Care Home: Bramble Down Nursing Home

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What the care home does well People said they were well cared for and the home was described as "excellent" by many people, including relatives. Care is provided by a happy and trained staff team, whose main priority is meeting the needs of the people living at the home. Pre-admission assessments gather sufficient information to enable the nursing staff to prepare for each person`s admission. The care planning arrangements, including the risk assessments and reviews were very good, ensuring all staff are made aware of people`s needs and how they wish to be supported. Subsequent record keeping was also clear and informative. People are admitted into a spacious, well-appointed home with all rooms being of a satisfactory size and having the benefit of an en suite bathroom. The home has good levels of up-to-date equipment that make caring for the people who live in the home safe. Leisure activities are well planned and provide stimulation and interest for people. The meals are nutritious, plentiful and varied and people are free to request alternatives if they do not wish to have what is on the planned menu. What has improved since the last inspection? The home has a positive approach to training and the Registered Manager continues to improve the training offered staff. Just over 50% of the care staff either have a National Vocational Qualification at level 2 or above, or are in training. What the care home could do better: Mrs Wright and her staff team provide a good quality of care to people living in the home. Personal, health and social care are all given consideration in care planning to ensure people feel safe, well looked after and have an opportunity to socialise with others. No requirements or recommendations for improvement have been made at this inspection. Key inspection report Care homes for older people Name: Address: Bramble Down Nursing Home Woodland Road Denbury Newton Abbot Devon TQ12 6DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Gurnell     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Bramble Down Nursing Home Woodland Road Denbury Newton Abbot Devon TQ12 6DY 01803812844 F/P01803812844 brambledown@msn.com www.peninsulacarehomes.co.uk Peninsula Care Homes Ltd care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Maximum number of service users to be accommodated is 40. The categories are PD 40, PD(E) 40 Date of last inspection Brief description of the care home Bramble Down Nursing Home is located close to the centre of the village of Denbury near the towns of Newton Abbot, Totnes and Ashburton. It is a care home with nursing that provides personal and nursing care to a maximum of 40 Residents. It can be reached by the number 176 bus from Newton Abbot that is run by a local bus service and stops outside of the home. There is also a large car park in front of the home that provides level access into the home. The home was purpose built approximately 20 years ago with care being provided on two floors. There are two passenger lifts between each level and also staircases leading up to the first floor. It also has a variety of equipment such as grab rails and ramps to ensure people living at the home are able to maintain their maximum independence. There are 23 single rooms and 8 double rooms and all have en-suite Care Homes for Older People Page 4 of 28 Over 65 40 40 Brief description of the care home facilities, nurse call system a telephone point, radio and television. Every person living in the home has the option to bring in items from their home to personalise their room. There are several communal areas that are used for activities, dining or just relaxing. The four bathrooms are of good size and have good disabled bathing facilities that are fitted with hoists and some have shower facilities. Outside of the home at the rear there is a level garden area laid to lawn with a path surrounding it. This is surrounded by the home on three sides and there is easy access for all of the people living at the home into it. Chairs and umbrellas are provided for the comfort of those using the garden. There is always a registered nurse on duty who is supported by care assistants and the ancillary manage the catering, work in the homes laundry or carry out domestic duties keeping the home clean. The homes current weekly fees range from 495 to 680 pounds and increase in line with the needs of the individual. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection of Bramble Down Nursing Home was undertaken on 11th June 2007 when the home was judged a providing good outcomes to the people living there. This unannounced inspection took place on the 10th August 2009. The homes Registered Manager was present and she and her staff team assisted with the inspection. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment form, which is a document provided by the Commission to enable the home to provide us with information about what the home does well, what plans there are for further development and improvement, and information relating to health and safety practices. We also sent 10 surveys to people living in the home, 10 to staff and three to health care professionals involved in providing specialist support to the home. Seven surveys were returned from people living in the home, six from Care Homes for Older People Page 6 of 28 staff and 2 from health care professionals: all commented favourably upon the quality of the nursing care and services provided at the home. On the day of the inspection a tour of the building was made and 15 people living in the home and 4 visitors were spoken with. Staff were spoken with and observed going about their duties and interacting with people. The records relating to the care of four people with complex care needs were looked at, as were the medication records, staff recruitment and training records and documentation relating to the servicing of equipment. 