Care Home: Bracken Lodge

What the care home does well Pre admission assessments are thorough and form the basis for comprehensive risk assessments and plans of care, tailored to each person living at the home. Staff treat people with dignity and care, respecting their individual choices and preferences and activities are centered around the person`s abilities. There is a varied menu on offer and people are supported to maintain a balanced diet. People should be confident that complaints will be listened to and acted upon. Staff receive the training they need to know how to protect people from abuse. People live in comfortable surrounding where there is a regular programme of maintenance. The staff team are well trained and there are sufficient staff on duty to meet the health and social needs of people. Recruitment procedures ensure that only suitable people are employed to work within the home. There is a strong management structure in place. The home has a quality assurance system which listens to peoples views and takes action to improve. What has improved since the last inspection? At the last key inspection in 2007 we made two recommendations. Letters are now sent to people to confirm their offer of a place at Bracken Lodge and that the home will be able to meet their needs. The home smelt fresh and there were no malodours during the visit. What the care home could do better: At the end of this inspection there are four recommendations: All care plans and any changes made should be discussed and agreed with the individual or their representative and signed for. If this is not possible then this should also be recorded. Medication administration recording should be improved with all handwritten entries being double signed and dated by two staff; `as required` medications to record when and why they may be needed and plain English instructions regarding the time of medicine administration.The water temperature log book for residents` baths should record temperatures each time and be kept in the bathroom. A copy of any accident report, involving a person living in the home, should be kept in each individual`s care file. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bracken Lodge 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 0 6 0 5 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 25 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 25 Information about the care home Name of care home: Address: Bracken Lodge 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB 01202428777 NOFAX 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) : Miss V Flemming,Mr W O`Flaherty care home 18 Number of places (if applicable): Under 65 Over 65 18 dementia Additional conditions: Date of last inspection Brief description of the care home 0 Bracken Lodge is a large detached property, situated in a quiet residential area of Southbourne, Bournemouth. The home is positioned within 400 metres level walk from the centre of Southbourne, which offers a wide range of amenities, such as shops, post office, churches, GP surgeries and library. The home is also close to the cliff top and sea. Parking for visitors is available on surrounding roads and there is a good local bus service nearby. Bracken Lodge accommodates up to 18 older people with dementia, who are in need of 24-hour nursing and personal care. The property has been converted for use as a care home and is arranged over three floors. A passenger lift is available to assist access between floors. The home has fourteen bedrooms, ten of which are for single occupancy. None of the bedrooms has en-suite facilities, but there are sufficient numbers of communal bathrooms and WCs available. The home has a lounge on the ground floor, which also provides a small dining area. This is the only communal space Care Homes for Older People Page 4 of 25 Brief description of the care home so recreational facilities are somewhat limited. There are issues over accessibility to some rooms but staff make good use of the space available. A secure garden is not available, but there is a paved patio area, with a water feature and pots of seasonal colourful flowers, where people can sit out under staff supervision. People are encouraged to participate in a range of activities organised within the home. At the time of the inspection the fees for the home ranged from £620 to £750 per week. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2*. This means that the people who use this service experience good quality outcomes. This was a statutory unannounced inspection required in accordance with the Care Standards Act. We looked at information sent by the home before we visited. We spoke to people who live in the home as well as people who work in the home. We also spoke to people who visit the home. During the site visit we looked at a variety of care records to find out how people were Care Homes for Older People Page 6 of 25 being supported, we also observed care in the home. What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are four recommendations: All care plans and any changes made should be discussed and agreed with the individual or their representative and signed for. If this is not possible then this should also be recorded. Medication administration recording should be improved with all handwritten entries being double signed and dated by two staff; as required medications to record when and why they may be needed and plain English instructions regarding the time of medicine administration. Care Homes for Older People Page 8 of 25 The water temperature log book for residents baths should record temperatures each time and be kept in the bathroom. A copy of any accident report, involving a person living in the home, should be kept in each individuals care file. 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 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 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. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. Evidence: The pre admission assessments for people who had moved into the home recently were seen. These were thoroughly completed by the registered manager and gave enough information for them to be able to determine whether the home could meet the persons needs. A recommendation was made at the last inspection that letters should be sent out to people, after a decision had been made to admit them, confirming their place and how the home would meet their needs. The home now does this and copies of these were seen, alongside care management and funding assessments. Care Homes for Older People Page 11 of 25 Evidence: People are encouraged to visit the home prior to moving in but given the nature of their needs, this is not always possible. However, people did confirm that they had received sufficient information about the home before making a decision about whether it was the right place for them to move to. Care Homes for Older People Page 12 of 25 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. Comprehensive systems are in place to provide staff with the information they need to meet the health and personal care needs of individuals, although medication recording could be improved. Individuals continue to be treated with respect and dignity. Evidence: The care files for two people living at the home were seen and reviewed. Each file contained detailed assessments, based on the pre admission information gathered and formed the basis of individual care plans. These reflected a persons preferences and choices regarding their care and were regularly reviewed on a monthly basis. However, there was no evidence to show that these had been discussed and agreed with each person or their representative. It should be demonstrated that this takes place and a recommendation was made that this is now discussed and recorded in the care files for each persons plan of care and any changes made. There was clear evidence of peoples health needs being met, within the care plans and daily recording, with GP visits arranged when necessary and chiropody, dental and Care Homes for Older People Page 13 of 25 Evidence: mental health needs met. Appropriate risk assessments and agreements had been undertaken where a person needed bedrails and daily entries made by staff, commented on physical and emotional needs and any changes noticed. Staff were observed to care for people with dignity and respect and the registered manager sets a strong ethos for how people living within the home should be cared for. The home had a good medicines policy and procedure in place and all storage was appropriate. The records had been fully completed, with no gaps in signatures and variable medicine doses correctly recorded. However, some hand written medication records were not double signed or dated; inappropriate abbreviations were written on one entry to indicate time of dosage and it was not clearly documented when and why some as required (prn) medications would be given. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to engage in social and recreational activities and are encouraged and supported to pass the time according to individual preferences. A choice of menu is provided and meals are nutritional and appetising. Evidence: Each day there are some activities for people living in the home and an activities list was displayed in the hall. No activities co-ordinator is employed at the moment but there is an expectation that staff engage with all people when they are free to. All activities and interactions are based upon peoples abilities and preferences and can range from just sitting and talking to going out for a walk, as one person had done that day. One person who was visiting the home said he was very happy with the one to one attention given to his relative and spoke very highly of the care and attention given to all people, by staff and the registered manager. An assessment of peoples interests and life style choices remains part of the pre admission process and ensures that peoples needs in this area are met. There is a Care Homes for Older People Page 15 of 25 Evidence: church service once a month and family and friends are welcomed into the home. Lunch seen on the day of the visit was beef casserole, mashed potato, carrots and spring cabbage with a choice of bread and butter pudding and cream or banana and custard for desert. The registered manager does all the shopping and the traditional menu offered, varies each week. The cook spoken to that day, demonstrated a good knowledge of peoples different needs and preferences and had worked at the home for 15 years. Care Homes for Older People Page 16 of 25 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. There are procedures in place to ensure that complaints are fully investigated and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection policies are in place, in order to safeguard residents from potential abuse and harm and staff receive appropriate training. Evidence: There have been no complaints made to the Commission or the home, since the last inspection and a copy of the complaints procedure is displayed prominently in the hallway. All staff have completed safeguarding training in the past year. There have been no safeguarding issues at the home. The home also has appropriate policies and procedures to deal with whistle blowing and missing persons and follows the No Secrets guidance. Care Homes for Older People Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bracken Lodge provides residents with a comfortable, safe and well-maintained place to live, which is clean and free from any offensive odours. Evidence: The home presents as a clean, comfortable, homely environment with no offensive odours (meeting a recommendation made at the last inspection). There is also an on going maintenance programme with a handyman available to fix things as needed. The Annual Quality Assurance Assessment (AQAA) told us about the changes they have already made to the environment: We have replaced new bay windows to room 1; we have 3 rooms redecorated (8,10,11); we continue the upkeep of our gardens with regular lawncare and new sensory plants. There is an infection control policy in place and staff are provided with appropriate equipment and training in this area. The laundry appeared well organised, with adequate equipment and handwashing facilities. Care Homes for Older People Page 18 of 25 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. Residents benefit from staff being recruited in line with good practice and being trained and deployed in sufficient numbers to meet residents needs. Evidence: Staffing levels appeared adequate on the day of the visit. The registered manager confirmed that each day shift has one registered nurse and two carers on duty and one registered nurse and one carer at night. These levels are sometimes changed to reflect the increased needs of people. A cook and domestic cleaners are also employed. More than 50 of the staff team are have currently achieved a National Vocational Qualification (NVQ) in care at level 2 or above or the equivalent. The induction file of one new staff member was seen and appropriately followed the Common Induction Standards. Three staff files were reviewed and found to contain all of the checks and records required under Schedule 2, including a Criminal Records Bureau (CRB) check and POVA 1st. One member of staff who was still awaiting the return of their CRB, was seen to be working under supervision that day, as required. All staff receive the necessary mandatory training in moving and handling, first aid, Care Homes for Older People Page 19 of 25 Evidence: fire safety and basic food hygiene and certificates were seen in staff files to evidence this. Other training is sourced from different places, including the Primary Care Trust (PCT) and local authority. Dementia training is received directly from the Alzheimers Disease society and the registered manager has also recently completed the Mental Capacity Act and Deprivation of Liberties training. There are plans for other staff to now attend this. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a registered manager in place to ensure that the home is safely managed, well organised and run in the best interests of residents and a developing quality assurance system, which is based on the views of residents. Practices in the home ensure that the health, safety and welfare of all are promoted and protected. Evidence: Miss Fleming has been employed as registered manager of Bracken Lodge since 1989 and has completed the NVQ level 4, Registered Managers Award. She is clearly a very hands on person, who is well respected by her staff team and shows a strong dedication to the people living in the home. One visitor spoken with said that she led from the front as far as caring for the residents and setting an example to staff. The home submitted a completed AQAA prior to the inspection as required and this forms part of their quality assurance process. The home send out relatives surveys annually and the last ones completed, from December 2008 were seen. Residents Care Homes for Older People Page 21 of 25 Evidence: surveys are also used and the AQAA states that a suggestion box is also available. The home does not hold any money for people living there. Fire records and servicing for fire equipment was seen to be up to date and other routine annual checks had also taken place and certificates seen as evidence. The water temperature checks were not up to date and it was recommended that the book be kept in the bathroom, to ensure that staff completed it when needed. A clear record of all accidents was seen and any actions taken. It was recommended that all copies of any incident involving a person living in the home, should also be kept in their individual care files to provide a thorough history. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 7 All care plans and any changes made should be discussed and agreed with the individual or their representative and signed for. If this is not possible then this should also be recorded. Medication administration recording should be improved with all handwritten entries being double signed and dated by two staff; as required medications to record when and why they may be needed and plain English instructions regarding the time of medicine administration. The water temperature log book for residents baths should record temperatures each time and be kept in the bathroom. A copy of any accident report, involving a person living in the home, should be kept in each individuals care file. 2 10 3 38 4 38 Care Homes for Older People Page 24 of 25 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). 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