Care Home: Bramblegate

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What the care home does well People only move into the home following an assessment of their needs. People living in the home are supported to make decisions in their every day life. People living in the service are supported to be part of the local community and participate in activities which interest them. There are care plans in place which demonstrate that people are supported with their care needs in the way they prefer and their emotional and physical needs are met. The home has a medication policy and practice within the home ensures that people are protected. There is a complaints procedure in place which people use. The home is clean. Recruitment policy and practice ensures that people are protected. What has improved since the last inspection? At the end of the key Inspection in July 2008 there were eight requirements and six recommendations. All staff working in the home receive safeguarding training which ensures that they understand the importance of protecting people from harm. Improvements to the environment mean that the home is a more comfortable place to live. A regular programme of maintenance means that issues are dealt with and resolved and the home is not allowed to fall into a state of disrepair. There is now a manager in post which means that the home is being managed and run with the best interests of the people living in the home. A quality assurance process is in place and people who live in the home have their views listened to and taken into account when changes are being considered. Monthly visits by a senior manager in the organisation mean the provider knows how the service is progressing in meeting people`s needs. Improvements to how training needs are identified and arranged means that staff are able to ensure that the health, welfare and safety of people in the home is protected. Work has been done with people who live in the home to help them in developing their care plans and understand that they have control over the information in them. Risk assessments are clear and support individual choices and lifestyles. People living in the home tell us they are supported to make healthy food choices. Training has improved and there is encouragement to participate in the National Vocational Qualifications which supports staff in having the skills they need to do the job. What the care home could do better: At the end of this inspection there are no requirements and no recommendations. Key inspection report Care homes for adults (18-65 years) Name: Address: Bramblegate 92 Ringwood Road Walkford Christchurch Dorset BH23 5RF     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: Tracey Cockburn     Date: 0 7 0 7 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 Adults (18-65 years) Page 2 of 26 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Bramblegate 92 Ringwood Road Walkford Christchurch Dorset BH23 5RF 01425276846 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Principle Care Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Bramblegate opened as a residential care home in December 2005. It was one of three homes owned and run by Principle Care Limited. In June 2008 Principle Care Limited was purchased by Active Care Partnership part of Southern Cross Healthcare. It is a detached house situated along a main road in Walkford. The property is in keeping with the neighbourhood. The home is registered to provide accommodation and support for four adults who have a learning disability. The philosophy of the home is to provide support to individuals who are moving onto greater independence. It is a family-style home and all four bedrooms are single with en-suite and kitchenette facilities. Three bedrooms are situated on the first floor and one bedroom is on the ground floor. There is a lounge / dining room area, separate kitchen and a garden to the rear of the house. There are areas for parking at the rear and side of the property. There is also an office which doubles as a staff sleep-in room. Local shops are within walking distance and there is a bus route into the neighbouring town of Christchurch. Fees charged by the home are variable and are assessed on an Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 4 Brief description of the care home individual basis according to the needs of the person. The current scale of charges, vary from 900pounds - 1600 pounds per week. For further information on fair fees and contracts access the website: www.oft.gov.uk Care Homes for Adults (18-65 years) Page 5 of 26 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service without telling them we were coming. When we planned the visited we looked at the annual quality assurance assessment sent to us by the home, in which they tell is what they are doing well and what they need to do to improve. We sent out survey forms to people who live and work in the home. We had three survey forms back from people who live in the home and six back from people who work in the home. Their views form part of the evidence about the service. We spoke to all three people who live in the home, we spoke to two members of staff, the manager of the service and the operations manager for the service provider. During our visit we also looked at care records with the permission of one person, staff recruitment records, training records, medication and information on incidents. We also walked round the home to look at changes which have been made. Care Homes for Adults (18-65 years) Page 6 of 26 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 Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People who may use the service have the information needed to choose a home that will meet their needs. Evidence: There have been no new admissions to the home since the last key inspection. Paperwork suggests that a detailed assessment is completed before any decisions are made. The annual quality assurance assessment says: All new referrals are assessed for suitability with regards to needs and compatibility with existing service users; taking into account existing service users opinions. A comprehensive assessment is carried out using information from various sources. This information is kept in a transitional fie until a decision has been made. All new admissions are given a user friendly service user guide and a contract to sign. Care plans and risk assessments are completed prior to admissions. All service users have their own key workers and this is determined on suitability, skills, knowledge, Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: gender, age and interests. The service user guide tells us that the long term goal for people living in the home is to move to more independent living and they have told us in their annual quality assurance assessment that: 1 service user is now on the local council waiting list; thus enabling him to move onto more independent living as he requested. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 are involved in decisions about their lives and play an active role in developing the care and support they receive. Evidence: The annual quality assurance assessment says: All care plans are developed in conjunction with our service users, they are then signed by the service user and retained by them. All care plans and risk assessments are reviewed monthly by key workers and any new goals are set by the key worker and the service users to ensure that goals are SMART. Service user satisfaction surveys shows us what we are doing well On the day we visited the service, we spoke to one person who lives there and they told us that they were having a review that morning, they told us they did not want to live in the home any more, they said they wanted to live on their own. The manager told us that they are working with the person and have put his name on the housing waiting list. The manager also told us that they are encouraging this person to chair Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: his own review meeting, taking place the day we did the site visit. The recommendation made at the last inspection that people should be supported to have ownership of their care plans. We found at this inspection that people know exactly were their care plans are and they are involved in the writing of them. The manager is working on developing this further to make better use of other mediums such as photographs and video to make the care plans more accessible. However the recommendation has been addressed. At the last key inspection we recommended that risk assessments should be in place. We found at this inspection that this has been addressed. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People who use the service are able to make choices about their lifestyle and are supported to develop their life skills. social, educational. cultural and recreational activities are developed to meet individual needs and wishes. Evidence: The annual quality assurance assessment says: Grow vegetables of choice in garden. Ask service users to complete another satisfaction survey in September 2009. Book individual holidays as requested by service users and not group ones. It also says: Service users are currently looking at college prospectus for September 2009 courses. 2 service users have requested the chance to gain employment; either paid or voluntary. All day care activities are requested by service users. Service users are encouraged to access all aspects of community and home life. Their leisure choices are actively pursued. Staff encourage families to visit or for families to Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: take them out. We spoke to all three people who live in the home and two people were going out for lunch separately with a supoprt worker, another person chose to spend time in their room following their meeting. One person told us that support staff were helping him make choices about what courses he might want to do. We observed staff encouraging people to make their own decisions during the day. At the last inspection we recommended that the service encourage and enable people to make healthy food choices. We found that the manager has been working with both the staff and the individuals living in the home to consider healthy eating, there are posters in the kitchen and meals are discussed at each residents meeting. People who use the service are also encouraged to do the food shopping with staff. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 health and personal care that people receive is based on their individual needs. the principles of respect, dignity and privacy are put into practice. Evidence: We looked at one persons file and found evidence that they are having their care and support needs identified and met. We spoke to one person who told us that staff are supportive and encourage hime to make choices each day. We found information in their care plan that they are able to see healthcare professionals when they need to. We spoke to one person who was at a review meeting about his care and support needs and a variety of professionals were present including the community nurse. We made a recommendation at the last key inspection that all staff receive medication training. We looked at the training for all seven staff working in the home and they have had medication training. We looked at the way medication is stored, there are no controlled drugs in the home at the time of the visit but there is an appropriate metal cabinet for their storage. we checked the medication for one person and found the signatures and number of tablets matched. We found no gaps in the MAR chart and the manager explained the Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: process of ordering medication in the home. the manager also told us that they will be using the auditing services of a local pharmacy as part of their quality assurance process. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People who use the service are able to express their concerns and have access to an effective complaints procedure. Staff receive the training they need to understand how to protect people from abuse. Evidence: The annual quality assurance assessment says: All service users have a copy of the complaints procedure in an easy to read format in their rooms. There is also a copy in the hallway. Staff are aware of procedure to follow if they have grievances and procedure is available in staff office and on staff notice board. House meeting are held weekly and any complaints recorded, however we are aware that this may not always be easy for service users therefore complaint forms are available in the hallway in order for service users to complain in private. Any complaints re: Home Manager can be passed directly to Operations Manager. We looked at the complaints log, clear evidence that concerns are taken seriously even minor ones and action taken, information clearly written and individual who has raised the concern has signed to say in agreement with the action taken. At the last key inspection we required the service to arrange safeguarding training for all staff. We found at this key inspection that all staff had completed safeguarding training in February 2009. Care Homes for Adults (18-65 years) Page 17 of 26 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Improvements to the home both inside and outside ensure people life in safe, comfortable and well maintained surroundings. Evidence: The annual quality assurance assessment says: Bramblegate has recently redecorated all communal areas in service users choice of colours. Matching dining room table and chairs have been acquired. New sofas have been purchased. 