Care Home: Brackenlea Care Home

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What the care home does well The staff are good at giving prospective residents the information they need to make an informed choice about this home. The manager is good at assessing whether the home can meet peoples needs before they move in. The residents told us that they like the staff who are kind and caring. The staff are good at recording peoples needs and then meeting those needs. They record the residents wishes and preferred routines and then they aim to meet those wishes when they offer care to the residents. The staff are good at helping the residents to maintain their independence and people are offered opportunities to continue their hobbies and interests. The residents said they like the food at the home and they are able to choose what they eat. The manager is good at making sure the staff are recruited properly and safely for the protection of the residents. The residents said they feel able to complain and that their complaints are dealt with appropriately. The management team at the home are able to manage the home in the residents best interests and they seek to make improvements based on what the residents tell them. What has improved since the last inspection? There were no requirements made at the last inspection but the manager has identified areas in which they wish to improve. These are recorded in the homes own assessment (The AQAA). What the care home could do better: We have required that the manager ensures there is an adequate laundry system so that people get the right clothes and that they are washed carefully to prevent damage. We have also required that the manager always makes an assessment of the residents ability to make their own decisions ( mental capacity assessment). This is so that the staff are able to protect people from harm but also allows the residents to make informed decisions when they are able to so. Key inspection report Care homes for older people Name: Address: Brackenlea Care Home Pearson Lane Shawford Winchester Hampshire SO21 2AG     The quality rating for this care home is:   two star good 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: Kima Sutherland-Dee     Date: 2 0 0 8 2 0 0 9 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 25 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 25 Information about the care home Name of care home: Address: Brackenlea Care Home Pearson Lane Shawford Winchester Hampshire SO21 2AG 01962713242 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shawford Healthcare Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 25 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Brackenlea is a care home providing personal care and accommodation for 25 older people including those who have dementia. The home is located in the village of Shawford three miles south of Winchester and is within walking distance of a mainline station, bus route and post office. All bedrooms are single; twelve of these have ensuite facilities. There is a lounge, a dining room and a conservatory. The home has an established garden and seating accessible to service users. Care Homes for Older People Page 4 of 25 Over 65 0 25 25 0 Brief description of the care home 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: We prepared for this inspection by reviewing the previous inspection report and any other information we had received about this home. The manager sent the AQAA when we asked for it and it was fully completed, we have used information from this assessment throughout the report. We carried out a site visit to the home on the 20th August 2009 and we spent 7 hours and 15 minutes at the home. During the site visit we spoke with seven residents and a visiting relative. We also spoke with the manager, the deputy manager, the head of care and the provider as well as a number of the staff. We also reviewed a sample of the homes documents and policies and we observed some of the interactions between the staff and the residents. Care Homes for Older People Page 6 of 25 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 7 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 8 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. This home gives people the information they need to make an informed choice. Residents needs are fully assessed to ensure that these needs can be met and people have an opportunity to visit the home. Evidence: New residents are given a service users guide which details the facilities and services at the home and the terms and conditions of the contract. This information is also offered to prospective residents or their families so they can make an informed choice about this home. Before people are offered a place the senior staff carry out a full assessment of their needs. This assessment includes information about their health, their needs and their preferences. The senior staff also use the assessments that are provided by social services or the hospital. The AQAA states that the home have improved the assessment process by including all of the care staff in discussing whether needs can be met at the home prior to Care Homes for Older People Page 9 of 25 Evidence: someone being offered a place. The staff said they had started to be included in the assessments and to meet people when they visited the home to look around. Care Homes for Older People Page 10 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. The residents benefit form a staff team that know them well and are able to meet their needs. The failures in the laundry systems affect the dignity of the residents. Evidence: A sample of four care plans showed that the staff had clear guidance about the needs of each resident and how those needs should be met. The plans recorded the health and welfare of each person and the involvement of any health care professionals such as G.Ps or district nurses. The staff had recorded regular health information such as a residents weight and skin condition to help people maintain their health. The manager stated that they found it difficult to always get a prompt response from the G.P when they requested a home visit and they were considering asking the residents whether they should change health centres. Each care plan had been reviewed monthly and the information was kept up to date and changed as needed. The care plans included risk assessments so that the staff could take action to minimise any risks. These included the risk of falls and of pressure sores developing. Care Homes for Older People Page 11 of 25 Evidence: The staff knew the residents well and they were able to give examples of how they had helped people to remain as independent as possible whilst minimizing the risks to each resident. The care plans included a new mental capacity assessment, this involved the staff assessing whether a person had the capacity to make decisions and whether they should be refered to the local authority for a more comprehensive assessment if the staff needed to restrict them in any way ( Deprivation Of Liberty). Three out of the four care plans seen included these but one had not been completed. The staff clearly knew each resident well and they were