Care Home: Braemar Court

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What the care home does well The home ensures that all residents have an assessment prior to admission to the home and care plans and risk assessments are then written with the assistance of the resident and/or their relative or representative. A visit to the home is also encouraged where possible. Mealtimes are unhurried and all meals are home cooked with an alternative option being available for each mealtime. Staff are available in the dining room to assist the residents with their meals if required. There is an efficient complaints procedure in place and the home`s processes and staff training should protect the residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents and staff training is on going. The management and administration of the home is good, with evidence of consideration being given to the residents` and/or their relatives` opinion. Positive comments were written about the service and also told to the inspector on the day. One resident told the inspector `if you don`t feel well they will make you a cup of tea and make you feel better`. Another said `I am so lucky to be here everyone is so kind to me`. One resident wanted to say that he really enjoys the food and looks forwards to mealtimes. What has improved since the last inspection? Four requirements were made following the inspection in April 2007 and these have now been met. All staff have now received safeguarding adults training and had knowledge of these procedures. The manager did look at the night staff rota and risk assessments are in place for one carer to work at night during the quite period supported by a sleep in carer. All the cleaning chemicals stored in the laundry have now been locked away for the safety of the residents. Another designated smoking area has been found so that residents are not smoking outside of the laundry area. What the care home could do better: No requirements have been made as a result of this key inspection. CARE HOMES FOR OLDER PEOPLE Braemar Court Braemar Court 16 Sydney Road Guildford Surrey GU1 3LJ Lead Inspector Lesley Garrett Unannounced Inspection 11th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braemar Court Address Braemar Court 16 Sydney Road Guildford Surrey GU1 3LJ 01483 502828 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) mazinnakeeb@aol.com Dr Mazin Al-Nakeeb Mrs Hazel Al-Nakeeb, Mrs Susan Al-Nasrawi, Mr Zaid Al-Nasrawi Mrs Hazel Al-Nakeeb Care Home 23 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (23) of places Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE Of the 23 (twenty three) older people accommodated, 6 (Six) may suffer from dementia. 11th April 2007 Date of last inspection Brief Description of the Service: Braemar Court provides residential care for up to twenty-three (23) older people. It is situated in a residential area close to Guildford town centre. Part of the house has been extended including the addition of a conservatory to the rear. Accommodation is arranged over three floors that are accessible by stair lifts. Access to some bedrooms requires residents to be physically able to manage the stairs. The home has a large garden. Some parking is available to the rear of the house and restricted parking on the road. The fees for this service range from £500 to £600 per week. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Mrs L Garrett Regulation Inspector carried out the inspection and the registered manager/provider represented the service. For the purpose of the report the individuals using the service will be addressed as residents, individuals or people who use the service. The inspector arrived at the service at 09:30 and was in the home for four hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The Commission did not send questionaires to people associated with the service. The manager had some blank survey forms that she had saved from a previous inspection and distributed these to residents, relatives and other health care professional. These were available for the inspector on the day of the site visit. The use of an ‘expert by experience’ (who is a person who visits the service with the inspector to help the get a picture of what it is like in or use the service) was also not used as part of this inspection. The home had supplied the commission with a documented Annual Quality Assurance Assessement (AQAA) some detail of which has been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records and health and safety records. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Four requirements were made following the inspection in April 2007 and these have now been met. All staff have now received safeguarding adults training and had knowledge of these procedures. The manager did look at the night staff rota and risk assessments are in place for one carer to work at night during the quite period supported by a sleep in carer. All the cleaning chemicals stored in the laundry have now been locked away for the safety of the residents. Another designated smoking area has been found so that residents are not smoking outside of the laundry area. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People who use the service only move in following an assessment and feel confident the home can meet their needs. EVIDENCE: The registered manager stated that she carries out all pre-admission assessments prior to the residents moving into the home to ensure that their care needs can be met. Two individual folders were sampled which both contained completed assessments. It was observed that the assessments concentrated on the activities of daily living to establish the exact care needs of each individual. The manager stated that she never accepts any resident with high care needs or very advanced dementia as she recognises these care needs cannot be met at the home due to its layout. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 10 The manager also stated that some residents are able to visit the home and assessments will take place then and this also allows those individuals to see the available bedroom. The home does not provide intermediate care beds. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Health and personal care that residents receive is based on their individual needs. Respect, privacy and dignity are maintained at all times. EVIDENCE: Two individual plans of care were sampled. Following the last inspection it was observed that the records were all kept in different folders making it very difficult to assess one individuals plan of care. The manager has now compiled individual folders for each resident. Two care plans were sampled and these were found to be well documented and contained the medical and personal care needs for each resident. Suitable risk assessments are in place for all areas of the residents’ daily life in order to promote independence whilst ensuring personal safety and wellbeing. The manager stated that during the admission process biographies were also written by staff making the plans very personal to each resident. There was no Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 12 evidence of nutritional risk assessments in place. There was documentation in place to demonstrate that residents are weighed every month and the cook is aware of residents likes and dislikes for food. The manager telephoned the inspector the next day to say that she had now had the information required to enable staff to start completing nutritional assessments for all residents, this will not therefore be a requirement at the end of the report. The manager stated that the all the residents are registered with a general practitioner (GP) and that they use three local surgeries. It was also stated that the GP would visit whenever they are called and are a good support to the home. A completed survey from one GP said ‘the home provides excellent standards of care and attention to all its residents. The attention to detail is very impressive’. The home also has access to other health care professionals including the district nurse, opticians, dentist and chiropodist. All of these visits including the GP are documented in the individual plans of care. The home has all of their medications delivered from a local pharmacy and that they use the monitored dose system for dispensing. Medication administration charts sampled showed no gaps or errors. The manager stated that all staff that administer the medicines have had training. The manager stated that the privacy and dignity of service users is maintained at all times. All the rooms are large en-suite for single occupancy. Care is delivered in their own room or en-suite facility. The preferred name that service users wishes to be addressed by is documented in their notes. Staff were observed to knock on bedroom doors prior to entering. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Individuals who use the service are able to make choices about their lives and recreational activities meet their expectations. EVIDENCE: The atmosphere at the home was calm and quiet with some residents observed sitting in the lounge and some remaining in their bedroom. The manager stated that the home does not have an activities organiser but she does arrange for activities to take place and the programme of events was observed displayed in the reception. The activity arranged for that morning was indoor bowls. The comment cards returned from the residents all stated that the home provided suitable activities. The manger stated that the hairdresser visits every week and Communion is held once a month and other religious denominations can be catered for. Musical entertainers visit the home every two weeks, there are exercise classes every week and also a reminiscence session every week. The manager said that she consults with the residents following each activity that are Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 14 provided by visiting professional to ensure that they have enjoyed the session before they are booked again. Every year the home books a canal boat trip and the notice for this year’s trip was on the notice board. The manager said this gives them time to see if this is something they would like to take part in. Visitors are welcome to the home at any time and during the inspection relatives were seen to be in and out of the home. One relative said ‘the carers are brilliant we are lucky to have our relative here’. A survey form completed said ‘I fail to see how I could ever have found a more satisfactory home for my relative’. Personal choice is encouraged at the home and during a tour of the building it was observed that many bedrooms had been personalised. A member of staff stated ‘we give choice all the time to the residents. They can get up in the morning when they want and go to bed when they want. They are never forced to do anything they don’t want to do’. The home has a full time cook who works Monday to Friday and has her food hygiene certificate. The manager also stated that she had also gained a qualification in nutrition and at a recent environmental health inspection they had been awarded four stars. A further cook is employed to cover the weekends. There is a four weekly rotation of menus and they offered choice and demonstrated that fresh vegetables and fruit are available every day. The dining room was a pleasant environment with the tables covered in tablecloths and napkins available. Condiments were also on the table along with drinks. The residents that were spoken to confirmed that they enjoyed the food and that choice was always available. Staff stated that residents could also have a cooked breakfast if they would like. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People living at the home are protected by the homes complaints and safeguarding adults procedures. EVIDENCE: All residents and their representatives have a copy of the home’s complaint policy and the manager said that she had not received any complaints since the last inspection. The manager said that the home has a complaints log if it was required. The manager operates an open door policy so that any concerns are dealt with immediately before they reach the formal complaint stage. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. A requirement was made following the last inspection that all staff receive safeguarding adults training and this was completed in July 2007. The home also has the current local authority’s multi agency safeguarding procedures. Staff spoken to had knowledge of the procedures to follow in the event of witnessing any abusive behaviour and was also aware of the whistle blowing policy. The manager had the same training as the other members of staff but it is still recommended that she attend the local authority’s training to remind her of their procedures. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The design and layout of the home enables people to live in a safe wellmaintained and comfortable environment. EVIDENCE: The location and layout of the home remains suitable for its stated purpose. The manager stated that because the home is on many different levels they never admit anyone who would need a hoist. The home is well maintained and all areas of the home, including the garden are accessible to the residents. The AQAA states that the decoration programme for the home remains ongoing and the home was viewed as pleasantly decorated and providing a homely environment for residents. Since the last inspection some walls in the communal areas have been painted and Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 17 some furniture and carpets replaced. Residents spoken to confirmed they liked their room and were comfortable there. The communal space available includes a lounge, dining room and conservatory and on the day of the site visit all areas were being used. There is a shaft lift, which is accessed in the lounge, and also a stair lift. During the last inspection in April 2007 a requirement was made that the chemicals stored in the laundry must be placed in a locked cupboard and this has now been done. Staff confirmed that they had received training in infection control and that they all worked in the laundry on a rota basis. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are trained and skilled and in sufficient numbers to support the residents in the service. Recruitment practices in place protect the resident’s from harm. EVIDENCE: The home had a relaxed atmosphere and staff was observed to undertake their tasks in a quiet and orderly manner. The inspector observed staff interactions with residents all of which were professional and supportive. The staff in the home during the day were relaxed and calm with the residents. Comments received on the day and in surveys said ‘ I feel fortunate that my relative is so well cared for’. Another told the inspector ‘ the staff are really wonderful if you press your bell they come to you straight away to see what’s wrong’. The staffing levels of the home were evidenced and considered adequate to meet the current needs of the residents. The rota demonstrated that there is still one carer at night with a carer that sleeps on the premises. The manager stated that the sleep in carer always helps last thing at night when the residents are going to bed and is there in the morning when they are waking. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 19 A requirement was made following the last inspection that the management review the night rota to ensure that the home has adequate numbers on at all times. The manager stated that this had been completed with risk assessments and staff meetings. The home currently has seventeen residents and none are high dependency most of them fall within the low dependency category. The manager stated that numbers at night are increased if a resident is unwell or needs more support during the night. The manager stated that all staff receive induction prior to starting work. All staff at the home now have their national Vocational Qualification (NVQ) at level 2 and some now have level 3. Two recruitment folders were sampled which demonstrated that all documentation required was in place. A recommendation was made following the inspection in April 2007 that all folders should be organised to ensure that all the necessary documentation is in place and this has now been done. The manager stated that all training in the home takes place regularly including the mandatory training. Training includes manual handling, safeguarding adults, fire awareness and food hygiene. The manager also stated that specialist training has also taken place in dementia and six members of staff are receiving palliative care training so that the home can follow the national gold standards framework for palliative care. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is robust to ensure the safety and wellbeing of residents and they are consulted regarding the running of the home. Their health and financial interests are safeguarded. EVIDENCE: The manager is the co-owner with her husband but she has the day-to-day responsibility of running the home. The manager stated that she has her registered managers award and undertakes periodic training with her staff to ensure that she is also regularly updated. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 21 The manager stated the home has a quality assurance programme that seeks the views of the residents regularly. Survey forms are sent out and the responses are acted upon. The manager also stated that regular resident meetings are held and these are documented and the minutes were seen. The manager also stated that the opinions of the residents are acted upon. The home collected surveys from other healthcare professionals for this inspection and it is recommended that this practice be maintained. The managers stated that only one resident manages their own finances and they have a safe in their bedroom. The home provides a personal allowance account and all transactions are documented and individual records and all receipts are kept. Health and safety certificates were all in place and this was observed on the completed AQAA and also the certificates are kept in the home. The electrical certificate was noted to be dated 1999. The other provider was not in the home on the day of the inspection and the following day the manager telephoned the inspector to say that they believed the certificate was valid for ten years but that the manager has now organised for another check to take place as soon as possible. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations It is recommended that the registered manager attend the local authority’s safeguarding adults training. Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Braemar Court DS0000013574.V359180.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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