Care Home: 15 Bramble Close

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What the care home does well The home has a very relaxed and homely environment that enables residents to feel it is their own home. The home is well decorated and well maintained and is wheelchair accessible throughout and in the garden. The current residents have low dependency needs. Staff encourage them to make their own choices as part of a flexible lifestyle and to reach their optimum level of independence in preparation for their transfer back into the community. Residents are supported to take ownership and control in all aspects of their lives. Care plans are person centred and regularly reviewed in full consultation with residents. Staff respect residents` privacy and dignity when providing personal care and ensure they have good access to healthcare. There is good provision of aids and equipment that is well maintained. Staffing levels are appropriate for residents` care needs with additional staff employed for residents` activities/appointments. Staff work well as a team, sharing information and knowledge. Recruitment processes are robust with the required checks obtained prior to appointment provided. There is a low staff turnover meaning residents are cared for by staff who know them. Communication is good with regular staff supervision and annual appraisals provided. What has improved since the last inspection? Two tenants have been successfully moved into alternative accommodation of their choice. Staff support has been increased by providing more training, supervision and staff meetings. Links with other professionals and housing providers have been improved to increase opportunities and quality of life for tenants. A cooking group and gardening group have been started and residents` meetings have commenced. Various strategies have been established to improve procedures around complaints and protection. More robust monitoring has been undertaken to ensure that health and safety checks on equipment and fittings are completed as required. What the care home could do better: The arrangements for storage were inadequate. The main bathroom was very cluttered with items of equipment and furniture that obstructed residents to easily access the bathroom. The laundry was very small with no space for sorting clothing. There were no door locks on residents` rooms. There were no foot operated bins for disposal of clinical waste. Notification of deaths, illness and other events had not been submitted to the Commission and there were no reports from visits by the Registered Provider available for inspection. The quality assurance programme needs further development to include more internal audits and to produce an annual plan for the home. Key inspection report Care homes for adults (18-65 years) Name: Address: 15 Bramble Close 15 Bramble Close Chigwell Essex IG7 6DR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Green     Date: 0 4 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 15 Bramble Close 15 Bramble Close Chigwell Essex IG7 6DR 02085027678 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): samuel.crawford@essex.go.vuk www.essexcc.gov.uk Essex County Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category 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: Physical disability - Code PD Date of last inspection Brief description of the care home Bramble Close is a purpose built rehabilitation unit located in Chigwell. It provides accommodation for 4 residents over 18, with varying degrees of physical disabilities. Bramble Close is a one-storey bungalow style building and accommodation is provided in single bedrooms, with en-suite facilities. The home is located on the outskirts of Chigwell, and it is accessible through the local bus service. It is able to address the needs of individuals with high dependency levels and provides the appropriate aids, adaptations and equipment to enhance the safety of the residents. The home aims to Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home provide the residents with a range of activities and experiences in order to maximise their personal development and independence. The staff aim to provide a service that is driven by equal opportunities, autonomy and maintaining the rights of the resident. The home has strong links with the local primary health care team and it uses the support and advice of professional teams linked to the home. The current fees are available from the home. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place on 2nd March 2010. All of the Key National Minimum Standards (NMS) for Younger Adults, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA Care Homes for Adults (18-65 years) Page 6 of 29 provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, staff and the manager. Surveys were sent to service users to obtain their views. Residents, staff and the manager were welcoming and helpful throughout the inspection. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The arrangements for storage were inadequate. The main bathroom was very cluttered with items of equipment and furniture that obstructed residents to easily access the bathroom. The laundry was very small with no space for sorting clothing. There were no door locks on residents rooms. There were no foot operated bins for disposal of clinical waste. Notification of deaths, illness and other events had not been submitted to the Commission and there were no reports from visits by the Registered Provider available for inspection. The quality assurance programme needs further development to include more internal audits and to produce an annual plan for the home. Care Homes for Adults (18-65 years) Page 8 of 29 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Bramble Close can be assured they will have sufficient information made available to enable them to make a decision and that their needs will be assessed prior to admission. Evidence: The home had a statement of purpose and service user guide that were comprehensive documents. Copies of both documents were viewed during the site visit and were seen to meet regulatory requirements. The manager confirmed that these would be made available to potential residents and their representatives. The admission process was discussed with the manager. There were three residents at the home, all of whom had been admitted since the previous key inspection. One had been admitted as an emergency admission and the remaining two were planned admissions. Referrals were received from social workers and assessments undertaken jointly with the manager or team coordinators. The records viewed included detailed assessments to ensure the residents needs could be met. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bramble Close can expect to have their care needs met by robust care planning and to be fully supported to take responsible risks and make independent decisions about their lives. Evidence: The arrangements for care planning were discussed with the manager and team coordinator and three care files was viewed. All residents had a named key worker. Each care record included a service user plan, a personal profile, an overview of weekly tasks, an agreed delivery of care, risk assessments with action plans, a manual handling risk assessment and action plan, a medication record, review sheet, communication record, a record of complaints/compliments, access to records and general information with details of their GP and social worker. Care plans were person centred and included good detail of the individual needs of residents personal care needs for example when getting in and out of bed, washing, shaving, showering, bathing, oral care, nail care, hair care etc. Care plans were also Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: available for needs when dressing, undressing and mealtimes etc and were all signed by the residents and their key worker. Risks assessments demonstrated that risks had been minimised and were regularly reviewed. Daily records were very detailed showing the range of activities that residents were involved in and also demonstrated that care staff were monitoring their changing needs. All residents were self sufficient and able to make their own independent decisions. Some also had a family member that was involved in their care and who assisted them in making decisions. Information on advocacy services was also made available to them. Bramble Close had a risk management strategy in place. The AQAA informed us that tenants currently living at Bramble Close have developed their own daily/ weekly routines and have become almost independent of staff support. From discussion with residents it was evident they were enabled to contribute to the daily life and routines of the home, with all risks comprehensively assessed and managed. Risks were assessed and minimised as far as possible without restricting individuals independence. Detailed risk assessments were seen for individual risks, which included for one wheelchair user getting stuck in doorways, access to vehicles, manual handling and access to college. Daily records were very detailed and provided good evidence of how the resident spent their day. This showed that residents were involved in a range of activities and also demonstrated that care staff were monitoring their changing needs and promoting their independence. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bramble Close are encouraged and supported to making their own decisions that promotes an independent lifestyle. Evidence: The AQAA informed us that Bramble Close encourages ordinary lifestyle principles and encourages tenants to engage in activities which interest them. The emphasis is on supporting tenants to make their own decisions about lifestyles, eg diet, attending to their own health needs, shopping, leisure activities. This was also confirmed in discussion with each of the three residents. None of the three residents were in employment. We were informed that as part of the rehabilitation process advice and support was given by staff on accessing benefits and any financial issues to enable them to return to the community. The AQAA informed us that tenants are generally able to communicate their interests. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: They are encouraged to make use of the local community and beyond using public transport with whatever assistance they require. Tenants are encouraged to maintain links with family and friends whilst they stay at Bramble Close. One resident told us they had their own television, DVD and computor and made their own decisions about what they wanted to do each day. They confirmed that there were no restrictions made and they could go to the pub if they wished. They do their own shopping every Monday and take a taxi unsupervised by staff. Another resident told us that they planned what they were going to do each day. They enjoyed going shopping once a week and their key worker accompanied them on these trips. They also liked going to nightclubs and had recently been to a disco and also planned to go on holiday to another care home that specialised in providing holidays for people with disabilities. The AQAA informed us that tenants are encouraged to maintain links with family and friends while they stay at Bramble Close. We were also informed that visiting was open access and there were no restrictions on time of visiting. One resident told us they sometimes had visitors and confirmed that they went home when their family collected them. Another told us their friends could come to see them. The atmosphere in the home was very relaxed and residents were seen to be able to make their own decisions about where and how they spent their day. One resident was watching television and other had chosen to stay in their room. Staff were observed to respect residents privacy by only entering their room with their permission. All residents spoken with confirmed they could make their own choices about what they did each day. One resident told us that they found the staff very supportive and helpful if they had any problems. All rooms viewed were very well personalised. The care plans detailed the household tasks that residents had responsibility for, for example cleaning and tidying their own room. One resident told us they enjoyed looking after their own room. We were informed that a cooking group and gardening group have recently been established Bramble Close. The home had a communal open lounge/dining room that opened to the kitchen. Residents were encouraged to e responsible for cooking their own meals in the rehabilitation kitchen that was fitted with a dishwasher, two microwaves, an oven and hob and fridge and freezer. We were informed that residents had an allowance of £30 per week each for food and were encouraged to do their own food shopping. Each resident had their own shelf in the fridge to store food and mainly cooked their own food with assistance. We were told that arrangements for times of meals were flexible and residents were very considerate of each other. This was also confirmed during the visit to the home, for example one resident was having their breakfast at 11am. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bramble Close are supported in their personal lives and have good access to healthcare services. Evidence: Two of the residents living at Bramble Close required some level of support with personal care. Residents told us that their needs were discussed with them and it was agreed what support they needed and how it would be given. Another resident self managed their own personal care but told us that staff were very supportive and would help them if needed. The care records confirmed that residents preferences about how they were supported were discussed and agreed with them. The ambiance of the home was very relaxed. Residents clearly felt comfortable with the life at the home and were able to choose how they spent their day and to express their individuality in the way they dressed and the way they wore their hair. One told us Im quite happy here. The AQAA informed us that Bramble Close residents personal support plan details the support they need and that residents are encouraged to take responsibility for their own healthcare and to make and attend appointments themselves, although staff Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: would accompany them if necessary. One resident told us they visited their own GP and also attended hospital appointments and staff accompanied them. The records of another resident confirmed that they attended outpatient appointments and had new glasses that they had organised themselves. From discussion with staff, the manager and an inspection of records it was evident that residents had access to GPs, consultants, chiropodists, opticians and occupational therapists as relevant. The arrangements for managing residents medication was discussed with the manager. The home followed the Essex County Council Administration of Medicines Policy and Procedures. Each member of staff has a medication workbook that includes a personal policy for Bramble Close of which a copy was seen. Residents requested their own prescription from their GP and collected their medication from the pharmacist. Care staff monitor the timings as several days were needed for the pharmacist to have medications in stock. With the exception of one resident who required assistance with their medication, residents were self medicating as part of a risk assessment. The systems were checked for the one resident requiring assistance. Medication was stored in a lockable box in their room. The medication administration (MAR) records and supplies were checked and confirmed that all medication was available and given as prescribed. However there was no monitoring of room temperatures undertaken to ensure they remained within safe recommended levels (maximum 25 degrees Centigrade). Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bramble Close are assured they will have their concerns and complaints listened to and acted upon and they will be protected by adult safeguarding policies, procedures and practices. Evidence: The AQAA informed us that ECC has a robust and comprehensive complaints procedure. Information on how to make a complaint is available. The AQAA also informed us that the new interim manager has recently produced a complaints procedure specific to Bramble Close and also a simpler picture type complaints procedure. This would ensure that the procedure could be easily understood by residents. The complaints policy and procedure was viewed and seen to include timescales for a response and to meet regulatory requirements. The procedure was included in the statement of purpose and service users guide. We were informed that one complaint had been received by the home since the previous key inspection. The Home had a safeguarding policy and procedures and a whistle blowing policy in place to ensure residents were safeguarded from abuse. The AQAA informed us that a training session in protection of vulnerable adults had been arranged for all staff. The manager said that CRBs for all existing staff are to be reviewed. The records viewed during the visit to the home confirmed that staff received training on abuse during their induction, through NVQ level training and annual updated training was also provided. The home had copies of the Essex Safeguarding procedures available for staff guidance to be used in the event of an allegation being made. There had been no Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: safeguarding alerts made since the previous key inspection. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bramble Close provides a clean, homely environment for residents that is well decorated, well maintained and comfortably furnished. However a lack of storage space prevents the main bathroom being easily available to residents. Evidence: The AQAA informed us that Bramble Close is a purpose built facility for people who have a physical disability. It is fully wheelchair accessible with level access throughout including showers. The unit is fully equipped with hoists and accessible kitchen facilities and specialist equipment. The rooms are large and nicely decorated and furnished. This was also confirmed during the visit to the home. The home was clean, well decorated, comfortably furnished and well maintained. Some residents individual rooms were seen with their agreement and were well personalised with photographs and personal items, for example televisions, computors, DVDs etc. However there were no door locks fitted to ensure residents privacy. Records confirmed that the home was appropriately maintained and that fire safety practices were in place to meet the requirements of the local fire service. The home was clean and odour free. However storage space was limited. The laundry room/cupboard was very small and housed two washing machines that had the capacity to carry out sluice cycles (wash at minimum 65 degrees for not less that Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: 10minutes). The tumble drier was stored in the corridor next to a work station with no facility for sorting and folding clothes. The main bathroom was clearly not used much as it was very cluttered with various items of furniture and equipment (coffee table, chair, mattress clothes driers, buckets and mops etc.) Staff hand washing facilities (paper towels and liquid soap) were provided throughout but there were no foot operated bins for their disposal. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by well trained, experienced and skilled staff who are clear of their role and are well supported and well supervised. Evidence: The AQAA informed us that the current staff team have all worked at Bramble Close since it opened thus a consistent approach is employed with very little use of agency staffing. This ensures that residents are supported by people they know and who are aware of their needs. We were informed that all staff have an NVQ level 3 qualification which exceeds the recommended standard for 50 care staff to have NVQ level 2. During the visit to the home staff appeared skilled and experienced with the client group and were motivated in their work. All staff were observed to treat residents with respect and to listen and engage in conversation with them. The AQAA informed us that staff had become very competent in assisting a resident with a complex condition that had been commended by a specialist nurse. The training records viewed confirmed that training had also been provided in understanding challenging behaviour, showing staff were able to develop their skills to ensure they were competent to support residents in such situations. Time was spent in discussion with a team coordinator during the morning of the visit to the home as the manager was on a training day but did attend later in the day. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Staffing levels comprised one team coordinator on site with additional cover to support residents appointments and two care staff (one awake) on duty at night. Residents appeared well cared for and were well supervised. From discussion with staff it was evident that regular meetings were held and handover sessions to ensure staff were appropriately supported and were kept up to date with residents changing needs. There had been no staff recruited since the previous key inspection. However the personal files for two current staff were viewed. Both included evidence that the required checks had been undertaken prior to appointment (two satisfactory references, CRB Disclosures, evidence of identification etc.). Their training records also confirmed they had attended infection control training, safeguarding adults and had undertaken training to NVQ level 3. The AQAA informed us that all staff have obtained an NVQ level 3 qualification and have attended or undertaken various other courses relevant to their work such as manual handling, adult protection, medication, first aid, infection control, health and safety. The training records viewed confirmed that since the previous key inspection training had been provided in first aid, safeguarding adults, manual handling, infection control, challenging behaviour (2 staff), and death and bereavement (2 staff). The AQAA informed us that all staff receive regular supervision and attend staff meetings. The manager explained the system of supervision in operation. There is an informal communication book to record an changes in residents needs. The manager is very accessible by telephone when not on site. All staff have an annual appraisal. Team coordinators supervise care workers and the manager supervises team coordinators. Meetings are held monthly where possible and care issues and training needs discussed. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that Bramble Close is a well managed care home that has good standards of health and safety that protects them. Evidence: The acting manager has many years experience of working for Essex County Council in residential and day care for learning disabilities. She holds the a City and Guilds qualification and NVQ levels 2 and 3. From discussion with the manager it was evident that she was skilled and competent and had undertaken recent updated statutory training (manual handling, safeguarding adults, first aid) and infection control, strokes and challenging behaviour. Throughout the site visit it was evident that the manager operated an open door policy and was available to support staff. The quality assurance programme was discussed with the manager. This comprised annual service user questionnaires. An action plan was developed from the findings of the consultation. Internal audits were undertaken in health and safety. All accidents and incidents were referred to Essex County Council Health and Safety. However these had not been referred to the Commission as is required under regulation 37. There Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: was no annual plan produced for the home. However there was clear evidence of ongoing informal consultation with residents. There were no regulation 26 reports from registered provider visits available to view at inspection and none had been received from the home. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, assessments/care plans, medication records, staff meetings, staff recruitment and training records, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting etc.). All accidents, injuries and incidents were well-recorded and appropriate action taken. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 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 39 26 Reports from Registered Provider visits must be available for inspection. This will ensure the Commission is fully informed of events in the home. 30/04/2010 2 41 37 Notifications off death, illness or other events must be reported to the Commission. This will ensure the Commission is fully informed of events in the home. 30/04/2010 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 20 Monitoring of room temperatures should be undertaken to ensure that medication is stored within safe recommended maximum temperatures (maximum 25 Degrees centigrade). Door locks should be provided on residents rooms to 2 26 Care Homes for Adults (18-65 years) Page 27 of 29 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 ensure their privacy. 3 4 30 30 Foot operated bins should be provided for appropriate disposal of clinical waste. The storage facilities should be reviewed to ensure furniture and cleaning items are stored separately and they do not restrict residents access to the bathroom. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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