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 information made available in the Statement of Purpose and Service Users Guide, plus other documents was of a good standard and should enable the reader to make an informed decision about moving to the home. The home gather a satisfactory amount of information about prospective admissions, which enables them to make a decision about the suitability of the home to meet their care needs. Evidence: The homes Statement of Purpose and Service User Guide were available in a small seating area inside the front entrance. People living in the home, or visitors, can sit in comfort to read them along with a copy of the last inspection report and a company booklet laying out its aims and objectives. There is also a company website that has information about this home and others in the group. It provides information from the choice of home to how care can be funded. The Annual Quality Assurance Assessment Care Homes for Older People Page 10 of 28 Evidence: confirmed the Service User Guide and other information is sent out to anyone enquiring about the home. Six of the seven people living in the home returning a survey confirmed that they had received sufficient information about Bramble Down to make a decision regarding its suitability. From the examination of care planning documentation it was evident that preadmission assessments are undertaken for all people considering moving to the home. The Registered Manager confirmed that either she or one of the nurses visits each person providing them with information about the home and undertaking an assessment of their care needs. This assessment, along with an additional assessment completed on the day the person moves into the care home, forms the basis of the persons care plan. Each assessment included a dependency profile which was used to establish the level of care the person needed and provided a baseline for future care to be measured against. There were also copies of social worker assessment/care plans and hospital discharge referrals where the person had come from hospital straight to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are comprehensive and well constructed from a wide range of information. The people living at the home are treated with dignity and respect, and are well cared for by the staff who also access the skills of health care professionals external to the home appropriately. Evidence: A large number of people living in the home were spoken with and all of those who were able to comment directly about the quality of the care and support they received said they were very satisfied: the home was described as excellent and very nice. They said the staff were kind and caring and assisted them promptly when needed. Those people who werent able to directly comment due to their poor health or confusion were seen to be comfortable, well groomed and appeared content. Seven surveys were returned from people living in the home, some of which had completed by relatives where the person was unable to do this themselves. Six of the seven people said they always and one person said they usually receive the care and support they require. Comments included, An excellent home! The manager is very approachable and organised. Registered nurses have sound knowledge and are very Care Homes for Older People Page 12 of 28 Evidence: professional. Care staff are kind and caring, my wife needs permanent nursing care. This has been expertly and sympathetically provided by Bramble Down Nursing Home, and friendly, individual care. Four care plans for people with complex care needs were looked at in detail. As noted in the previous outcome group an assessment of care needs is undertaken on the day a person moves into the nursing home and this forms the basis for their care plan. Each of the care plans examined provided sufficient detail to ensure peoples needs were well-known and met in a consistent and safe manner. Peoples preferences with regard to their personal care were also recorded and it was evidence that where more specialist advice was needed, such as from the palliative care team or the stoma nurse, this was sought promptly. The care planning process was very good with regular reassessment and care plan reviews taking place. Each plan provided photographic identification of the person it was about. There were risk assessments for issues such as pressure area care, nutrition, mobility and the risk of falls, and the use of bed rails. This ensured that risks to the persons well-being associated with their poor mobility or health were clearly identified and actions taken to reduce the risk. The care plans and risk assessments had been reviewed each month to ensure these provided a current reflection of each persons needs. The people living at the home have a choice of General Practitioner that they register with. Through the General Practitioners the Registered Manager can obtain referrals to other health care professionals who visit the home to provide care or advice in their field of expertise. This may include District Nurses, Community Psychiatric Nurses, Continence Nurse, and Occupational Therapists. Other services such as Dentistry, Audiology and Chiropody are provided to the people living at the home as required. One General Practitioner returned a survey and this confirmed the high quality of care provided at Bramble Down. The Registered Nurses are responsible for all medication related activities. Records of all medicines received into the home and disposed of were maintained, and medication records were neat and accurate. There is a medication storage room and trolley for each floor. Both rooms provided the necessary level of security and the trolleys were purpose made and lockable. Additional safe storage was available in the nurses office for controlled drugs and a sample of these were checked and the balances were found to be correct. The people spoken to said the staff treat them with dignity and respect. Personal care Care Homes for Older People Page 13 of 28 Evidence: was provided in the privacy of the bedroom or another appropriate area such as the bathroom. Staff were seen knocking on bedroom doors before entering and when in discussion with people they addressed them in a respectful and friendly manner at all times. Rooms were only shared where there had been an agreement for this to happen. 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. Meals are of good quality, nutritionally balanced and very well presented. Activities are well planned and provide interest and stimulation for people who are at risk from isolation. The level of choice given to the people who live in the home, over a wide range of issues, is good and allows them to maintain a degree of independence. Evidence: The home is commended for its commitment to providing social activities for people who, due to their health care needs may be at risk from isolation. An activities coordinator is employed 5 days a week, 3 full days and two half days, who provides a range of activities at no charge. She displays a calendar of events on notice boards in the home. One communal area is being used as an activities room and a large storage cupboard provides numerous items to engage people. Six of the seven people returning a survey said there are always or usually activities arranged to take part in: one person preferred to stay in their own room. Comments included, the activities are organised and very valuable and the coordinator is a star. We are very happy with how the home keeps in touch with us, and entertainment is varied