Care Home: Braemar Lodge Residential Home

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well Braemar Lodge is a small care home that has a relaxed and caring atmosphere. One relative said, “The residents feel at home. My relative says that they are quite happy and contented.” Someone living at the home said, “There is nothing I can think of for them to do better that would improve things for me.” People living at the home benefit from being cared for by a stable staff team, many of who have worked there for a number of years. The manager is experienced, has a very hands on approach and is always available to residents, their families and staff. People living at Braemar Lodge and their families said that they like the staff at the home and find that they are kind and friendly. Before moving into the home people are encouraged to visit, and staff from the home will assess their needs to make sure that Braemar Lodge will be suitable for them. Visitors are always made welcome and people appreciate the staffs’ openness and helpfulness. People’s views are important to staff and management, and the home has a clear complaints procedure in place. What has improved since the last inspection? Since the previous inspection management at the home have worked hard at addressing the issues raised at that time. Some improvements have been made to the premises that have made life better for residents. A new shower area has been installed. A new boiler system has ensured the proper supply of hot water at all times. Care planning at the home has continued to develop and now provides a more person centred approach that reflects people’s individual needs and wishes. In general there is a sense that staff have a greater awareness of the importance of individuality. There has been a move away from institutionalised practices such as communal toiletries that we found at the previous inspection. The manager is very keen to provide staff with as much training as possible. They have made some progress in the last year in updating staff knowledge in core areas. Some staff are now undertaking good training in dementia care. The manager and another member of staff have already undertaken this course. Their increased understanding is already having benefits for people living at the home. Signage has been developed and there is a greater understanding of people’s complex needs.Braemar Lodge Residential HomeDS0000059881.V378741.R01.S.docVersion 5.2A new cook has been employed. New menus have been developed and when implemented should provide people with a greater variety and choice. A cleaner has been employed for a few hours each week. This has improved the cleanliness of the home. The manager has also ensured that proper hand washing facilities are in place in toilets and bathrooms to improve infection control. What the care home could do better: People living at the home and their families are very happy with the care and support offered at Braemar Lodge, and generally this is managed well. However this inspection did highlight a potentially serious shortfall in the management of a person’s healthcare and in the management of safeguarding. Management need to address these shortfalls and ensure that robust systems are in place to monitor practice and documentation. Although the manager has worked hard to improve training levels at the home. There are still many gaps in staff being kept up to date in essential areas, and in their all being trained in dementia care for which the home is registered. This needs continued work so that people are cared for by knowledgeable staff who can deliver good care based on current best practice models. Staffing levels at the home are variable and may not always provide adequate cover to ensure that people receive the care and support they need at all times. We have asked the provider to review this and provide us with their findings. Key inspection report CARE HOMES FOR OLDER PEOPLE Braemar Lodge Residential Home 481 Victoria Avenue Southend On Sea Essex SS2 6NL Lead Inspector Ms Vicky Dutton Key Unannounced Inspection 10th December 2009 08:30 DS0000059881.V378741.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.2 Page 2 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 Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braemar Lodge Residential Home Address 481 Victoria Avenue Southend On Sea Essex SS2 6NL 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) 01702 339728 Mrs Saima Munir Raja Kirsti Linden Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12) of places Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2009 Brief Description of the Service: Braemar Lodge is registered to provide care and accommodation for twelve older people. Braemar Lodge is also registered to provide care for people who have dementia. The home currently offers day care services for up to six people from Monday to Friday. The premises provide homely and comfortable living areas. There is a choice of communal areas including lounge, dining room and conservatories. The accommodation for residents is provided over two floors and consists of six single and three shared rooms. Access to the first floor is via a passenger lift. The second floor is for staff use only. There is a pleasant and secure garden and some off road parking. Braemar Lodge is in keeping with houses in the vicinity. It is situated in close proximity to Priory Park and is close to local community facilities and services. The home has a Statement of Purpose and Service User Guide available that provide up to date information about the home. The last inspection report was available to people in the entrance area of the home and referred to in the Service Users Guide. The Service Users Guide dated May 2009 stated that fees range from £380:00 to £450.00 a week. There are additional charges for hairdressing, chiropodist, taxis, toiletries and newspapers. There is a flat rate charge of £45.00 per day for day care services. Braemar Lodge Residential Home DS0000059881.V378741.