Care Home: Brackenbridge House

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What the care home does well The Registered Manager is effective in running the home for the benefit of people who use the service. There are good systems in place to monitor the quality of the care provided. A very well maintained environment is provided for people and it was clear from touring the building that a high priority is given to redecoration and creating a homely environment with the purchase of good quality, fixtures, fittings and furniture. The records of care are kept to a high standard with individual care records giving good detail on peoples` individual needs as well as a rounded picture of peoples individual experiences, values and preferences. What has improved since the last inspection? The good standards of care in the home had been maintained since the last inspection. We noted improvements to the environment, as mentioned already, with the purchase of new items and decoration. What the care home could do better: We did not make any Statutory Requirements as part of the assessment and inspection of the home during this key inspection. Key inspection report Care homes for older people Name: Address: Brackenbridge House Brackenbridge House, Brackenhill Victoria Road Ruislip Middx HA4 0JH     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: Susan Woolnough-Singh     Date: 0 8 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 Older People Page 2 of 23 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 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 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Brackenbridge House Brackenbridge House, Brackenhill Victoria Road Ruislip Middx HA4 0JH 02084223630 02084264437 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Group Limited Name of registered manager (if applicable) Gillian Browne Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service user who can be accommodated is 36 The registered person may provide the following category / ies of service user 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: Old age, not falling within any other category Code - OP Date of last inspection Brief description of the care home Brackenbridge House is a purpose built care home for older people in Ruislip. It is set in large grounds which are well maintained. The home is near public transport and local shops. All bedrooms are single and many have en suite facilties. There are three lounges on the ground floor and a large dining room. The catering and laundrey facilities are located on the ground floor. The home us well maintained andattractively furnished and decorated. Home Group Limited are the Registered Providers of the Care Homes for Older People Page 4 of 23 Over 65 35 0 Brief description of the care home home. Care Homes for Older People Page 5 of 23 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: The inspection visit took place on 25th January 2010. We looked at all of the Key National Minimum Standards for Older People. The last key inspection of this service was carried out on the 2nd and 4th of February 2009. The 2009 inspection resulted in a quality rating of Excellent. In April 2009 the Registration of the provider changed from Warden Housing Association to Home Group Limited. The Registered Manager and the staff group have remained the same. The focus of this inspection was to ensure that standards were being maintained with regard to the registration of a new provider. The inspection took approximately four hours and forty five minutes. We talked to a small number of people who live in the home to ascertain their views. We looked at minutes of various meetings such as residents, staff and relatives to form a view on the development of the service. We examined staff records, care records and a sample Care Homes for Older People Page 6 of 23 of health and safety records. We met with the Deputy Manager of the home as the Registered Manager was not on duty. We looked at the Annual Quality Assurance Assessments, this was completed by the Registered Manager in November 2009. This is a self assessment and sets out how the minimum standards are being met, improvements made and improvements planned. The AQAA gives basic statistical information on people who use the service and staff. We used some of this information to form our opinion of the service. Care Homes for Older People Page 7 of 23 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 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 23 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 23 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 are considering moving into the home have the information they need to help them make an informed choice. People have an assessment to ensure that the home is able to meet their care needs. Evidence: We received a copy of the Statement of Purpose. This document contains the information required in the National Minimum Standards for Older People. The information is clear and sets out the facilities available in the home, staffing arrangements, and key policies and procedures. We looked at the care records of two people who live at Brackenbridge House. An assessment of need is completed for people prior to moving in to Brackenbidge House. The home does not offer residential intermediate care. Care Homes for Older People Page 10 of 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plan describes peoples individual daily needs. The information on the care plan is very good. The home has recently introduced person centered care plans and these reflect a holistic picture of the person life. People have access to professional health care