Care Home: Braemar Care Home

What the care home does well The home provides care in a well-maintained pleasant and welcoming environment by a well-managed supported, well-trained and qualified staff team who work in a manner that recognises residents need for personal privacy and dignity. Areas of particular note were outcome areas relating to health and personal care, daily life and social activities, the environment and staffing (especially training) all of which we assessed as excellent. What has improved since the last inspection? Not applicable as this is a new registration. What the care home could do better: Following this inspection no requirements were made and there were no areas of concern. However the production of the daily menu in a format or formats that all residents can understand would ensure residents were aware of the choices they had made with regard to food.. Key inspection report Care homes for older people Name: Address: Braemar Care Home Braemar RCH Ltd 24-25 Wimbledon Park Road Southsea Hampshire PO5 2PU     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: Peter McNeillie     Date: 2 6 0 1 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 28 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 28 Information about the care home Name of care home: Address: Braemar Care Home Braemar RCH Ltd 24-25 Wimbledon Park Road Southsea Hampshire PO5 2PU 02392811399 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Braemar RCH Ltd Name of registered manager (if applicable) Mrs M J Bungaroo Type of registration: Number of places registered: care home 26 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 who can be accommodated is: 26. The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Braemar is a privately owned and managed care home providing care, support and accommodation for up to twenty six persons some of who may have dementia. The home which is a converted three storey period building is located in a pleasant residential area in Southsea close to shops, community facilities, a beach and the centre of the city of Portsmouth with easy access to the M27 Care Homes for Older People Page 4 of 28 Over 65 0 26 26 0 Brief description of the care home motorway. Accommodation is available in twenty two single and four double bedrooms all with ensuite toilet facilities arranged over three storeys accessible by a lift. To the rear of the property there is an enclosed safe garden with seating which is fully accessible by residents. Car parking spaces can usually be found close to the property in Wimbledon Park Road and adjoining streets. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first report since the home was re registered in August 2009. The initial registration by the present owners was in 1989. The re registration resulted only in the legal status of the home changing to that of a limited company and made no difference to the ownership, day-to-day management and operation. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, the registration application, responses by the registered person at a pre registration interview, sampling residents, staff training and recruitment records. We talked with residents, staff, visiting relatives, health care professionals and management. Care Homes for Older People Page 6 of 28 we also received a response by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA). During this inspection which took place on 26/01/2010 between the hours of 9.15 am and 2.30 pm we were assisted by The Registered Manager, Registered Person and other members of care and support staff all of the key standards for older persons were inspected. The results and findings contained in this report will determine the frequency and type of future inspections. Care Homes for Older People Page 7 of 28 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 28 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 28 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. The home has a system of assessing and identifying residents needs which ensures these needs can be met safely. All needs are met within a risk management policy that requires residents and or their representatives are consulted whn decisions are made that affect them. Intermediate care is not provided therefore this standard does not apply. Evidence: The Registered Manager informed us that residents were only admitted in accordance with a pre admission policy and procedure that required a detailed written assessment of need and risk by a member of the homes management team being carried out in consultation with the potential resident or their representative. Care Homes for Older People Page 10 of 28 Evidence: This would involve the manager or a member of the homes management team visiting the prospective resident who are also are encouraged to initially visit the home to assist them in gauging whether it provides a suitable environment for them. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be taken into consideration when developing a care plan . To confirm compliance with the above and the National Minimum Standards for older persons we viewed the records chosen by us at random of three residents recently admitted. All records seen were very detailed, easy to understand, dated and signed by both the assessor and the resident. All took into consideration the needs, wishes, choices and aspirations of the potential resident as well as any present or potential risks. Evidence was also seen that confirmed that all assessments of need and risk are subject to regular reviews to ensure changing needs of residents continue to be met safely and care plans (Section 7-11 of this report refers) updated to reflect any changes. Respite care is not available in the home. Care Homes for Older People Page 11 of 28 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 home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures residents needs are met within a risk management policy that involves residents and or residents representatives in decisions that affect them. Evidence: As part of our inspection plan, we viewed a random sample of three residents care plans All of the detailed and well presented care plans which were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks. (The previous section of this report; standards 1-6 refers). Records seen also confirmed residents were consulted about the plan when it was developed. Some residents verbally confirmed this others told us