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. This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent nearly eight hours at Braemar Lodge. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to three visitors during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Braemar Lodge was basically completed by the manager. It gave us the information that we asked for, and helped us in our assessment of the home. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from two residents, five relatives, one visiting professionals and five staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.2 Page 6 What the service does well: Braemar Lodge is a small care home that has a relaxed and caring atmosphere. One relative said, “The residents feel at home. My relative says that they are quite happy and contented.” Someone living at the home said, “There is nothing I can think of for them to do better that would improve things for me.” People living at the home benefit from being cared for by a stable staff team, many of who have worked there for a number of years. The manager is experienced, has a very hands on approach and is always available to residents, their families and staff. People living at Braemar Lodge and their families said that they like the staff at the home and find that they are kind and friendly. Before moving into the home people are encouraged to visit, and staff from the home will assess their needs to make sure that Braemar Lodge will be suitable for them. Visitors are always made welcome and people appreciate the staffs’ openness and helpfulness. People’s views are important to staff and management, and the home has a clear complaints procedure in place. What has improved since the last inspection? Since the previous inspection management at the home have worked hard at addressing the issues raised at that time. Some improvements have been made to the premises that have made life better for residents. A new shower area has been installed. A new boiler system has ensured the proper supply of hot water at all times. Care planning at the home has continued to develop and now provides a more person centred approach that reflects people’s individual needs and wishes. In general there is a sense that staff have a greater awareness of the importance of individuality. There has been a move away from institutionalised practices such as communal toiletries that we found at the previous inspection. The manager is very keen to provide staff with as much training as possible. They have made some progress in the last year in updating staff knowledge in core areas. Some staff are now undertaking good training in dementia care. The manager and another member of staff have already undertaken this course. Their increased understanding is already having benefits for people living at the home. Signage has been developed and there is a greater understanding of people’s complex needs. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.2 Page 7 A new cook has been employed. New menus have been developed and when implemented should provide people with a greater variety and choice. A cleaner has been employed for a few hours each week. This has improved the cleanliness of the home. The manager has also ensured that proper hand washing facilities are in place in toilets and bathrooms to improve infection control. 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. Braemar Lodge Residential Home DS0000059881.V378741.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 Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. (Standard 6 not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Braemar Lodge can feel confident that staff will try to ensure that the home is suitable to meet their needs. EVIDENCE: We saw that the home had both a Statement of Purpose and a Service Users Guide in place. Both had been updated in May 2009. Although the Service Users Guide contains some inaccuracies such as the home being ‘specially designed’ and, ‘no changes have occurred with staffing’ it generally provides good and useful information for people. We saw that copies of the Service Users Guide were available in people’s bedrooms so that they could be referred to. The manager said that when people are considering moving into Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 10 the home they are only given verbal information and are not given a copy of the Service Users Guide. This should happen so that people have access to good information that they can view at their leisure to assist their decision making process in choosing a home. Some people living at Braemar Lodge had become familiar with the home before moving in, as they had been there using the day care service. Previous inspections had shown us that staff from the home always assessed people’s needs before they moved in to make sure that the home would be suitable for them, and staff able to meet their needs. To see if good standards are being maintained we looked at the files of two people who had most recently moved into Braemar Lodge. We found that good pre-admission assessments had been undertaken. Information was also available from Social Services about people’s needs. Management do however need to review the assessment format in use to ensure that it covers all the appropriate areas as identified in the current standards. For example the current format did not include reference to people’s potential foot care needs or their history of, and potential for being at risk of falls. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 7, 8, 9, 10. People living at Braemar Lodge will receive care that seeks to recognise and meet their individual needs and preferences. EVIDENCE: We received wholly positive feedback about the care and support offered to people at Braemar Lodge. People living in the home told us, “I have no complaints about the care” and, “I always have the help I need, the staff are very good.” Relatives said: “The standard of care is excellent,” “They take excellent care of service users. They tend to care for individual needs exceptionally well. Even when I have seen them extremely busy they seem to have an eye for individual care, detail and compassion,” and, “The service and care they give my [relative] is very good. Their needs are always met. They always look lovely and clean and their clothes always match.” A relative spoken with felt that things in the home had improved recently, and was very Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 12 happy with the care their relative was receiving. A visiting professional felt the same and said, “Well done Braemar, you have put in a lot of work to ensure that service user’s needs are being met.” We saw a number of thank you cards where relatives praised the care and support offered by the service. Our observations of care during the day showed that people received appropriate care and support. Staff were attentive and residents appeared well groomed and appropriately dressed. On surveys all five staff who completed these said that they were ‘always’ given up to date information about the needs of the people that they support. They felt that ways of sharing information worked well. Staff spoken with and observed demonstrated that they had an understanding of individual resident’s needs. We looked at a number of care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how they are helped to meet them in an individual way. Since the previous inspection care planning has been reviewed and those in place now provide an individual and person centred approach. We saw that care plans in place provided sufficient information for staff to enable them to offer individual support. Care plans detailed the individual support needed relating to different aspects of care such as mobility, personal care, continence, nutrition, social activity and sleep. We saw that where possible care plans had been agreed with residents or their relatives. Care plans are kept under regular review to identify any changes in people’s needs. Risk assessments were in place relating to appropriate areas of care such as moving and handling. Daily care records are maintained. These were generally good but sometimes lacked a person centred approach through staff referring to having carried out aspects of care through a number system. Areas where care planning could be improved were discussed with the manager. For example one person had bed rails in use on their bed. An occupational therapist had done the assessment but the ‘sleep’ care plan made no mention of the use of bed rails or how staff were to use these safely. Other items will be referred to in subsequent sections of this report. Records showed that people access appropriate health care to meet their needs. We saw that a range of different professionals such as doctors, district nurses, opticians, dentists, chiropodists and specialists are involved in ensuring people keep as well as possible. On surveys both people said that they always received the medical care that they needed. Relatives felt that they were kept informed of any concerns. Assessments were in place in relation to people’s heath care needs such as nutrition, falls and risk of developing pressure sores. Nutrition records are maintained and people’s weight is mostly monitored so that any potential issues might be identified. At the moment the home only has stand on scales, so that frailer people cannot be monitored in this way. The manager said that this is in hand, and hopes that sit on scales are soon to be provided. Since the previous inspection some staff have undertaken relevant training such as Bone Health and Falls Prevention, Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 13 Pressure Area Care, and Catheter Care. This will help to improve their knowledge and skills in caring for people. Although people receive good health care support we did have concerns about the management of one person’s diabetes. Care staff are undertaking regular blood sugar monitoring. They had not had proper training to do this. The manager said that they had undertaken training and shown the staff what to do. There was no protocol in place to show that the district nursing team or diabetic care team retained responsibility for this task and monitored staff competence. There was no indication that the person had given consent for staff at the home to carry out this invasive procedure. Although very good information about hypoglycaemia was available, there was no care plan in place relating to staff undertaking glucose monitoring, or of what to do with the information. A letter from the diabetic nurse requested that the person’s glucose be monitored once a day before meals. The times recorded did not equate to this. On occasions very high levels had been recorded but it was not clear that any actions had been taken about this. The manager said that they discussed readings with the diabetic nurse. Following discussion the manager undertook to review current procedures. As part of this inspection we looked at how people’s medication is managed. Medication at the home is generally well managed but some areas were practice could be improved were discussed with the manager. Handwritten entries on medication administration record sheets had not been countersigned to show that the details recorded were correct. Some medication had not been properly booked in to provide a good audit trail. Management also need to monitor the use of creams. In one person’s room we found cream dated November 2005 that had been prescribed for another named resident. Staff training