and excellent. Activities from external facilitators include Pets as Therapy; visits from Shaldon Zoo and the Donkey Sanctuary; keyboard players; a classical guitarist; a harpist and visits from a group of belly dancers. In-house activities include reminiscence sessions for Care Homes for Older People Page 15 of 28 Evidence: which the home has obtained many household items from years ago, gardening, playing with the Wii game and arts and crafts. Each Wednesday, the care staff also become involved in the activities to enable them to assist more people individually and to become involved with people with more than just care giving. Peoples involvement is recorded in their care plans and it was evident that people who prefer or need to stay in their own rooms are included in the activities, for example when the animals visit the home they are taken to people in their own rooms. Some people said they did not wish to attend anything on offer and were happy to read their paper in their own room, whilst others choose to attend some events and not others. The Registered Manager confirmed that many family member are involved with the activities particularly the gardening and they and some of the people living in the home have developed a sensory garden with highly scented plants. Visiting can take place at any reasonable time and several visitors were seen to come and go during the day. Those visitors spoken with were very complimentary about the home. One person has a meal with their relative each week for which the home makes no charge and another relative said how they have been able to continue to offer care and support themselves. People are invited to personalise their rooms with items that they wish to bring in from home and this was evident in many of the bedrooms. They also have the facilities to have their own telephone line for which they receive a bill from the phone company direct, as well as the internet. People said the meals were excellent and really nice. Menus are displayed on the notice boards in the dining rooms and there were two choices available for the lunch and tea time meals: fresh fruit is provided with each meal. Breakfast was served in peoples own rooms and a selection including cereals, porridge, fruit, toast and a cooked breakfast was available each day. People said they often request meals that arent on the menu and the chef is always happy to oblige. All seven people returning a survey said they always or usually enjoy the meals. Comments included, the food is very good. Kitchen staff [are] excellent and have a real interest in nutrition, and the food is excellent and portions are tailored to individual needs. The cooks are involved in how the food is prepared for the people in the home based on the results of the nutritional assessments and specialist meals are catered for such as those for people who have diabetes and those who require a soft or pureed diet. The Registered Manager said ministers of religion can visit at any time and a regular Christian service is held each month. Mass can be said at the bedside of a person if this is their wish and a bible is available in the home. They also state that all religions Care Homes for Older People Page 16 of 28 Evidence: and beliefs will receive the same respect and opportunity to be practiced. 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. People living in the home and their relatives can be confident that any concerns or complaints they may have will be taken seriously and will be resolved promptly. The home has taken satisfactory steps to reduce the risk of any form of abuse through training and robust recruitment practices. Evidence: The home has a very comprehensive complaints procedure which was on display in the front lobby. Further to this the home had a copy of the procedure in both the Statement of Purpose and the Service Users Guide: the name and the address for the Care Quality Commission need to be updated in these documents. Neither the home nor the Commission has received any complaints since the previous inspection. People said they felt they could raise any concerns with the staff or the Registered Manager and had confidence that any concerns they have would be dealt with appropriately. This was further supported by the relatives spoken with as well as the surveys received. Staff from the home have attended Adult Protection training providing them with information about the signs and symptoms of abuse and the actions they should take should they suspect someone is at risk. The Annual Quality Assurance Assessment reported that this training is also ongoing. The staff records provided evidence that all staff are vetted during their application process and a Criminal Records Bureau check Care Homes for Older People Page 18 of 28 Evidence: is carried out, ensuring as far as possible only suitable staff are employed. The home has robust policies and procedures for Adult Protect, disciplinary issues and whistle blowing. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides spacious, comfortable, clean, well equipped, adequately decorated, and well-proportioned accommodation that is suitable for the people who live there. Evidence: Bramble Down Nursing Home is located close to the centre of the village of Denbury near the towns of Newton Abbot, Totnes and Ashburton. It is a care home with nursing that provides personal and nursing care to a maximum of 40 people. It can be reached by the number 176 bus from Newton Abbot that is run by a local bus service and stops outside of the home. There is also a large car park in front of the home that provides level access into the home. The home was purpose built approximately 20 years ago with accommodation provided on two floors with wide corridors servicing all the bedrooms, bathrooms and communal areas. There are two passenger lifts between each level and also staircases leading up to the first floor. It also has a variety of equipment such as grab rails and ramps to ensure people living at the home are able to maintain their maximum independence. There are 23 single rooms and 8 double rooms and all have en-suite facilities, nurse call system, a telephone point, radio and television. There were good levels of natural lighting and also artificial lighting in all areas of the home. Every person living in the Care Homes for Older People Page 20 of 28 Evidence: home has the option to bring in items from their home to personalise their room and all rooms were comfortably furnished to the liking of the people who lived in them. Many were provided with an adjustable height bed that made providing caring for them easier. There are several comfortably furnished communal areas that are used for activities, dining or just relaxing. The four bathrooms are of good size and have good, high