observed speaking to the residents in a kind and caring manner. One member of staff was chatting to people in the dining room during tea time and they demonstrated appropriate physical touch to guide people and encourage them to talk. Two residents said the staff were kind and that they did everything they could to make their lives at the home comfortable. Another resident said There are enough staff, they are busy but they come to help me when I need help. One visiting family member praised the staff and said they were kind and understanding. The staff have policies to follow regarding the safe administration of medication and the records showed that these are followed. The staff have been trained to administer medication and the records were completed correctly. A record of each residents medication was kept and medication was administered as it was prescribed. A recent complaint included concerns that clothing was not being returned and other peoples clothing was being used. When we spoke to one resident and a relative they also said that sometimes clothes are mixed up and they get others items of clothes. A relative said they had spoken to the staff about this before but it had not changed. The manager said that if they have young staff in the laundry, items can get incorrectly washed leading to clothes shrinking or whites not staying white. The laundry uses separate boxes for each resident and the staff have asked families to clearly label each item. Despite these measures mistakes are still being made. These failings affects the dignity of each resident. Care Homes for Older People Page 12 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. The residents benefit form a range of social and leisure opportunities. The home provides meals which the residents like. People are able to choose how they spend their time and their visitors are welcome. Evidence: The sample of four care plans showed that the staff have recorded each residents preferred routines such as when they like to get up and go to bed. These assessments included a personal history profile and each persons preferred activities. The home organises a range of activities that people can choose to participate in. Recent activities have included a garden party, sing along, a visiting PAT dog and afternoon tea in the garden. The residents said they were happy with the activities. The home employs an activities coordinator who works for two hours a day four days a week. People can continue their chosen religion and a communion takes place in the home every two weeks. The residents religions are recorded in their care plans as well as any other cultural or dietary needs. The staff also discussed peoples individual interests and they gave examples of how they had helped people to maintain their independence. One resident still enjoys dusting around the home and until recently another resident had laid the tables at lunch time. Care Homes for Older People Page 13 of 25 Evidence: The AQAA states that as well as organised activities staff spend time with people one to one, although this is not always recorded in the home. One member of staff was observed spending time in a residents room talking and listening to them when they spoke about their hobbies and their family. The member of staff was very encouraging and positive and they asked the person if they would be interested in sharing their interest with some of the other residents. People said they can choose what to do and how to spend their day. One person said they choose not to go out although there are occasionally opportunities to do so. There had been a recent incident at the home were the staff needed to complete a mental capacity assessment as they may have needed to restrict a resident for their own safety. Three other assessments had been completed but not for this resdident. The staff did seek an assessment of whether they should restrict the liberty of one resident but this was not done until after the incident occurred. The manager agreed that the assessment should have been completed although they said that they had sought advice but had not received the support from other agencies that they had expected. The residents said they liked the food at the home. they said that normally a menu board was filled in but this was blank on the day of the inspection. There was a new cook on duty who was getting to know what the residents liked or disliked and they were guided by the staff who knew people well. The staff said that although they give people choices of food in the morning they need to remind people again before meal times and alternatives are always available if people change their minds. The staff said they offer people more food and there are snacks available through the day, as well as fruit. Care Homes for Older People Page 14 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. The management of the home have the procedures in place to deal appropriately with complaints and safeguarding referrals for the protection of the residents. The residents have the information they need to make a complaint. Evidence: The home has a complaints policy and this was displayed in the hallway. Two residents and one relative said they knew how to complain and they would speak to the manager. The staff said they knew how to respond to complaints and how to report any concerns to the senior staff. The manager kept detailed records of any complaints and this record had four complaints between January and August 2009. These complaints had been managed appropriately and letters had been written to any complainant explaining any findings and any action that would be taken as a result. The commission had received a copy of one of these complaints and they had written to the complainant explaining that it is the responsibility of the provider to deal with their concerns. The provider had demonstrated that they had responded to this person. The manager was also able to explain how the complaint had come about and what action the staff had taken at the time. The senior staff are following their own complaints procedures. The AQAA states that Policies and procedures for Safeguarding Adults are available and staff are trained in the subject as part of their induction and ongoing training Care Homes for Older People Page 15 of 25 Evidence: programme, and are aware of how to respond should such a situation arise. The homes procedure is up to date and the staff know where this is kept. The four staff training records seen demonstrated that three staff have had recent training in safeguarding vulnerable adults. The manager has also attended training in safeguarding. The manager and two other senior staff also attended training on the mental capacity act and the deprivation of liberty in June 2009. Three out of the four care plans seen included a mental capacity assessment which relates to whether people are able to make their own informed decisions. One assessments had not been completed. There had been a recent incident at the home were a mental capacity assessment should have been completed. The staff did seek an assessment by the appropriate agency on whether they should restrict the liberty of one resident for their safety but this was