Care Home: Bramcote House Care Home

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CARE HOMES FOR OLDER PEOPLE Bramcote House Care Home Town Street Bramcote Nottingham NG9 3DP Lead Inspector Bhavna Keane-Rao Unannounced Inspection 2nd March 2009 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramcote House Care Home Address Town Street Bramcote Nottingham NG9 3DP 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) 0115 925 7316 F/P 0115 925 7316 Bramcote Nursing Home Limited Ms Azza Hebeshaw, Mr Mahmood Saba Mrs Ann Elizabeth Warner Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Terminally ill (1) of places Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Bramcote House Care home is situated 5 miles from the city of Nottingham, within the village of Bramcote. It is close to public transport and local amenities. It is an old period house, which has been sensitively adapted into a care home ensuring many of the old characteristics are still in place whilst being suitable for service users needs. Both residential and nursing care is provided to older people. There is a choice of sitting areas and a separate dining area. Although there are 12 single and 5 double bedrooms some double rooms are used as single. A passenger lift offers access to all three floors. The entrance to the building and the gardens are accessible to wheelchair users. Service users and visitor may enjoy the large garden area and seating to the rear of the building. The current weekly fees, which are discussed during admission, are £490.80, this excludes chiropody and hairdressing fees. Information about these costs as well as the day-to-day operation of the home can be found in the home’s statement of purpose and service user guide. These documents and a copy of the last inspection report are available to people who live there and those interested in coming to live at the home. On the day of the inspection visit, twenty two people were living at the home. Bramcote House Care Home DS0000026420.V373985.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 stars. This means the people who use this service experience good quality outcomes. An unannounced visit was made to the home as part of a key inspection. It started at 10.45 and lasted 5 hours. Information that we hold about the service was used to plan the visit and produce this report. The main method of inspection used is called ‘case-tracking’, which involves choosing a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff, any visitors and observation of care practices. Our visit to the home focused on whether key standards had been met and to check on how people feel about the service provided. The care received by three people was followed in detail to ensure the health, safety and welfare needs were fully met and that they were supported to maintain their dignity, autonomy and choice. We spoke with four staff members on duty, a physiotherapist, about half of the twenty two residents, including those being case-tracked and to two visiting relatives. People spoke about their experience of living at the home. Their personal records, general house records and staff records were looked at and the way care was given to the people was observed. All were positive about the level and quality of care given. All spoke enthusiastically about the “wonderful staff and the home’s manager.” Any comments we received will be mentioned in the main body of this report. We saw most areas of the home, sampled some of the main meal and looked at records in the home. The manager was present throughout this inspection. What the service does well: Bramcote is a limited company with the owners involved in the running and maintenance of the home. The manager is always either present or easily contactable. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 6 The home is comfortable, homely and clean, and there is a happy atmosphere among both the staff and the residents. They have access to attractive gardens. There is a training programme, to ensure that staff know how to safely care for and support people living in the home. People told us “this is the next best thing to being in my own home.” People are cared for in a kind, friendly and dignified manner they told us “They (staff) can’t do enough for us.” There is training programme, to ensure that staff know how to safely care for and support people living in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 7 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 Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. Enough information is available to help people choose where to live. The assessment processes in place are used to ensure that the care team can meet each new person’s individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide, which give people information about the home, are updated regularly so that people who are interested in coming to live at the home have an insight into what is offered. A copy of the statement of purpose is kept near the front door for easy access. It is also readily available for people who visit the home. This information, alongside being able to visit the home and see how it operates, can help people make an appropriate decision about coming to live at the home. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 9 People who live here and visitors spoken with, told us they were given plenty of information, shown all around the home, and made to feel very welcome. They said they were encouraged to speak with others who already lived there and to sample some of the activities, to give them a ‘flavour’ of what to expect at the home. One person told us “ I was given a brochure after visiting the home.” Before people move into the home, the manager or a senior staff member visits them to assess their needs, to make sure they can be cared for in the way they want and need. This was confirmed to us by people who live here and a relative. The care plans we looked at had completed assessment forms in to confirm this. A person we spoke with said they were able to ask any questions and state what their personal needs were before they moved into the home. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. People’s personal and health needs are attended to by staff who understand their needs and treat them with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection report for this home told us that the care planning system used to record people’s health, welfare and social needs and wishes were comprehensive enough to inform staff how to care for them in the manner they needed and wanted. Looking at the care plans for three of the residents, it was confirmed that they are still realistic in meeting the residents’ needs and wishes. The care plans are well-set out and easy to read and follow. The care plans showed that where possible, people were involved in their own care plans and people we spoke with confirmed this. They said they were happy with the care provided; someone said, “all of my mother’s care needs are identified and met”. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 11 When a person was unwell, the personal care given was clearly described in care notes, which were generally up-to-date. The manager is in process of developing these further. A healthcare person told us they had visited very regularly. They had never had any negative experiences with the staff or manager. They told us that staff follow all the recommended treatments through and that there had not been any major concerns with the home. They said it was an advantage for the residents that most of the staff had been around for a long while. The medication practices we looked at were well-organised and medicines safely administered. There are systems in place to ensure any unexplained gaps are followed up. There was a photograph of each resident at the front of their individual medicine record sheets. At present these are being up dated by the manager. Staff are trained to give the medicines out safely. The supplying pharmacy checks the medication practices regularly. People told us that staff treat them with dignity and respect their privacy. Visitors told us, “the staff are absolutely brilliant; there is a lovely atmosphere here. We couldn’t wish for anything better. They really are so very caring”. Residents said, “the staff are very good, very caring” “it’s lovely here” “It can never be like my home but it’s next best thing”. A person told us, “I looked at many but liked it here the most”. During our visit we saw that residents were treated with dignity and respect. The staff were jovial, friendly and responsive to the residents in different situations we observed and the residents were relaxed and happy. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is excellent. People enjoy the variety and quantity of activities provided. They are supported to make choices and decisions about their daily lives. They have a balanced, nutritious diet in quantities and variety to suit the tastes and wishes of all the people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity organiser works 16 ‘motivating’ hours per week. Care staff provide various activities throughout the day so that the residents can do regular activities and are kept occupied as they wish. They kept clear, descriptive records of the activities the residents engaged in. Regular discussions are held with people where they decide what activities they want. We were told, and saw for ourselves, that quite a few people join in the activities together but that each person’s preferences are taken into consideration for what is provided. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 13 Staff encourage people to be as independent as possible whilst sensitively supporting them to take part in individual activities safely and to their satisfaction. Residents and visitors told us that staff asked the residents what they wanted and helped them to make everyday decisions individually. People told us “the entertainment is good”, “It’s a good home” “I don’t think I can be in a better place” “I’m well looked after”. Visitors told us they are always made very welcome with “with a tray of hot or cold drinks”. When asked if the staff meet the needs of the residents, they said, “they can’t do enough for them.” We saw meal plans and were told that people had a say in what they would like on the menu. This was confirmed to us by people we spoke with. Last year all residents were consulted with about the menu plan. Their likes, dislikes and how they were able to manage their food was recorded and was also viewed in the kitchen. A choice of two main meals is regularly prepared; the chef and care staff regularly speak with all the residents to ask if they would prefer something different from the main menu. In this way, the cook ensures that they meet the range of people’s needs and choices and everyone eats what they want each day. All the food is freshly prepared and three fresh vegetables are provided with each lunchtime meal. The soups and the puddings are all homemade, as are the main courses. One person said, “the food’s fabulous and always smells so good.” Another person said “there’s always choice and variety” Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. People are protected, supported safely and with consideration by well-trained, considerate staff and a conscientious, well-respected manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last report demonstrated how the home takes the issue of addressing complaints and ensuring that residents are safe very seriously. There is now a robust system in place for staff recruitment which involves all relevant safety checks being undertaken before employment. Residents and visitors told us that they would always speak with the manager or staff if they had any concerns. But a visitor assured us that they have never had any reason to complain, especially about the care given. They said, “There’s a lovely relaxed atmosphere”. People told us that they would always know who to go to with a complaint but that they never had any and were very happy in the home. The manager showed us she has systems in place for recording and responding to concerns or complaints. The service has not received any complaints. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 15 Staff said, and their training records showed, that they are well trained in knowing how to protect people. Staff members told us about how they support people to keep them safe, how they would report any concerns. We observed a friendly and happy rapport between residents and staff on duty during the inspection visit. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21, 23 and 26. Quality in this outcome area is good. The home provides a clean, comfortable, hygienic and safe environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us that their rooms are decorated as they want. The bedrooms we looked at were personalised, clean and homely. The carpets in number of bedrooms, the corridors and lounge had been fitted just after the last inspection. There is an on going programme of redecorating bedrooms as they become vacant. All the bathrooms and shower areas were also viewed. Whilst there is an obvious sign of constant use these were found to be satisfactory. The manager Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 17 has stated that these are decorated frequently. There was hot and cold water in all bathing areas. This had been raised as an area of concern at the last inspection. A visitor confirmed that the communal areas and the person’s own bedroom were always clean and tidy. One person told us “this is an old building with wear and tear but it’s still kept homely and relaxed.” During our visit, we observed people moving around freely and with support, and taking part in individual or group activities as they chose. The home has a large, pleasant, well-tended garden where residents and their families can sit in good weather. During the inspection, the afternoon activity took place in the large lounge and was enjoyed by a number of the residents. People told us that “this is a lovely big home with a great big garden”. In one identified bedroom it is noted that the carpet is taped to the cellar access. This can present a trip hazard in the future and needs to be reviewed. The last Environmental Health Officer’s report in February 2009 was positive in its feedback. There were no issues to address. The last fire safety check was done in January 2009. Records showed that checks were kept by the maintenance person to ensure hygiene is safely maintained in the home. The manager keeps a record of all maintenance and ongoing improvement of the premises. An issue of the small lift was raised by a number of people and raised at the last inspection. The providers are aware of this and have come up with a number of solutions which are being considered. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 28, 29 and 30. Quality in this outcome area is good. Residents’ care needs are met by trained and competent staff This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us they feel comfortable with the staff and were complimentary about the care they provide. We also received very positive comments about the staff at the home from relatives and a healthcare professional. People told us, “They can’t do enough for us”, “Nothing is too much for them”, “They’re wonderful”, “This is the best care home,” “I couldn’t speak too highly of the care and support received.” Relatives provided comments, “All the staff are very nice. There’s a lovely relaxed atmosphere”, “Most impressed by staff attitude”, “Staff are so friendly and welcoming and willing to do things for the residents and us.” A health care professional told us, “We have no major concerns; most of the staff have been around for a long time. That’s helpful to the residents’ wellbeing.” When asked if staff were always available when needed, all said yes without hesitation. The staff duty rota showed there are enough care staff members, as well as, during the daytime, the manager, housekeepers, a cook and an Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 19 activity organiser to support the twenty two people who currently live at the home. Staff members commented, “We are a close team like a family. I love coming to work. We are really well supported by the manager.” The records of two recently recruited staff members showed that they had been recruited and employed after the required checks had been made to ensure the safe care of the residents. They told us that their induction was very thorough. The manager told us that even after a lengthy induction period, support and training is ongoing throughout their working lives at the home. Staff told us that they feel they have plenty of training. The training certificates in staff records and the training records confirmed this. People we spoke with told us they felt that staff are aware of and respect diversity. “We have a church person come to visit us and we are taken to church services if we want to go”. On the day of the visit holly communion was underway. Staff told us that staff meetings are held regularly, these were viewed. They also told us that they could speak up and their opinions were asked for by the manager, which helped to make them feel valued. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35 and 38. Quality in this outcome area is good. The manager and staff are an enthusiastic, supportive team that keep the environment homely and the people safeguarded and comfortable This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked in the care home for many years, with much experience in the care of older people and management of a care home. Everyone spoke very highly of her. A relative told us, “I visit regularly. The manager is really lovely person. She can’t do enough for my mother” A resident said, of the manager, “Nothing is too much trouble for her and she knows all about every resident.” Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 21 A health care visitor told us they have on going discussion with staff and the manager. At present there are no residents’ meetings. However this is due to lack of interest form residents. The manager stated she had previously held meetings which no one wished to attend. This was confirmed by people we spoke with. The manager showed us that she had distributed questionnaires to find out what people think of food provided by the home, to monitor and take action to continue improving the service provided. She also showed us the outcomes of the survey and how she put people choice. The home does not have any input into people’s finances. The manager confirmed that staff have regular formal, one-to-one meetings with her on regular basis and also as and when required or requested. Staff told us they have met with the manager on a one-to-one basis and that they felt “very supported” by her. They told us that the manager is always available, has an ‘open door’ and always listens to what they want to say. All staff said they chat with the manager on a daily basis whilst at work. They all agreed that they feel very supported by the manager of the home. There were comprehensive health and safety policies and documents in place. These are updated annually, or as necessary, by the manager. Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 X X 3 Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bramcote House Care Home DS0000026420.V373985.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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