support and staff in the home help people to maintain good standards of personal care and health care. Medication policies and procedures are in place to promote the safe administration of medication. Evidence: We looked at the care records of two people who live at Brackenbridge House. These contained a care plan and risk assessments. A new care plan format has been introduced since the last key inspection. The plan contains information with regard to the persons daily needs incorporating physical and emotional care, cultural and spiritual needs and participation in organized activities that take place in the home. Included in the care plan is an assessment of the persons mental capacity and how this will affect the their ability to make judgments and decisions. In conjunction with this a Deprivation of Liberty care plan assessment had been completed, with Care Homes for Older People Page 11 of 23 Evidence: information on how capacity may affect some activities that people choose to do for example only, going out unaccompanied. Personal stories are being completed for people to go with their care plan information. One story was complete and the other was being completed with the person and their family. The personal story includes interesting information on people s life such as childhood memories, adult life and memories including employment, and life values, likes and dislikes. Records relating to health are kept to a good standard. We were able to see that people had been seen by health care professionals such as the General Practitioner, Dentist and Optician. The District Nurse is also involved in health care monitoring and treatment where required. The information pertaining to health on the care plan covers mobility, diet, weight and skin care tissue viability. A medication policy and procedure are available for staff guidance. Senior care staff are trained and designated to administer medication. The provision and administration of medication has changed since the last inspection. A monitored dosage system provided by a National Pharmacy has been introduced. This allows for a more accurate method of ordering, storing and administering medication. We looked at the storage area for medication and the records used for the administration of medication and found these to be in order. Care Homes for Older People Page 12 of 23 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. People have autonomy and choice with regard to the routines of daily living in the home. People are able to make decisions with regard to how they spend their day and regular activities are arranged for those who wish to join in. Varied meals are provided in a pleasant and spacious dining room. Evidence: The home welcomes visitors and the staff place an emphasis on ensuring good communication with family and friends. Activities and social events are organised at the home. A life and social history is taken for each person and this forms part of the care plan and helps staff to have a picture of peoples experiences. We were able to see an example of these on care plans. A separate recording is made of activities participated in daily, this is noted on the care plan. An activity Leader is responsible for making arrangements for leisure interests. Her Care Homes for Older People Page 13 of 23 Evidence: aim is to develop an individual plan for each person to include their preferences and interests. We were able to see a record of individual activities and a summary of peoples participation. We met with the activity leader who was giving one of the female residents a manicure. The Activity Leader explained that a small group of residents had put together a story to enter into a competition. She said that most of her work was done on a one to one basis with people. An activity programme for the week is available and this includes board games, quizzes, music and walks in the garden. Community groups such as junior school children give concerts and outings to the theatre and boat trips are arranged. We spoke with four people who use the service. People confirmed that activities are available but not all wished to join in group activities, one person liked to travel independently. People spoke in general about their life in the home and indicated that they were satisfied. One person is in daily contact with family living overseas via email and skype. Meals are prepared in the kitchen and two sittings take place in the dinning room which is pleasant and spacious, tables are laid for each meal. There is also a small kitchen on the first floor where people and their visitors may prepare drinks and snacks. The AQAA informs us that peoples dietary preferences are noted and these are recorded. People spoken with confirmed that they are satisfied with meals at the home. We received a copy of menu for four weeks. We noted an addition to the breakfast menu since the last inspection being honey and yogurt as well as a selection of cereals, toast and fresh or tinned fruit. There is a two choice dinner menu which is served at lunch time and this consists of mainly traditional British dishes. Supper is a snack meal such as soup and sandwiches, pasties, baked beans or egg on toast etc. Care Homes for Older People Page 14 of 23 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. Policies, procedures and guidance is in place for people who use the service and staff, with regard to complaints and safeguarding vulnerable adults. Evidence: A welcome pack is available for people new to the service this includes clear information on the complaints procedure and how complaints are investigated in house and externally. There is information on adult protection, types of