not done until after the incident occurred. The manager did have the information they needed in a previous assessment. Care Homes for Older People Page 16 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. The home is suitable for the needs of the residents and well maintained. Evidence: The home is suitable for the current residents and it is well maintained and comfortably decorated and furnished. The residents said they liked their home and that their rooms were comfortable. The home has the necessary equipment to meet peoples needs including specialist baths and ramps. The staff have been trained in infection control and this was documented in the training records. The staff were seen wearing gloves and aprons whilst providing personal care to prevent the spread of infection. The kitchen staff also wear gloves when they handle food. The home has a schedule of improving the environment and staff are employed for maintenance and cleaning. Care Homes for Older People Page 17 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. The residents benefit form a safely recruited and well trained staff team. There are enough staff to meet the residents needs and they are well supported by the managers of the home. Evidence: Three residents said that although the staff could be busy they always helped them when needed. The residents also said that they liked the staff and they were kind and patient. The staff said that were enough people on duty each day to meet the residents needs. The staff duty rota showed that there were four carers and the manager on duty in the morning as well as a cook and a cleaner. In the afternoon there were three carers but another member of staff comes in at busier times around tea time. The staff knew the needs of each resident and they gave examples of how they met those needs. These included physical and health care needs and also social needs and helping the residents to carry on with their chosen routines and interests. The home employs a part time activities co ordinator who is responsible for making sure that as well as group activities people have individual time to do their hobbies or just to talk. A sample of three staff files demonstrated that the manager uses robust recruitment Care Homes for Older People Page 18 of 25 Evidence: procedures for the protection of the residents. Each file contained the correct checks through the criminal records bureau and the protection of vulnerable adults. The staff files included a full application form that recorded peoples previous employment and two written references. A new member of staff was completing their induction training and they had worked with more senior staff. They said that they had received support from the staff team so they could get to lnow their role and responsibilities. The staff records had a list of the induction training that had been completed and any training courses this staff member had attended. The staff have a range of training opportunities that enable them to increase their knowledge and skills. The training records demonstrated that the staff have recently attended the following courses, Fire safety, manual handling, infection control, games and activities and health and safety. The management of the home are committed to supporting the staff to complete their National Vocational Qualifications (N.V.Q) in care. All of the eighteen staff either have or are working towards these qualifications. This exceeds the expected standard. Care Homes for Older People Page 19 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 is effectively managed in the interests of the residents. The manager seeks the views of the residents to improve the service. Evidence: The registered manager is qualified and experienced to manage the home and the staff team. The manager is supported by a clear senior management structure and they are can consult other team members for advice at any time. The manager has kept up to date with regular training and they recently attended courses in the deprivation of liberty, and fire safety. The manager wrote in the AQAA that they have an open approach which encourages residents, their families and the staff to speak to them at any time. Two residents and a member of staff confirmed that the manager is approachable and supportive. The residents do have opportunities to air their views and two people confirmed that the home holds residents meetings. The manager also seeks peoples views by Care Homes for Older People Page 20 of 25 Evidence: distributing surveys. The results for the survey in May 2009 had been reviewed and changes had been made as a result to improve the service. The senior managers visit the home regularly and they complete reports about these visits. A record of the visits between January and June 2009 was kept in the home. They also carry out twice yearly audits of the service and these inform them of any improvements that could be made. The manager supports the staff team and the staff have the opportunity to regularly meet the senior staff to discuss their roles and the standards of their work. The staff said they felt well supported by the manager and they could go and seek advice or ask questions. The manager and the senior staff ensure that the home is managed safely by completing all the checks on the equipment and making sure the home is fully insured. A recent small fire at the home was dealt with quickly and efficiently and the home staff were praised by the fire service. The home maintains all the fire records and these were up to date. A recent environmental health inspection required the home to keep regular records of the fridge and freezer temperatures and these had been started. These records showed that the checks were being completed regularly and that the staff had been instructed to complete these for the safety of the residents. The manager keeps a record of any accidents or incidents in the home and they inform the correct authorities of any incidents. The staff record an defects in the home and maintenance is arranged and there is an ongoing programme of redecoration and improvement. Care Homes for Older People Page 21 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 22 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 1 10 16 The registered person must provide suitable facilities and services to the service users. This includes arranging suitable laundering of clothes and keeping the residents clothes separate. 30/09/2009 To enable the residents to feel dignified and valued the staff must make sure that the laundry is suitable and adequately managed. 2 14 12 The registered person must 30/09/2009 ensure the home is conducted so as to make proper provision for the care and welfare of service users. The manager must complete assessments of the residents ability to make informed decisions. Where there is a need to restrict a resident Care Homes for Older People Page 23 of 25 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 for their safety or benefit a deprivation of liberty assessment must be sought. 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 24 of 25 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. 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