they could not remember. Care Homes for Older People Page 12 of 28 Evidence: Staff who had a good understanding of the contents of the care plans and risk assessments were able to explain to us how the care plans were put into day-to-day practice. All of the residents spoken with confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management were treated with respect, that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. A number of visiting health care professionals and relatives were spoken with. All confirmed the home keeps them informed about individual residents, made them feel welcome and dealt with any queries or questions in an open frank and professional manner. All parties commented that the general atmosphere, professionalism and staff attitudes was excellent. The residents right, and the opportunity to take risks is seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how they were to be managed however in many instances due to their dementia a large number of the residents would have difficult in understanding the concept of risk. Any restrictions would be included in the care plan following consultation with the resident or their representative. Staff who had a good understanding of the contents of the care plans and risk assessments were able to explain to us how the care plan was put into day-to-day practice. Residents informed us were able to see the doctor of their choice or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses, physiotherapists, occupational therapists, other specialists had been consulted when required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. Care Homes for Older People Page 13 of 28 Evidence: All medication which is dispensed by a pharmacist is securely stored and administered in accordance with a medication policy and procedure by staff who have received training in the administration, recording and the security required when handling residents drugs and medication. During this process we noticed senior staff responsible for administering residents medication wore a tabard instructing that they should not be interupted or spoken to whist involved in handling residents medication. Those responsible to this simple but effective method of improving residents safety are to be congratualted on this excellent example of best practicce. All staff handling medication told us they were aware of and had read the procedure which also includes provision for those residents who wish subject to a risk assessment to retain responsibility for their own medication. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. The home takes issues of equality and diversity seriously. In their AQAA the manager told us: We provide training to staff to promote awareness and recognise negative impact and prejudices. We are fortunate to have a culturally and chronologically diverse staff team. We discuss issues of equality and diversity and challenge discriminatory practice. This is incorporated in our statement of purpose. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. Evidence: A varied and busy social activities programme organised by an activity organisers or external independent providers both in the home and community based were available. Residents expressed how important the activities were and how much they enjoyed them. All confirmed that participation was up to the individual and no one was forced to join in. We were told in the AQAA that a number of residents attend clubs, a day centre, go out to lunch with friends and relatives and attend church. Regular trios out organised by the home to theatres, or local places of interest are also available. In house activities on offer include, an outside entertainer, board games, bingo, crafts, quizzes etc. we were told that the programme is very flexible and would t be changed to meet the wishes and needs of residents. Care Homes for Older People Page 15 of 28 Evidence: The manager informed us that the local Alzheimers society who had also provided training for two of the homes activity organisers had been consulted and their advice sought to ensure that the needs of residents with dementia were also being addressed. The home has regular visits from local Church of England and Roman Catholic clergy who conduct services and communion in the home.The needs of members from any other faiths would be if required catered for but at the time of this visit no members from other faiths were residing in the home. Residents and the homes staff informed us visitors were welcome at any time.Visiting relatives told us they always felt welcome,were encouraged to visit at any time, were able to share a meal with their relatives and that there was excellent two way communication between them and the home. Through out the home there were photographs and photo collages of events that had taken place such as birthdays and Christmas etc. This also included a visit by The Deputy Lord Mayor of Portsmouth on the occasion of the homes 20th anniversary at which time she met with residents. staff and relatives We were told in the AQAA that during her speech she had commented about the good reputation Braemar had locally. The quality, quantity, presentation and choice of food including special diets served came in for particular praise from the residents. A written daily menu based on residents likes and dislikes was displayed. We highlighted the need to ensure that the menu was displayed in format that all residents would understand. This is of prime importance for persons with dementia who may find the addition of pictures would be beneficial to understanding the daily menu and when making choices. This has previously been recognised by the Registered Manager who showed us a selection of photographs that was being assembled to produce pictorial menus and to assist staff in helping residents make meaningful choices about the food they wished to eat. A verbal undertaking was given the pictures would be employed and displayed in the manner suggested as a matter of urgency. Care Homes for Older People Page 16 of 28 Evidence: We observed residents taking their mid day meal which residents informed us meals could be taken in their own rooms if they wished. The meal was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Tea and coffee making facilities were available to residents and visitors at all times. Care Homes for Older People Page 17 of 28 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. A complaints