Care Home: Bramley Lodge

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What the care home does well Bramley Lodge was found to be a very comfortable and homely place to be with a happy and relaxed atmosphere. The service user guide is very clearly written, with pictures in some parts to help people understand it better. Before people stay at Bramley Lodge for the first time, a full assessment is completed, which becomes a big part of each person`s care plan. The care/support plans are very person centred and people are supported to improve themselves, if they want to, particularly in areas such as independence and daily life skills. Photographs of familiar things and places are used to help people make real choices about what they want to do or where they want to go. Bramley Lodge has a very good complaints procedure and Quality Assurance is very important to the staff and management. Feedback and comments are collected on a regular basis to help Bramley Lodge become an even better place to stay. What has improved since the last inspection? This is the first key inspection since Bramley Lodge became registered with the Commission in March 2008. What the care home could do better: Copies of staff records, such as application form, references, Criminal Records Bureau Disclosures etc. should be maintained at Bramley Lodge, in accordance with regulation 17(2). CARE HOME ADULTS 18-65 Bramley Lodge The Street Riddlington North Walsham Norfolk NR28 9NS Lead Inspector Debra Allen Unannounced Inspection 9th September 2008 08:00 Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 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 Bramley Lodge DS0000071577.V371501.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 Adults 18-65. 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. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramley Lodge Address The Street Riddlington North Walsham Norfolk NR28 9NS 01692 652345 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) Thera East Anglia Annika Christine Short Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD 2. The maximum number of service users who can be accommodated is 2 Date of last inspection N/A – New Service Brief Description of the Service: Bramley Lodge is a new small, residential care home providing short-term care for young people with a learning disability and very challenging behaviour. The home is owned by Thera East Anglia, which is a subsidiary of the registered charity, Thera Trust. The detached bungalow has been adapted and extended to provide two large single bedrooms, with a separate bathroom/shower room. There is also a communal lounge, an activities room, a small kitchen for promoting life skills and a large main kitchen/dining room. The back garden is enclosed and offers people access to a large grassed and patio area. Parking is provided at the front and side of the home. The fees are currently variable, according to each person’s individual needs and support requirements. Bramley Lodge DS0000071577.V371501.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. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This is the first key inspection since the service became registered with the Commission in March 2008 and took place over a period of six hours. During this time discussions were held with the current service manager, day-to-day manager and a member of staff. A tour of the premises was also carried out. Care plans, staff files, health and safety information and other records required for regulation were also examined as part of the inspection process. One requirement has been made as a result of this inspection. What the service does well: Bramley Lodge was found to be a very comfortable and homely place to be with a happy and relaxed atmosphere. The service user guide is very clearly written, with pictures in some parts to help people understand it better. Before people stay at Bramley Lodge for the first time, a full assessment is completed, which becomes a big part of each person’s care plan. The care/support plans are very person centred and people are supported to improve themselves, if they want to, particularly in areas such as independence and daily life skills. Photographs of familiar things and places are used to help people make real choices about what they want to do or where they want to go. Bramley Lodge has a very good complaints procedure and Quality Assurance is very important to the staff and management. Feedback and comments are collected on a regular basis to help Bramley Lodge become an even better place to stay. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 6 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. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. Respite guests receive comprehensive information, in appropriate formats, to ensure they and their relatives know what support is offered by Bramley Lodge and new guests have the opportunity to visit before they stay there. A full needs assessment is carried out for each guest prior to their staying at Bramley Lodge so they know that staff will know what support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All respite guests are given a copy of the Service User Guide, which was seen to be in written and picture format. A photograph album and a CD are also available with pictures and brief descriptions of Bramley Lodge. The Statement of Purpose and complaints procedure are also in written and picture format. The Service User Guide explains how Bramley Lodge is a place where people can stay for a short break away from their home and that they are invited to stay for the day, overnight or both. It also explains how the staff will work with each individual and their family to plan the right transition, which can be for day visits, staying for tea and can take as long as is needed. Initial needs assessments are carried out by the manager of Bramley Lodge, together with the people using the service, their family and their social worker. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is good. The assessed needs and risk assessments for all respite guests are shown in individual care plans and people are encouraged to make decisions and their views are taken into consideration, which helps to ensure Bramley Lodge continues to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were looked at in detail during the inspection and each of these contained a section called: “Getting to know you before your stay at Bramley Lodge”, which outlined specific care needs. Personal ‘pen pictures’ were also seen that were very informative and clearly written in the first person such as: “Information you will need to work with me safely”. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 10 Risk assessments were also seen to be in place, and were completed to a very high standard with clear descriptions of hazards and how to maintain people’s safety as much as possible, without total restriction from certain activities or situations. Some of the risk assessments seen covered areas such as: personal care, medical conditions, physical support, relationships & emotional support, finances, learning opportunities, domestic & life skills, leisure, behavioural support and transport. All personal information, relating to guests, was seen to be stored securely in the office, ensuring confidentiality. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. The people who currently use the service are able to make choices about their lifestyle and they are supported to participate in various activities, which suit their individual needs and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans, which are put together for each respite guest were seen to be very person centred and opportunities were noted to be available for personal development if people wanted, particularly in areas such as social and daily life skills. It was acknowledged that routine and structure is extremely important for the people staying at Bramley Lodge and, for this reason, very detailed timetables have been compiled for each individual, which contain pictures, titles and descriptions of each activity, which were seen to include things such as garden Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 12 maintenance, music, computers, jobs, money, exercises, music therapy, art, baking, learning, free-time and breaks. A statement of timetable guidelines was also seen to assist staff, which read: “These guidelines have been put in place to give an idea of what is needed for each session. Please remember to follow all risk assessments at all times, this is to maintain your safety and [name]’s. Also, remember to plan each session in advance so you and [name] know what you are doing. There was also good evidence of regular external activities such as walks, pub visits, boat trips and shopping. Additionally, an ‘Objects-of-Reference’ folder was seen with photographs of relevant places such as different areas to go walking, different local pubs and local shops. This was acknowledged as an excellent way of assisting people to make genuinely informed choices. Although a mealtime was not observed, nor a formal menu seen, during the inspection, a discussion with the manager and the records looked at, supported the fact that people staying Bramley Lodge are offered a healthy diet and enjoy their meals and mealtimes. Evidence was also noted of special requirements or diets being catered for. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. The personal and healthcare support that the people staying at Bramley Lodge receive is based on their individual needs, to ensure the principles of dignity, respect and choice are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User Guide explains how Bramley Lodge aims to support people as individuals and help them to be as independent as possible and this statement was seen to be backed-up by the information contained in the care plans that were looked at during the inspection. The contents of these provided good evidence that people staying at Bramley Lodge receive personal support in the way they prefer, and that their physical and emotional healthcare needs continue to be met during their stay. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 14 The support plans were seen to be compiled with information in the following sections: Statement of Purpose Service User Guide Emergency Information My Support Plan My Behaviour Support Plan My Risk Assessments My Last Review (including My Goals) My Recent Support Notes More detailed information was contained within these sections, such as ‘My Morning Routine (if I stay at Bramley Lodge)’ which explained what is usual, what is liked/preferred and what personal care tasks can be carried out unaided. ‘My daytime routine’ had good explanations as to why a structured routine is required. In respect of personal care, once again, the records seen were written in the first person and promoted dignity and respect, acknowledging what is best for each individual, without being patronising. These records very clearly highlighted exactly what is required, how to do, when to do and how to support each person to do as much for themselves as possible. Some quotes that were noted included: “I would like to be more independent with my personal care so please don’t do everything for me” and “I like to have a choice and decide for myself what to wear each day”. The medication section, within the support plan, provided excellent information and clear descriptions, including photographs of each person’s actual medicine and packaging, together with what it is, why it is used, how to administer and when to administer. At present, none of the people staying at Bramley Lodge are able to retain and administer their own medication but they are protected by the home’s policies and procedures for dealing with medication and the staff were noted to be very well trained in this area. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People staying at Bramley Lodge have their views listened to and acted on and they are protected from abuse, neglect and self harm as much as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bramley Lodge were seen to be very proactive with regard to encouraging feedback, comments and complaints from the people using the service, their families, staff and other external professionals. Very good records were seen to have been maintained of all comments or complaints received, together with outcomes and action plans, all of which were seen to have been signed and dated by the day-to-day manager and service manager Records looked at confirmed that staff are well trained in areas relating to the protection of vulnerable adults. Additionally, a folder was seen, which contained professional contacts in respect of adult protection, full policies and procedures and information on Safeguarding Adults (Vulnerable Adults at Risk of Abuse). Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. Bramley Lodge provides a homely, comfortable and safe environment for respite guests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was carried out on the day of inspection and all areas were seen to be clean and tidy and the whole environment had a very comfortable and homely feel to it. Good signage was observed throughout the home to assist people staying there to recognise different areas. No safety hazards were noted during the course of this inspection. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. Thera East Anglia has a robust recruitment procedure and an excellent training programme, however, copies of certain staff records should be kept at Bramley Lodge, to ensure they are available for inspection at any time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were looked at and the manager confirmed that the application forms, references, Criminal Records Bureau Disclosures and contracts were held at Bramley Lodge’s Head Office (Thera East Anglia). However, the files that were seen did contain the following sections: Staff Details Induction Training Additional Training Mandatory Training Supervision Planner Review Planner Annual Leave Record Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 18 Record of TOIL Record of Certificates Some of the training noted included: Person Centred Approaches, Rectal Diazepam & Buccal Midazolam Administration, Fire Safety, Protection of Vulnerable Adults, Health & Safety, Moving & Handling, Social, Personal & Sexual Development, Food Hygiene, Communication, SCIP, First Aid, Epilepsy and Sign-Along. Medication training was confirmed within the induction section and a specific Medication Training folder was seen to be maintained, which included a staff list and dates of medication training and the six-monthly assessments. All the records looked at confirmed that all staff receive monthly supervision sessions with their line manager and an appraisal/review every three months. The staff spoken to individually on the day of inspection confirmed they were very happy in their work and felt very supported by other staff members, the management team and the organisation as a whole. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is excellent. Bramley Lodge is a well run home, in which the service users’ views are taken into consideration and their overall health, safety and welfare is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The day-to-day manager is currently in the process of becoming registered with the Commission as the service manager for Bramley Lodge, with the current manager providing operational management for other Thera East Anglia services, as well as Bramley Lodge. It was confirmed during the inspection that the operational manager will undertake the monthly visits and provide reports to the Commission as required under Regulation 26. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 20 Meanwhile, the day-to-day manager is very experienced, with over ten years of managing services and holds NVQ 2 and 3 in care and is due to complete his RMA (Registered Manager’s Award) in September of this year. As mentioned in the complaints section, Bramley Lodge is very proactive in respect of its Quality Assurance process and regularly seeks comments and feedback, by way of questionnaires, from the people using the service, their families, staff and other external professionals. The results and feedback received were seen to have been recorded, reviewed and an action plan compiled accordingly. Each person staying at Bramley Lodge also completes a daily communication/feedback sheet, which assists with communication between the person staying at Bramley Lodge and parents or carers. Excellent records were seen to be kept and maintained in respect of areas relating to health and safety, such as: Health & Safety Checklist Weekly Health & Safety Checks Six Monthly Checks Weekly Fire Alarm Test List Fire Drills and Full Evacuation Logs First Aid Boxes – Contents and Checklist Fridge and Freezer Temperature Charts Repairs Log COSHH Data Sheets Food Temperatures Bath/Shower Temperatures Weight Charts Minutes of Health & Safety Meetings A training booklet for health and safety in care was also seen to be available for staff. A Fire Risk Assessment was also seen, which had been approved by the Norfolk County Council Fire and Rescue Department. Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 X 4 3 4 X X 4 X Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 17(2) Requirement Copies of staff records, such as application form, references, Criminal Records Bureau Disclosures etc. should be maintained at Bramley Lodge Timescale for action 30/11/08 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 Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 23 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 Bramley Lodge DS0000071577.V371501.R01.S.doc Version 5.2 Page 24 - 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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