”. The manager agreed that this is correct. A relative commented; “ The two cooks are very good, food is homely and not in short supply”. It is clear from my observations and feedback from service users’ that the food provision is excellent. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has a complaints procedure which is on display, included in the service user guide and available in each bedroom. The home keeps a record of complaints and of action that has been taken. Training of staff in the area of protection is arranged by the home. New recording systems have been introduced to monitor concerns regarding behaviour. Training for staff concerning violence and aggression remains an outstanding issue. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received about this home for some time. The home has a complaints procedure, which is on display in the home and a copy available in each bedroom. Questionnaires were sent to service users and relatives prior to the inspection. Findings were as follows; 9 of 13 relatives confirmed that they always know how to make a complaint 2 did not and 2 did not comment. 16 of 21 service users’ confirmed that they always know how to make a complaint, 3 confirmed that they did not know. A discussion was held with the manager about publishing complaints processes more and it was suggested that the procedure could be produced in different formats and complaints processes discussed in service user meetings in an attempt to increase service user understanding and awareness. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 19 Other comments were made about complaints which included the following; “ There are a few I can speak to and know who they are”. “ I have had no reason to make a complaint”. “ I do not wish to make a complaint”. “ If I had a complaint I would go and see the manager”. “ If I had any complaints I would speak to staff. I do, if I want something doing. I can not think of any complaints at the moment”. There have been no recent concerns or allegations/ incidents of abuse. Prior to the last inspections a few aggressive incidents occurred between one or two service users’ which were not reported as they should have been to increase service user protection However, I was pleased to see that the home has put in place a reporting system for staff to record even minor concerns or untoward incidents. I asked staff and relatives if they had seen any concerning behaviour in the home their responses included the following; “ No I’ve never seen or heard anything”. “ No there have been no incidents.” “ No shouting or anything concerning”. I was pleased to see staff training certificates for recent abuse awareness training. All staff have either, received or are about to do this training. The certificates confirmed that the training had covered the following areas; Definitions of abuse, neglect, recognising signs and symptoms, prevention and appropriate incident reporting. With the knowledge gained from this course it should ensure that staff are equipped to better protect the service users’. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26. Quality in this outcome area is Excellent. The provider and manager have ensured that the physical environment of the home is appropriate for the needs of the service users. It is homely, clean, safe, comfortable and well maintained. The home has a range of adaptations and equipment designed to fit within the homely environment to meet the physical needs of the service users’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I found the home’s atmosphere to be positive, homely, friendly and happy. The pharmacist who accompanied me on this inspection agreed with my findings as did other people who made comments as follows; “ The home itself has a nice homely feel to it”. “ The home provides a nice atmosphere” “ The home generates a friendly, lively atmosphere”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 21 The home is a large detached building. It is attractive throughout and well maintained. Communal areas comprise of a large lounge, small lounge, dining room and conservatory. The rear garden is plesant and attractive. One relative said positively; “ Lots of different rooms, lounge and a conservatory for privacy”. Another said; “ She wanted a home where she could sit in a conservatory or look at a nice garden she has got both here”. A service user told me; “ What impressed me was the layout of the building and the amenities”. Another said; “ I like to sit in the conservatory and garden”. The home has got some nice touches to make it feel homely such as; flowering plants in the garden and a large fish tank in the dining area. I looked at five bedrooms all have en-suite facilities. They were nicley decorated and fitted with good quality furniture and fittings. All service users’ spoken to confirmed that they liked their bedrooms. One service user told me. “ I used to share but have been given my own room now”. Another said; “ No other homes I have been in or looked at had a full en-suite shower and everything”. Another said; “ My room has its own en-suite. I have brought my own bed in and my TV”. The home has range of equipment to increase service user independence and safety examples being; a passenger lift, large assisted toilet rooms and specialist bathing eqipment. One service user told me; “ I need to be hoisted and they do this properly”. I looked at two toilets on ground floor, two on the first and two bathrooms. I saw that these were all reasonably clean and were provided with liquid soap, paper towels, hand wash signs and waste bins. I saw disposable gloves and aprons in various areas No communal items were observed in any toilet or bathroom, or any bar soap. I looked at staff files and saw that the two establised staff members have received infection control training. The deputy told me; “ All staff including laundry and cleaning staff, have either done infection control training or are doing ot”. Systems and resources I have mentioned all ensuring that any infection transmission in the home should be minimal which is good as that prevents risk to service users’. The laundry is quite small for the size of the home. However, it was quite organised, clean and tidy and is eqiupped with commercial machines. Flooring and walls were of a good standard. Two sinks, one for staff hand washing purposes liquid soap and paper towels were provided in this area, again good resources to prevent infection spread. I did not detect any odour in the home, it smelt fresh. I saw that it was clean and orderley. About the cleanliness of the home the following comments were received from relatives and service users’; “ Kept very clean”. “ General The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 22 cleanliness, there is no smell about the place”. “ The care home is always clean and tidy. Bedrooms are kept clean and bed linen changed frequently”. “ It always looks and smells clean”. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is Adequate. The home usually provides enough staff to meet the need of people using the service. However, some exploration and attention is needed due to comments received in completed questionnaires. The home ensures that staff receive, relevant training for the purpose of delivering improved outcomes for people using the service. Recruitment processes are sound preventing harm to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels remain adequate for example; on the morning of the inspection staffing levels were provided as follows; Manager Care staff x 6 Cleaner x 2 Laundry/ bed maker x 1 Catering staff X2. The manager told me that agency staff are used at times but not as often as before. She also said; “ Where possible we try to use the same agency staff that know the home and residents’ however, this is not always possible”. I noted comments in questionnaires received and discussed these with the manager as they do need exploring, as it could be that staff behave differently The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 24 when she is not there. “ Make sure get and keep staff so agency do not have to be used weekends”. “ To them they see nothing wrong in sitting around a table in another room where residents can not be observed filling in paperwork and having a chat while cords are being pulled for toilet requirements. “ Some of the staff are not able for their care and efficiency, some would rather have a cigarette outside”. Other comments were also received concerning for example; the quality of agency staff which were provided to the manager to look at as these issues could have a negative impact on the service users’ lives and service provided. During the inspection I asked all staff, relatives and service users’ I spoke with about staffing and staffing levels. They responded as follows; “ Could be more at times. Sometimes people call and there are no staff”. “ More staff were needed before. With the staffing levels now, things have improved, staff not rushing around”. “ I think there are enough staff. There are more staff to attend to needs than where I was before”. “ Oh there are enough staff, better than it used to be. It is better as well now as we only do care tasks”. “ Seem to be enough staff. I’m here most of the day”. Comments about the staff themselves were positive and included the following; “ Friendly.” “ No problems with staff attitude “. “ The staff are nice and kind”. “ Staff very friendly “. “ Generally the staff are kind and caring”. At present 64 of the care staff have achieved NVQ level 2 or above. I looked at two senior files and saw that both held a certificate confirming their NVQ level 3 certificate. The manager confirmed that new staff is undertaking the required induction packages. Folders containing the induction package were stored in the office. I looked at two new staff files and was pleased to see that all required records were in place for them and that the required checks had been carried out. I did note that there was no reference for one staff member from her last employer but there was a written record explaining why. A satisfactory Criminal Records Bureau (CRB) check was on file for each staff member. I was pleased to see that the home has taken the initiative to ask staff to sign a new declaration periodically to confirm no criminal proceedings since their last CRB was carried out. These processes are positive and help to ensure that service users are protected and are safe. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. The manager has the required qualifications experience to run the home. She has been working hard to improve the home across all areas to provide an increased quality of life for service users’. Quality assurance processes have developed considerably since the last inspection but still need some further work. Generally health and safety processes are good but need attention in a couple of areas to ensure that the service users’ are completely safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has achieved her Registered Managers Award and has been approved by the Commission as a fit person to run the home. She has really developed since the last inspection in that she has addressed most of the The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 26 requirements made from previous inspections and it is clear that she has grown in confidence. One staff member told me that she feels supported by the management and is happy to approach them for guidance and advice. A comment received from a relative is as follows; “ We feel that if we had to make contact that our approach would be dealt with in the professional, businesslike, approachable manner already experienced”. Quality assurance systems have developed over recent months. The manager able to confirm and show me work she has undertaken to put in place a quality assurance assessment process. The system developed now needs regular auditing to ensure that the staff and service are conforming to processes and required practice as is already being done with the medication system to ensure efficiency and safety. This work has been complemented by the owner, by him now making a monthly report of the findings of his own quality auditing of the home and service. Processes are in place to gauge service user views and involve them where possible examples being; questionnaires and service user meetings. I checked a random sample of service users money held in safe keeping by the home. I found that money was correct against balances and that receipts and two signatures verified all expenditure which is positive as this ensures that service users money is safeguarded. I looked at staff files and found written evidence to confirm that regular supervision is being carried out. The manager confirmed that processes are in place to ensure further supervisions are regular. A staff member told me; “ yes we have regular supervision from a manager”. I looked at the kitchen and found this to be clean and orderly. I saw that temperatures of hot food, fridges, freezers and food deliveries are taken and recorded. I saw that food was date labelled and stored correctly such as; high risk food stored at the bottom of the fridge and potatoes stored on wooden racks rather than directly on the floor. Generally, all staff have received the required mandatory training or it is being arranged such as ; fire training. Most gaps in training were concerning very new staff that have only recently been employed. I looked at a sample of service certificates and records and was pleased to find the flowing; water bacterial test negative 15.12.06. Five year fixed electrical wiring test satisfactory 30/1/02. Hoist service 14.12.06. Gas landlords safety certificate satisfactory 18.10.06. Work is needed however, to address the following to make sure that service users’ are safe; There is no means to limit access to the laundry where high risk equipment, hot water and exposed copper piping is located and has a potential to cause injury. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 27 Although portable electrical appliances are tested annually, there is no process at the present time for testing electrical items brought into the home by service users’ in between these annual checks. Hot water temperatures are tested by an external contractor three monthly. These checks need to be complemented by in-house processes to ensure that each hot water outlet is checked at least monthly. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 4 x x x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 2 The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24 Requirement The registered person and manager must continue with the quality assurance processes within the home to ensure that audits clearly identify conformance and non conformance and that records of corrective actions taken are made. Timescale of 01/02/07 not fully met. Staff must all receive training violence and aggression training to ensure that they have the skill and knowledge to identify potential behaviours which may give concern and manage these correctly to prevent harm to service users’ and make sure that they are safe. The following must be put into place to ensure that service users are safe; Access to the laundry must be restricted by a suitable and safe means. All electrical appliances brought into the home must be suitable The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 30 Timescale for action 01/08/07 2 OP18 13(6) 01/09/07 3 OP38 13(4)( c) 01/07/07 checked by a competent person before they are used. Hot water testing must be increased from three monthly to every month. These concerns were brought to the managers attention during the inspection. 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 OP27 Good Practice Recommendations The registered persons must examine and explore reasons made about staffing in comments from service user and relative questionnaires to prevent service user dissatisfaction at any time. The Brambles DS0000024978.V333347.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 DS0000024978.V333347.R01.S.doc Version 5.2 Page 32 - 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. 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