specification disabled bathing facilities that are fitted with hoists and some have shower facilities. The home has a dedicated housekeeping team and the home was found to be very clean and tidy: people said the home was always clean and there were no unpleasant odours. The home has a good standard of decor, furnishings and fittings, which provide a comfortable and pleasing environment for the people who live there. The gardens are large and pleasant with level access enabling people to sit out in good weather: chairs and umbrellas are provided for the comfort of those using the garden. Some ground floor rooms have direct access to the garden area. The home employs a staff member to oversee the day-to-day repairs and redecoration of the home ensuring it is maintaining in good and safe order. Equipment such as hoists and the passenger lifts are regularly serviced to ensure they continue to be safe to use. Radiators were guarded to reduce the risk of burns should someone come into contact with them then they are on. There are thermostatic mixer valves on water outlets such as sinks in en suites and baths to reduce the risk of scalding from hot water. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs staff in sufficient numbers, and with satisfactory qualifications, skills, and experience, to meet the needs of the people who live in the home. The recruitment procedures protect people from the employment of potentially unsuitable staff. Evidence: The staff were described as kind and caring and people confirmed they are assisted promptly, indicating there are sufficient staff on duty. All seven people returning a survey said they received the care and support they required and staff were available when they needed them. One relative said all the staff have a friendly, responsive relationship with [relatives name], all smiles and kind words. Another person said care staff are kind and caring have lovely relationships with my mother. At the time of the inspection there were 36 people living in the home, many of whom had very complex needs and were highly dependent upon the staff. The home has 2 qualified nurses on duty during the day until 5pm when one nurse is on duty. Eight care staff are on duty during the morning and early afternoon and 5 care staff during the early evening: a further care staff works from 7pm until 11pm. Overnight there is one qualified nurse and 2 care staff. Staff are supported by housekeeping, laundry, catering, maintenance and administrative staff. Care Homes for Older People Page 22 of 28 Evidence: Staff spoken with and those returning a survey said they were well supported in their work and received the necessary training to ensure they have the skills and knowledge to care for people with complex care needs. One staff member said staff work very well together. Since working here Ive seen excellent care being delivered to all patients. Training is very good too. The home as a holistic view of all patients and all needs are met. A training programme ensures staff receive regular updates in training and the Registered Manager confirmed that nine care staff have achieved a National Vocational Qualification at level 2 or above, and a further seven staff are in training. New care staff are provided with an in-house induction program and this was evident in the staff file of one newly employed care staff. New staff work alongside a more experienced member of staff until they, and the Registered Manager, feel they are competent and confident to work alone. The qualified nurses are also supported to update their professional skills and evidence was available that nurses had recently received training in catherisation and venepuncture. Three staff recruitment and training files were looked at. These provided evidence that the home has followed its recruitment procedure and obtained the required information about staff prior to the commencement of their employment, ensuring as far as possible only suitable staff are employed. 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. Bramble Down Nursing Home is a well managed home. The Registered Manager and her staff team strive to provide a safe, happy and caring home for the people who live there. Evidence: Mrs Wright, the homes Registered Manager, is a qualified nurse and has many years experience in managing care homes. People living in the home and the relatives spoken with all said they had confidence in her management of the home. Comments included, an excellent home, the manager is very approachable and organised and the best nursing home in Devon. The home does not manage the affairs of any of the people living in the home but does provide safe keeping for money should people wish to use this. Receipts for expenditure were kept and records of each persons balance maintained: a sample was checked and found to be correct. Care Homes for Older People Page 24 of 28 Evidence: From discussion with staff and the Registered Manager, and from the examination of staff files, it was evident care staff receive regular one-to-one supervision with a qualified nurse to review their work practice and to identify any training and development needs. The Registered Manager offers supervision to the nurses and the ancillary staff, and in turn the she is offered supervision by the companys Operational Manager who visits the home frequently. Regular nurses and staff meetings enable the staff team to come together to discuss the running of the home and make suggestions for improvement. The Registered Manager gave an example where care staff had made suggestions to enable them to spend more time with people in leisure activities each week, rather than this solely being the responsibility of the activities coordinator. The home has a formal quality assurance process which consults with people living in the home, their relatives and health care professionals such as the General Practitioners and Community Mental Health Nurses. The results for the most recent consultation in June were made available and these demonstrated a very high level of satisfaction. The home is managed with the needs, and safety of the people living in it, as the priority. Staff have received adequate training and the home has been maintained to a good standard. There have been measures taken to provide a safe environment such as radiator covers and thermostatic mixer valves to reduce the risk of burns and scalds, and the fire safety system has been regularly tested and serviced to ensure it is maintained in a safe working order. The home has invested in standing and moving aids and bathrooms provide baths that are suited to the needs of people with very restricted mobility. 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. 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