1 x Service users has had his bathroom redecorated at his request. New bedroom furniture has also been acquired. External window frames have been painted and surrounding gardens have been improved. Garage door has also been painted. Maintenance repair book in situ to enable quick reference and repairs. The environment has been improved considerably both inside and outside, the entrance to the home is now at the front, the fence has been fixed and the windows have been replaced. The living room has been completely refurnished with the involvement of the people living there. Brand new sofas and chairs, repainted and new carpets. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: At the last key inspection we required the service to improve the furnishings and decor in the home, we also required the service to keep a record of maintenance in the home and when it was completed. We found at this inspection that both requirements had been met. We spoke to one person who uses the services and they told us they are really please with the sofas in the lounge, he said he chose the colour and the decorations. The home was clean, there is a rota in the kitchen which encourages people who live there to be responsible for chores in their own home such as hoovering, cleaning their bedrooms and bathrooms. There was also evidence in the staff meeting minutes that staff are reminded to supoprt people in maintaining hygiene standards in the home. The laundry room is clean and suitable to meet the needs of four people sharing a house. Care Homes for Adults (18-65 years) Page 19 of 26 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff in the home are trained and in sufficient numbers to support the people who use the service. Evidence: We looked at the recruitment file for one person and found that they had started work in the home following a satisfactory criminal records bureau check. The other information required by regulation was in place. The manager told us that they were interviewing soon and one of the people living in the home would be on the interview panel. The annual quality assurance assessment says: Service users are encouraged to take part of the recruitment process with 1 service user taking part recently. Day care has also been changed to reflect their personal choices. Living room has been redecorated to service users choice. It also says: 1 x staff at Bramblegate has completed trainer training. All staff are allocated individual responsibilities and feed back at monthly meeting. Bramblegate advocates staff autonomy. Staff have been allocated to specific houses since under new management through Active Care. It also says: More training needs to be made available in specialist area; epilepsy, autism. Local trainers are being looked into. We have access to an Autism Consultant through the company. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: One person who returned a survey form said: Bramblegate is a happy home and an enjoyable place to work Another member of staff said in the survey form they returned: I think the house has improved dramatically during the last six months A survey said: The manager is very good at making sure all staff training is up to date Training has been addressed and manager is developing opportunities for staff, encouraging staff to take on a variety of responsibilities. At the last key inspection we recommended that staff are encouraged and supported to complete national vocational qualifications. the manager told us that the newest member of staff will be enrolled on NVQ training. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is based on openness and respect and there are effective quality assurance systems in place. Evidence: One person who works in the home returned a survey form which said: the home is run well. good manager Another person returned a survey form which said: It is a very organised home, the manager is brilliant New manager who has been in post since November 2008, fit person interview next week. Quality assurance process in place. At the last key inspection there were five requirements in this outcome area. At the time of the last key inspection there was not a registered manager in post, at this inspection there is a manager in post who was about to complete the fit person interview as part of the registration process. The manager has been in post since November 2008. One of the requirements regarding quality assurance had been repeated for the third time. We found at this inspection that there is a quality assurance process in place, systems in the home are audited monthly and the manager told us that people who Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: use the service and are involved in the service were asked their views and the results were collated into a short report which was shared with the people who use the service at one of their meetings. At the last inspection a requirement was made that regulation 26 visits take place, we found that since the last inspection there have been monthly visits made by the operations manager and these visits have been clearly recorded. At the last inspection we made a requirement regarding fire records and found at this visit that fire records were up to date, this included all the weekly and monthly checks as well as training. At the last key inspection we made a requirement that mandatory training such as infection control, food hygiene, moving and handling and fire safety must be in place for all staff. There are seven staff working in the home and we found that there are still some gaps in mandatory training, however the manager is aware of where the gaps are and has arranged training for those staff who are not up to date. Care Homes for Adults (18-65 years) Page 23 of 26 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 Adults (18-65 years) Page 24 of 26 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 Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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