procedure with which residents had confidence was in place. The home has clear policies and procedures in place, which ensures residents, are protected from abuse. Evidence: A complaints procedure, which is also included in the service users guide included information on how to contact The Care Quality Commission (CQC), was available, as was a record of complaints. CQC have received no complaints about the service since registration. Residents, visitors and staff spoken with stated they felt comfortable in discussing any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly. A safeguarding policy and procedure designed to protect vulnerable residents from abuse developed in accordance guidance contained with the publication No Secrets and the Hampshire County Council procedure was available. Records viewed, management and staff spoken with confirmed all had received training in recognising abuse and demonstrated they knew the procedure to follow Care Homes for Older People Page 18 of 28 Evidence: should they witness or suspect the abuse of any resident. Care Homes for Older People Page 19 of 28 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. A safe, well maintained, comfortable, clean and suitably furnished home is provided for residents which meets their needs. Evidence: The home which is a converted three storey period building is located in a pleasant residential area in Southsea close to shops, community facilities, a beach and the centre of the city of Portsmouth with easy access to the M27 motorway. Accommodation is available in twenty two single and four double bedrooms all with ensuite toilet facilities. To the rear of the property there is an enclosed safe garden with seating which is fully accessible by residents. Car parking spaces can usually be found close to the property in Wimbledon Park Road and adjoining streets. We noted all areas of the home were very clean and free from unpleasant odours and obvious hazards. Residents who told us how satisfied they were with the accommodation and how much they liked their rooms, confirmed the home is always clean and smells fresh. Care Homes for Older People Page 20 of 28 Evidence: An infection control policy and procedure was in place as were disposal aprons, gloves, antiseptic hand soap. Those responsible for the high standard of cleanliness are to be commended. Staff informed us they undertaken and completed infection control training, and were aware of the services policies and procedures of hygiene issues and infection control. The decor and furniture which was of a very high standard was comfortable, homely and in an excellent state of repair, met residents individual and collective needs. The high standard was maintained through a rolling programme of decoration, maintenance and replacement that ensures the building continues to be a pleasant place to live and kept safe for residents and staff. Apart from personal mobility aids a number of communal aids had also been provided to assist residents, these included, lifts, hoists and grab rails. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: At the time of the inspection staff numbers and the deployment of staff was sufficient to meet the residents needs. This view was confirmed by residents who told us there was always staff available when they needed them. We were told by the registered manager that there is always a minimum of three care staff supported by a cook, two cleaners and the registered manager or joint proprietor available at all times during daytime. At night two waking staff plus telephone emergency back up staff are available. As part of this inspection, we viewed three staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust equal opportunities recruitment, and selection procedure, which is designed to protect residents. Care Homes for Older People Page 22 of 28 Evidence: This involves the completion of an application form, the signing of a rehabilitation of offenders declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment, records seen confirmed that all staff are subject to an in house induction and a training programme that include first aid, handling medication, food handling, moving and handling, dementia awareness and infection control. Following completion of their induction programme all staff are expected to undertake a National Vocational Qualification (N.V.Q.) training course. Information provided by the manager told us 81.25 of staff had been trained to at least NVQ level two, of these 43.75 trained toNVQ level three and 6.25 to NVQ level four. Those responsible for this excellent result are to be commended. Care Homes for Older People Page 23 of 28 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 management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents, whose views about living in the home are formally sought. Evidence: The registered manager who is also the joint proprietor of the home has experience of managing resources for older persons for many years. Apart from her experience the manager also holds a registered managers and NVQ level four qualifications in care. In talking with staff we were satisfied that the home has a clearly defined management structure and staff were aware of their responsibilities and the limits of their authority. They described the management as approachable, accessible and willing to listen to any ideas they may have for the improvement of the service. Care Homes for Older People Page 24 of 28 Evidence: As part of the homes quality monitoring system, residents, residents representatives and visiting health professionals and social care professionals are invited to participate in satisfaction surveys. The views expressed in these surveys are seen as key in highlighting areas that may require improvement or attention for the future development of this service. We were told by the Registered Manager no monies were being held on behalf of residents. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents, procedures to follow in the event of fire (including evacuation) . We were also informed that all of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade to ensure residents were protected from scalding. Care Homes for Older People Page 25 of 28 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 26 of 28 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 27 of 28 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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