records showed that staff had undertaken training in administering medicines, but there is no system in place to monitor staff competence on an ongoing basis. The manager said that they were about to take a more advanced course in the management of medicines. It was advised that the Royal Pharmaceutical Society guidelines on managing medicines in a social care setting be obtained and these provide comprehensive and clear information for staff. During the day staff treated residents with kindness and respect. Doors were kept shut when personal care was being undertaken. Concerns raised with us earlier in the year, and investigated by social services, indicated that people’s dignity was not always promoted in the management of continence, or in the way that their clothing is managed. The manager has worked hard to address this. Some staff have undertaken ‘Decency and Dignity in Care’ training. The manager said that more staff will undertake this training as more places become available. One member of staff said, “The home is always promoting to look at the person first, respect their privacy, independence and diversity.” At this inspection we saw that the use of such things as bubble bath and shaving foam on a communal basis as noted at the previous inspection seems to have stopped. We saw that people had their own named toiletries in their Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 14 rooms. People’s individuality could be further supported by offering them choices in this area rather than all the same ‘smart price’ type brands. At the site visit we raised with the manager that where people use incontinence pads these should be stored in a way that protects people’s dignity. On many occasions, including in shared rooms, these were on full display. A new member of staff, who is also new to the care sector, referred to people who need assistance to eat as ‘feeders.’ This is a term that they must have picked up in the home, and which does not support people’s dignity. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 12, 13, 14, 15 People have some opportunities to enjoy a fulfilling lifestyle, and enjoy wholesome home cooked food. EVIDENCE: More able people spoken with in one lounge area, where they mix and chat with people attending the home for day care, seemed generally happy with level of activity. One person said, “The staff try to make it a happy day for everyone.” A relative said, “They have fun afternoons where the staff play games with the residents getting everyone involved in having fun.” A second lounge area is used more to accommodate people who are frailer and have more advanced dementia. We saw that staff still offered them choices about what music or television they wanted on, what drinks they wanted, assisted them to select their own biscuits and so on. Staff were attentive and spent one to one time with people. One member of staff said, “There is a good atmosphere in the home and always activities going on. Always happy and friendly with service users and staff.” Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 16 At the moment a member of staff is designated to provide activities for two hours on four afternoons each week. At other times the manager said that staff provide activity and occupation. People’s preferences with regard to activity and occupation are recorded to a degree in care planning, but this could perhaps be more detailed particularly for those with dementia. For example in the office we came across a photograph album belonging to a resident. The family had put this together to provide the resident with enjoyment reminiscence and stimulation. The person’s social activity care plan said ‘X is not able to participate in the usual daily activities due to their illness, but staff to encourage X to listen to music as they seem to enjoy this. Staff to have one to one dialogue with X whenever possible.’ Thus a potentially valuable point of contact and pleasure for the person could be missed, with staff being unaware of the resource available. The manager and one member of staff have just completed an in depth training course in dementia care. Five other staff are currently working on this course. The manager hopes that the knowledge gained will be put to good use in providing a more stimulating environment for people with dementia. In discussion they recognised that more equipment and items to provide interest would assist this process. The AQAA said that the home could improve by, ‘Purchasing more items to provide activities such as music CD’s, reminiscence books, and more staff training for activities.’ Staff were respectful of peoples wishes and residents were able to go where they wished in the home. Daily living preferences such as rising and retiring times were recorded in care plans. If people had any specific requirements to meet their spiritual needs this was also recorded. Details of advocacy services were available to assist people in finding independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. People are able to welcome visitors at any time. Relatives came and went during the day to visit or take their relatives out. Those spoken with said that they were always made welcome. People spoken with were happy with the food provided. They said that the food was tasty and plentiful. One relative said that they were not sure about the quality of the food provided. They said, “Not always convinced there is a good diet. One day lots of baked beans no peas or fresh vegetables. Meal was flan, potato croquettes and baked beans.” But another said, “The home provides very good, healthy big portion meals for the service users which I believe is very important.” We saw that since the previous inspection fresh fruit and vegetables are now more available and in everyday use. A new chef is in post. They are experienced and keen for people to enjoy good