Care Home: Braceborough Hall

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What the care home does well The home is in a quiet and peaceful setting in the village with wooded grounds. A resident commented that a reason for choosing the home was that it had an excellent reputation in the village area. People are cared for in a clean and comfortable environment and the home is decorated to a good standard. All people spoken with made positive comments about the care they received; one said it was a beautiful home with large, spacious rooms and she never felt cramped. Another said that she enjoyed sitting in the conservatory and watching the garden. There is an extensive range of activities tailored to the needs of people. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager and senior staff work well as a team and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. What has improved since the last inspection? More time has been spent encouraging both people and staff to interact, including eating together at main meals. Training updates have been held on new laws on adult protection issues including whistleblowing. Environmental improvements have included refurbishment of the dining room, including curtains, carpets and dining furniture, new chairs and side tables in the main lounge, adding en suite facilities to two rooms in the Old Hall and complete refurbishment of a further two rooms in the Old Hall. Junior staff have been encouraged to act up as senior staff on shifts to give an insight of senior duties. The manager has delegated paperwork to three senior staff members, including risk assessments and care plans. What the care home could do better: We identified no issues of concern at this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Braceborough Hall Braceborough Hall Braceborough Lincolnshire PE9 4NT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Western     Date: 2 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Braceborough Hall Braceborough Hall Braceborough Lincolnshire PE9 4NT 01778560649 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Susan Linda Burcham care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Braceborough Hall is a large detached stone building, the villages former main house. There is a modern ground floor extension and a conservatory attached to the main building, but the home has retained many of the original features in the older part of the building. There are large well maintained landscaped gardens, with walks and seating for residents and a drive and car parking to the front of the home. The home is situated in the centre of Braceborough village, with the towns of Stamford and Bourne and the large village of Market Deeping all nearby, with a good range of facilities. Personal care services are provided for up to 25 older people and on the day of the inspection, 18 people were being accommodated. The home provides long-term residential care, with four bedrooms kept for respite care and there is also a provision for day care for one person on one day of the week. The basic philosophy of the home is to promote a warm family atmosphere, free from any forms of institutionalisation. Residents are encouraged to maintain their chosen lifestyles and maintain their independence. There is a residents charter, which reflects the basic values of choice, Care Homes for Older People Page 4 of 24 Brief description of the care home empowerment, rights of citizenship and advocacy. The home is owned and managed by an individual proprietor. Weekly fees range from £450 to £550 and information on these and the facilities of the home are available from the manager. Care Homes for Older People Page 5 of 24 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately four hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent Care Homes for Older People Page 6 of 24 out surveys to people before we visited the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of four people through their records and assessing their care. We spoke to two people who use the service and saw rooms of those people who said we could and to one staff member. The manager was present throughout the visit and the general outcomes of the visit were discussed with her. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The home does not provide intermediate care. Evidence: We saw the statement of purpose which was comprehensive and clear. It contained terms and conditions and contracts. The service user guide we saw contained useful information for people. It was in large print. The manager said that she or a senior member of staff always visited prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records we saw confirmed this. We saw written admission records that were clear and gave staff all the information they needed to meet the needs of people. Care Homes for Older People Page 10 of 24 Evidence: A resident we spoke with described how she had visited for the day before she was sure she wanted to move in permanently. Four rooms are set aside for respite care and we spoke with an occupant who said she had regular respite care whenever her daughter was abroad. Another said that this home had been chosen because it was clearly the best of the ones she and her family saw. A staff member described the admission process and the importance of making new residents and their families welcomed. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care practices ensure that people receive good care and their medical needs are met. The privacy and dignity of residents are respected. Evidence: Care plans we saw contained information about the health and personal care needs of people. They were reviewed regularly and signed where possible by people or their relatives or advocates. We saw a medication policy that was clear and comprehensive and we saw that the mid day medication round was carried out safely. People received regular visits from district nurses and other agencies involved with their care. A visiting GP said the standard of health care was very good and staff were on the ball regarding knowledge of residents and when to call the GP. We saw staff carrying out their duties with kindness and sensitivity towards people, especially when attending to their personal needs. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are regular, extensive and are tailored to suit the individual needs of residents. People have a choice of meals from a balanced and varied menu. Evidence: A previous inspection found that the home has an activities programme, organised by the manager. The pre inspection questionnaire evidenced that activities take place in the home and outings are also undertaken. A variety of activities is provided for residents including entertainers, indoor games such as board and card games and trips to local pubs and shops. Braceborough Hall recently opened its gardens and grounds for the local charity flower show and other recent activities included a Spanish evening with paella, cream teas, aerobics and pub afternoons with competitions such as magnetic darts. On the day of the inspection people were sitting in the quiet lounge, the conservatory or the TV lounge. One was taking the dog belonging to the owner and adopted by residents, for a walk. In the afternoon games and a sing along were to be held. People we spoke with all said they had a choice of whether or not to take part. They described the garden fete which is held in August and advertised in the surrounding villages and which all local people can attend. Meetings for residents are held regularly and staff described a ballot held on what future activities people wished Care Homes for Older People Page 13 of 24 Evidence: to take part in. People we spoke with all said they enjoyed the meals served. One said the mid day meal was excellent and another that whatever was on the menu was lovely. The menu for the week was displayed in the dining room and offered alternative choices of meals. The cook has the basic and advanced food hygiene certificates. She was knowledgeable about the nutritional needs of service users and described cooking for people on various diets, the current ones including six diabetics. People were informed about the main lunchtime menu and were offered a choice if this did not appeal to them. The most recent visit from the environmental health officer resulted in the home being awarded five stars in their award scheme. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for addressing complaints and for protection from abuse are clear. People and their families are confident that their comments and concerns will be listened to. Residents are protected by clear procedures on safeguarding adults. Evidence: Records we saw showed that since the last inspection there had been no complaints. People spoken with said they did not wish to complain but knew how to make a complaint. One said she would certainly know how to find somebody to make a complaint to and it would always be seen to. The home had an up to date copy of the Local Authority adult protection procedures and staff members said they had read it. Staff confirmed that they had received training in safeguarding adults and knew what to do in the event of abuse happening. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and pleasant environment with both private and communal space that is generally suitable for their needs. Evidence: We saw that the home was maintained to a high standard internally. The grounds and gardens were particularly well tended and offered peace and seclusion. There were flowers in tubs and baskets around the home and the newly built decking area off the conservatory, with a ramp leading into the main garden. Recent improvements had included refurbishment of the dining room, including curtains, carpets and dining furniture, new chairs and side tables in the main lounge, adding en suite facilities to two rooms in the Old Hall and complete refurbishment of a further two rooms in the Old Hall. Staff described how any maintenance issues were addressed quickly by the maintenance personnel. There were safety notices around the building to prevent the spread of infection and COSHH regulations were observed throughout. People we spoke with said they liked their rooms and were pleased with the standard of decoration. One commented on the large size of the rooms and said the home did not feel cramped at all. The building smelled clean and fresh throughout. Care Homes for Older People Page 16 of 24 Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people. Staff members are suitably trained, qualified and competent. Evidence: The daily staff rota we saw showed that there was a senior carer plus three carers for 18 residents. In addition the manager could assist during busy periods. There were two nights carers plus one on call senior. People and staff members we spoke with all said there were enough staff to care safely for the needs of people. The home also employed two domestic staff and one laundry person Monday to Friday, a cook and a handyman/gardener. The manager said that four members of staff have recently achieved the NVQ, a nationally recognised qualification, at Level 2, with four working towards it and one staff member had achieved NVQ level 3, with two working towards it. The most recent staff member to be employed described how she had an interview, gave three references and underwent CRB/POVA checks. She also underwent an induction course. Staff records confirmed this. We saw training records demonstrating that statutory training has been undertaken and that staff received regular supervision. There were minutes of regular staff meetings. We saw records that showed very little staff turnover and staff spoken with confirmed Care Homes for Older People Page 18 of 24 Evidence: this. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the health, safety and welfare of people are promoted. The views of people are listened to and they are involved in decisions affecting them. Evidence: The manager who is also the owner managed the home for 24 years. She is a trained nurse and has the NVQ assessors award. People we spoke with all made positive comments about the way the manager ran the home, finding her approachable and supportive. There is a sound quality assurance procedure, with separate questionnaires for people, their relatives/visitors and staff. The findings are recorded on a graph and acted upon. A number of the responses showed a one hundred per cent answer of excellent. Staff records we saw showed that supervision took place regularly and joint appraisals were held using a Managerial Development Skills Matrix. Staff members were asked to complete a self assessment form and a questionnaire on caring practices. The home had its own Codes of Conduct for staff and also used the General Care Council codes of Care Homes for Older People Page 20 of 24 Evidence: conduct. Health and safety policies were well documented and showed a clear commitment to ensuring the wellbeing of people. Records were well maintained. We saw minutes of the last residents meeting and this showed that residents have a voice and feel free to express opinions. A sample of residents financial records were examined and showed that finances for people are kept in a safe place and there is a clear system of accounting in place. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. The homes pre-inspection questionnaire evidenced that fire alarm, fire drills and emergency lighting checks have been undertaken. A check of the fire log was undertaken and it was found to be up to date. The homes pre-inspection questionnaire has evidenced that maintenance and service histories of all aids and adaptations are carried out as required by law. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 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 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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