abuse and the reporting of this. The training spreadsheet received indicated that all staff have training in the protection of vulnerable adults, and the majority had received training in abuse awareness. The organisation operates a system called Tell Us, this electronically records complaints coming in to the organsisation and can be viewed by senior managers. The AQAA informed us that the home had not received any complaints during the inspection year, since January 2009. This was verified when we looked at the records,we were able to see a selection of compliments that had come to the home during 2009. These came in the form of emails, cards in remembrance, and thank you cards. The comments were mainly from relatives and were positive and spoke kindly of staff. Care Homes for Older People Page 15 of 23 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 safe and well maintained environment. The premises is maintained and decorated to an excellent standard. Evidence: A tour of the building took place. We were able to see that all parts of the home are very well maintained, decorated and clean. The bathrooms were seen and found to be clean and equipped to meet the needs of people with impaired mobility. We were able to see that the bathrooms have been decorated and individualised providing a pleasant environment. Since the last inspection a number of improvements had been made these included the purchase of a new Hall Table, and a Coffee Table and Sideboard for the large lounge. Communal areas of the home have been decorated and soft furnishings purchased to complement the decor. We were able to see that the winter garden was well maintained and tidy. The kitchen had been inspected by London Borough of Hillingdon Environmental Health during 2009 and had received a four star rating. Care Homes for Older People Page 16 of 23 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. The staff team at Brackenbridge are able to meet the needs of people who live at Brackenbridge House. Recruitment procedures are in place to safeguard vulnerable adults and ensure suitable people are recruited as carers. Staff are trained to enable them to carry out their work with people competently. Evidence: The recruitment of staff is administered by the Human Resources Department. The Registered Manager is involved with selection and interviewing potential candidates. We were informed that no new employees had been recruited since the last inspection in January 2009. Therefore, we did not look at the recruitment files of new staff. There is a robust recruitment procedure in place. We looked at a training spreadsheet for care staff and catering and housekeeping staff. Some of the training care staff have received is safeguarding vulnerable adults, fire safety awareness,COSHH, and moving and handling. Some staff have also received training on dignity, and equality and diversity. The Annual Quality Assurance Assessment informs us that there are twenty six care Care Homes for Older People Page 17 of 23 Evidence: workers, this includes the senior staff team. Five care staff and a duty officer are on shift in the morning and four care staff and duty officer in the afternoon evening. There are two waking night staff and one member of staff is on sleep in duty. The AQAA informs us that twelve staff have completed Skills for Care Induction training and twenty four staff have a National Vocational Qualification. Care Homes for Older People Page 18 of 23 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 managed by an experienced and competent Registered Manager. There are policies and procedures in place for staff to follow with regard to health and safety and finances. Health and Safety is monitored and a safe well maintained environment is provided for people who use the service. Evidence: The Registered Manager has been in her position since March 2006 and has the Registered Managers Award and is an NVQ assessor. The Registered Manager has worked at Brackenbridge for twelve years and was formerly the Deputy Manager. The Registered Manager has reviewed the National Minimum Standards and information on how these are being complied with and improved on is in the Annual Quality Assurance Assessment document. Areas for improvement have also been identified. Care Homes for Older People Page 19 of 23 Evidence: A Quality Assurance and monitoring process is in place. The results of survey findings are published and displayed in the home. We looked at a selection of minutes from resident and relatives meetings and could see that people had been consulted on home matters in these forums. The management of the home are not responsible for peoples financial affairs, this is usually organised and monitored by family members. However, the home may manage small amounts of personal allowance for people for every day items. These transactions are recorded and receipts are kept. Health and safety policies are in place for the guidance of staff. The Statement of Purpose contains information on fire procedures and prevention. We looked a small number of health and safety records. We were able to see that the fire alarm system had been serviced in 2009 and the last fire drill had taken place on 24.9.09. Weekly fire alarm checks are recorded and carried out. The Annual Quality Assurance Assessment listed dates for equipment and maintenance. Care Homes for Older People Page 20 of 23 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 21 of 23 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 22 of 23 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 Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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