home cooked food. The home currently works out menus on a fairly ad hoc basis. Although people will always be offered an alternative if they do not like what is on offer, there is not a specific daily choice of meal available. People all tend to have the same. We saw that a new four weekly menu plan had been Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 17 compiled. The new menus showed that a greater variety of foods were to be offered, and that a choice of meals would be also offered. The manager said that they plan to implement the new menus at the beginning of the year. A cook is employed each day but only work until early afternoon. One of the two care staff on duty therefore prepare the tea time meal. Although hot choices such as scrambled eggs or beans on toast are sometimes offered, tea time frequently consists of sandwiches. The home should consult with residents to ensure that this meets their preferences. We discussed the presentation of food as we saw at lunchtime that plates were served fully plated up with a lot of gravy. Many residents would be able to serve themselves with things like gravy. This would support their choice and independence. We saw that where people needed help to eat, this was done in a caring and sensitive manner. There were plenty of drinks of offer throughout the day. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 16, 18. People will be cared for safely by staff who have good skills, but who may not always put their knowledge of safeguarding into practice. EVIDENCE: There was a clear complaints process in place that was on display for people and available as part of the Service Users Guide. On surveys people said that they knew who to talk to if they were not happy with anything and knew how to make a complaint. Since the previous inspection no complaints have been recorded by the home. We saw that there were up to date local authority guidelines, and local procedures available to give staff understanding and guide their practice in relation to safeguarding. A flowchart was available showing actions to be taken in the event of an incident. According to training records although most staff have undertaken recent training, five staff involved in care at the home have yet to undertake training in safeguarding vulnerable adults. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 19 The home does need to monitor its practice in order to ensure that people are fully safeguarded. We saw that one person had a recent bruise on their upper arm noted on their body chart. There was no reference to this in their daily notes. There was no indication that management had tried to ascertain how the bruise had occurred, and if any actions or reporting were necessary. Since the previous inspection one safeguarding alert has been raised in relation to Braemar Lodge. The concerns raised were investigated by Social Services. The manager has worked hard to address the practice issues in relation to people’s care and dignity that the alert and investigation raised. Although not currently a particular issue in the home, care plans viewed showed that where people’s behaviour may be difficult this is identified and advice given to staff. Neither the manager or staff have undertaken any specific training in managing challenging behaviour; the manager said that the dementia training had assisted understanding. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 19, 20, 21, 26. People live in a homely and pleasant home. EVIDENCE: Braemar Lodge generally provides a comfortable and homely place for people to live. There is a pleasant garden for people to enjoy. Since the previous inspection management have worked to improve the environment. Visitors spoken with liked the home and thought that good progress had been made in improving the environment. Relatives said, “I like the new improvements the home has done to the decoration and furniture arrangements,” and, “A friendly home from home environment.” Works need to continue so that the home reaches and maintains a good standard throughout. Since the previous inspection flooring has been replaced in some Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 21 areas, some bedding and curtains have been replaced and some areas redecorated. Most importantly the home’s hot water supply has been improved so that people can enjoy regular baths and showers. Signage has been developed to assist people who have dementia. Although improvements have been made the building needs to be better monitored to ensure that general issues are picked up and dealt with. For example we found that some taps in people’s rooms were not working properly. The mixer tap of the sink in the new shower area was not regulated and was running very hot which could create a potential hazard to people. Curtains in a conservatory area were not hung properly. A new shower area has been developed on the ground floor. The home now provides three shower areas and an assisted bath. Although inadequate storage facilities remain an issue, at this visit things were tidier and better organised. Since the previous inspection a cleaner has been employed. They work at the home for six hours each week. (Normally 10.00 to 13:00 on Saturdays and Sundays.) At other times night staff and day care staff undertake cleaning tasks. The employment of a cleaner has improved the general cleanliness of the home. Odour control was generally good when we visited, although one relative said, “Not always good smells.” Although night staff have cleaning tasks identified that they must carry out and sign for, further development would be beneficial to make sure that there is rotational approach to ensuring that all areas are cleaned regularly and deep cleaned on a regular basis. For example the laundry area of the home was not clean and well presented. The home’s laundry area is accessed externally and is suitable to meet the needs of the home. Training records showed us that most staff have undertaken training in infection control. We saw that infection control information was available to staff to guide their practice. Since the previous inspection improved hand washing facilities have been provided in bathrooms, toilets and the home’s laundry area. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 27, 28, 29, 30 People who live at Braemar Lodge will be supported by caring staff, but may find that the home does not always provide sufficient staff to meet their needs. EVIDENCE: We had positive feedback about staff working in the home. People said, “I don’t have a bad thing to say about any of them,” “All in all I think they are doing a very good job,” “Staff are busy and happy,” and, “The staff are always very helpful and do the best they can for all the residents.” People living at Braemar Lodge benefit from having a stable staff team. Staff turnover is low and agency staff are not used. One visitor spoken with thought that this was a real strength of Braemar. They said, “The best thing about here is the stable staff team. They all know the residents and each other well and create a family feel.” Staff were positive about their role. One said, “We work as a team. Training is always offered and there is a good atmosphere in the home.” The manager felt that staffing levels at the home were adequate and suitable to meet people’s needs. Five staff on surveys felt that there were ‘always’ enough staff to meet the individual needs of people using the service. There is Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 23 a basic level of two care staff provided, one of whom will be a senior. The manager is additional to this during the day on four days each week. The provider is also on the rota as working from 09:00 to 13:00 on four days each week but is mainly involved in office based tasks. An activities person (Who is also the cook) works for two hours on four afternoons each week. A cook is provided in the mornings, and a cleaner at weekends. During the week up to six extra people are accommodated during the day. During the evenings two staff are available, and at night there is one awake and one sleeping in member of staff. During the weekends there is only a senior and one member of care staff on duty during the day and evening. The manager said that three people need the assistance of two staff with daily living tasks. The AQAA indicated that eight people need help with dressing/undressing washing and bathing and that five people need help to eat or prompting with their meals. It was stated that twelve people have dementia. Staff also have to carry out cleaning, catering and laundry tasks. Since the laundry area is accessed externally there could be occasions when only one member of staff is available in the building. Some staff also regularly work a double shift and therefore have an hours break in the middle of the day. Although they do not leave the building, this still only leaves one carer officially available to residents. On the day of the site visit staff were attentive, and fairly available to residents. Although people attending for day care received no specific additional service, they seemed happy chatting and amusing themselves during the morning. The manager said that normally staff would be providing some occupation. Our main concerns are around staffing levels during evenings and weekends when only two care staff are available. Staffing levels provided are not based on any form assessment tool to assess people’s dependency levels/staffing levels required. Management therefore risk people not being supported in the way that they need by having the correct number of staff always on duty. During weekdays the needs of people attending the home for day care also need to be factored in. These issues were raised at the previous inspection. One relative said “Possibly more staff would help. If 13 residents needed one to one attention obviously some would be waiting for an unacceptable time.” To ensure that people are looked after by a skilled and well trained workforce current standards recommend that at least 50 of the home’s care staff hold a National Vocational Qualification (NVQ) in care at level two or above. At Braemar Lodge out of ten care staff, three have an NVQ and a further two have started to work towards this. The domestic person employed also holds an NVQ in care. To see how well people are protected by the home’s recruitment procedures we looked at the files of the two most recently recruited staff. We saw that a good process had been followed, and appropriate checks such a references, identification, and POVA first checks had been carried out. Criminal Records Bureau checks were not in place before people had started work. The manager Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 24 was reminded that this is no longer acceptable unless a check from a previous employer is deemed to be ‘portable.’ We saw that satisfactory induction processes were in place with staff undertaking a basic induction and then moving onto a Skills for Care based programme. The manager said that staff would work on a supernumerary basis for their first few shifts. On staff surveys and in speaking to staff, they said that they had completed a range of training over time. The manager said that they are keen for the staff to do as much training as possible. Training records show that most staff training concentrates on the core areas, with some additional training such as the Mental Capacity Act, Depravation of Liberties, Activities, also being covered by some staff. Other staff have undertaken less training. Since the last inspection the manager and one member of staff have undertaken a detailed dementia care course. Five other staff are currently undertaking this. The manager needs to ensure that all staff have good training in dementia care as the home is registered to provide this service. Staff need to have up to date knowledge and work to current thinking on best practice. One member of staff said, “Some of the older staff are a bit ‘set in their ways’ and don’t always demonstrate a good attitude towards their younger counterparts, or to changing their work practices to reflect modern thinking regarding care for people with dementia.” Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 31, 33, 35, 38. People live in a home that is well managed and run with their best interests in mind. EVIDENCE: The manager at Braemar Lodge is registered with CQC. The manager is experienced and holds NVQ at level three in care. They are currently undertaking their Leadership and Management award, a recognised qualification, to enhance their skills. In discussion with the manager it was clear that they are committed to providing people with a caring and improving service. Since the previous Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 26 inspection they have worked hard to meet the requirements that were made at that time. Although this inspection has raised issues that need to be addressed and shortfalls in practice, in discussion the manager demonstrated that they have the skills and ability to manage these and continue to develop good practice in the home. We saw that regular resident and staff meetings take place to offer people the opportunity to express their views. The manager had completed the AQAA for this year and this gave us a basic but useful picture of the home. The provider is very involved with the home and is on the rota as being in the home on four mornings each week. They also undertake the regular monthly visit that is required by Regulation. We saw that since the previous inspection surveys have been undertaken with people as a quality exercise. Responses on surveys were positive. The home also operate a system of auditing and quality monitoring The last inspection showed that people’s monies held by the home were well recorded and managed. The manager confirmed that all visiting professionals now provide individual receipts. The system is regularly audited by the provider to ensure that accurate records are maintained. No major health and safety concerns were noted during this inspection. The manager was reminded however that as the home is registered to provide dementia care staff need to be constantly alert to any potential hazards relevant to people’s individual identified needs. For example should the home accommodate anyone prone to wander, a side gate leading to the front of the house was not secure. Good fire records were maintained and a fire risk assessment was in place. The manager was advised to remind visitors that they should sign in and out of the building, and also that a register of people attending for day care should always be available. This is so that in an emergency how many people and who is in the building is clear. A training matrix indicated that a good deal of effort has been put into staff training over the last year. Staff have undertaken basic training in some core areas such as control of hazardous substances (COSHH), fire, first aid and moving and handling. However there are still a lot of gaps. For example only three care staff are identified as having undertaken food hygiene training in spite of the fact that they are involved in food preparation and serving. Three carers are not identified as having completed moving and handling training. We were particularly concerned about one member of staff who undertakes regular sleeping in duties. There is no record at all of them having completed moving and handling training, recent fire training or training in other areas that would be potentially important to this role. Their last first aid training was in 1999. This has the potential to put people at risk. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 X X X X 2 STAFFING Standard No Score 27 2 28 2 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 2 Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 28 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. 1. Standard OP29 Regulation 18 Requirement Staffing levels at the home must be reviewed to ensure that sufficient staff are provided to meet the needs of people living at the home at all times. Details of how the review has been carried out, and what the outcome has been to be sent in to us. All staff working at the home must receive suitable training to ensure that they can meet the identified needs of residents and ensure their safety. This refers to the need for all staff to be trained in dementia care and in core areas such as food hygiene and moving and handling. Timescale for action 01/02/10 2. OP30 18 01/04/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 29 No. 1. Refer to Standard OP1 Good Practice Recommendations People should be given a copy of the home’s Service Users Guide as part of the assessment/introduction process. This will help them in assessing the home’s suitability to meet their needs. Staff at the home should continue to develop suitable activities and occupation to meet the individual needs of people who have dementia. A system of monitoring the premises should be introduced so that any issues are identified and dealt with in a timely manner. Proper cleaning schedules should be developed so that all areas are properly cleaned on a rotational basis. 50 of the homes care staff should be trained to NVQ level two or above so that people receive care from well trained staff. 2. OP12 3. OP19 4. 5. OP26 OP28 Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 30 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Braemar Lodge Residential Home DS0000059881.V378741.R01.S.doc Version 5.3 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!