Care Home: Bramshall`s Old Rectory

What the care home does well The home is well managed with a wealth of permanent staff that have worked there for many years. The home is located in a peaceful village with stunning views and the people living in the home benefit from this. The care offered to the people is of a high standard and consistently good. The manager and all her staff take pride in their individuals roles and ensure that the home is run in the best interest of the people living in it. The home was exceptionally clean, hygienic and well maintained. Relatives spoken to at the visit were very complimentary about the manager and all the staff. They told us they had full confidence in the home and the care that was given and the overall reputation was second to none. What has improved since the last inspection? The care records were improved and more detailed information was included. The requirements and recommendations made at the last visit were all met. Some redecoration had been completed. What the care home could do better: The manager discussed ways in which they want the home to further improve. One issue regarding medication was noted (Standard 9) and corrected at the time of the visit. Some training updates were overdue and the manager was aware of this and had made plans to rectify this. Key inspection report Care homes for older people Name: Address: Bramshall`s Old Rectory Leigh Lane Bramshall Nr Uttoxeter Staffordshire ST14 5DN     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: Joanna Wooller     Date: 1 3 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Bramshall`s Old Rectory Leigh Lane Bramshall Nr Uttoxeter Staffordshire ST14 5DN 01889565565 01889565415 anil_r_patel@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Tudor Care Plc care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: PD minimum age 60 Years Date of last inspection Brief description of the care home Bramshall Old Rectory is a 30-bed Care home, providing personal care and nursing care. The home is registered to care for people with physical disabilities, needs associated with old age, or dementia related conditions. The home is situated in the village of Bramshall with good road access to Uttoxeter, some three miles away, in delightful country surroundings. Excellent views are afforded over the rolling Staffordshire countryside. The original buildings have been extended, lifts and stairs access the three floors. A homely environment has been created throughout. Hotel services and facilities including bathrooms, laundry and catering are good. Communal and lounge facilities are spacious and well furnished. The Care Homes for Older People Page 4 of 25 Over 65 3 15 25 0 0 20 Brief description of the care home home has 26 single and two double rooms for married couples or those who prefer to share. Nurses and care assistants led by a Registered Manager, who is a first level nurse, deliver care. Staff training is given a high priority. Health service professionals such as district nurse, community psychiatric nurse, and physiotherapist are accessed when required. Local Doctors who are also a pharmaceutical dispensing practice service the home. Activities, hobbies and entertainment all take place and transport is provided when required. Families and friends are encouraged to take part in activities and to be involved with the home. The home has not published its fees for residency in the Service User Guide. Readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that that people who use this service experience good quality outcomes. This unannounced inspection was carried out by one inspector over one day between 0900 and 1500 hours. The Manager was in the home and she participated in the inspection process. The inspection included the following elements A walk around the building, observation and inspection of care records, discussions with people who use the service, case tracking whereby we select several people who use the service, chat to them and look at their care plans and lifestyle in the home. Discussions with several of the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues and training, recruitment and health and safety. We were made welcome in the home and all assistance was given to gain the Care Homes for Older People Page 6 of 25 evidence required for the report. We had dealt with no complaints since the last key inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have information available for people to use, to enable them to make a choice about living there. Each person will have their needs assessed prior to admission. There are no intermediate care beds in the home. Evidence: The AQAA told us We regularly review the care package for each resident to ensure that ongoing needs are met and changes catered for. Customer satisfaction surveys are positive and we have very few letters of complaint and many letters of appreciation. We saw that the care plan was generated from the initial pre-admission form. There was evidence that people were only admitted once the pre-admission assessment was carried out. One lady told us that the care manager met her prior to admission and they discussed Care Homes for Older People Page 10 of 25 Evidence: her care needs and expectations before she visited the home. One relative told us that the home were marvelous, that the manager had supported them all from the first meeting on wards and they were informed of all the necessary information. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service each have an individual plan care which sets out their health, personal and social needs. The health care needs of the people are met and they are protected by the homes medication policies and procedures. Individuals living at the home are treated with respect and their right to privacy is upheld. Evidence: The AQAA told us Care plans, training, equipment and policies are all regularly reviewed, assessed and in place. Our care plans are comprehensive and ensure that a uniform standard of high quality care is continually delivered. We saw that the care plans were comprehensive and suitably reviewed. Health, personal and social care needs were documented. People living in the home are supported to by the staff to maintain varying levels of Independence and there was evidence that their privacy and dignity is considered at all times. We saw evidence that specialist medical, nursing and therapeutic services are accessible at all times and the home supports the people to attend hospital appointments if necessary. The Care Homes for Older People Page 12 of 25 Evidence: District Nursing service supports some people living in the home that receive personal care only. We saw that the care records reflected the current condition of those people case tracked during the visit and relevant intervention was recorded and reviewed. Medication administration, storage and ordering/disposal were inspected. The medication refrigerator temperatures were recording high and this was to be investigated by the care manager. One persons medication had been refused and not discarded and this was also brought to the attention of the care manager. The medication policies and procedures were otherwise followed and no issues were raised. One relative commented On arrival Mum was made so welcome and she has settled well. I dont think we could have found anywhere more lovely. She eats well and joins in most of the activities. Another relative told us We cannot praise the home, the manager and her staff enough. You could drive for miles and not find a better home. The staff are all marvelous, caring and friendly. We have total peace of mind when we leave the home, that she is being well looked after. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 experience the lifestyle, which matches their individual expectations. They have contact with relatives and friends as they wish. People who use the service exercise choice and control over their lives and they receive a balance and wholesome diet. Evidence: The AQAA told us The home has its own activity coordinator who organizes games, quizzes and other activities both in house and from outside people. People are encouraged to go out with their families and friends who can also visit and participate in the home if they so wish. Many families attend social activities. We saw that the people in the home benefited from a full activities programme which catered for all abilities and needs. The full-time activities coordinator is highly motivated to ensure that each person has their individual social needs met. Some physical activities are performed along with quizzes and craft sessions. We saw that visitors were welcome into the home at all times and persons living in the home enjoyed visits out of the home and receiving visitors in the home. Care Homes for Older People Page 14 of 25 Evidence: We saw that the kitchen was well managed and they had received a 5 star rating from the local environmental health officer. The menu was varied, well planned and had seasonal changes made to cater for fresh fruit and vegetables. The menu changes were discussed with the people living in the service at resident meetings and options were given at each meal time. One lady told us I visit the church locally and enjoy going to friends for tea. The staff give me choices and ask me if I would like to join in activities and I have a choice whether to or not. I have visitors to my room or we chat in the lounge. One relative told us Mum is eating a lot better at the moment and I think the menus are varied and the food very good. A relative survey told us I am so pleased Mum joins in with most of the activities and really enjoys them. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident that their complaints will be listened to and acted upon. People who use the service are protected from abuse. Evidence: The AQAA told us The complaints procedure is displayed in the hallway at the entrance to the home. All staff are POVA checked prior to employment being commenced. POVA training is given to all staff on induction and an annual update is given. Any concerns are dealt with immediately. A quality review system allows people to air their views. We saw that the complaints procedure was displayed in the home and training for staff had been carried out. People who used the service told us that they were listened to and action was taken to resolve any concerns. They told us they welcomed the customer satisfaction survey as they wished to praise the staff in writing and confirm their satisfaction. One lady told us The staff are friendly but not too friendly, they listen to me and show me respect. If I have any concerns I would speak to the Manager or one of her senior staff, and I know they will deal with it professionally and quickly. One relative told us We always feel comfortable about raising any issues and we know that the staff will listen and the concern will be acted upon. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a safe, well-maintained environment that is clean, pleasant and hygienic. Evidence: The AQAA told us The home is well maintained and we try to give a homely feel in a non institutionalised environment. The home is well kept and free from odours. The home is a safe place to live. Maintenance is on going and we employ a maintenance man daily. A gardener comes to the home weekly to ensure the upkeep of the home is a very high standard. The home operates a rolling policy of decoration and the home tries to use quality fittings where possible. Infection control is taken very seriously and staff have protected clothing available and mandatory training is given. We saw that the home was clean and tidy and well maintained. The hygiene levels at the home were of a good standard and the protective clothing was available for the staff to use. We saw several bedrooms which were well personalised and comfortable and appreciated by the people living in them. Some people told us that they were very happy with their stunning view of the countryside and their comfortable surroundings. One lady told us This is my home, and the staff respect my space. The home is well maintained and very clean, the staff assist me to keep my room clean and tidy. A relative told us The home is immaculate, yet comfy and homely. The staff make it very welcoming at all times. Care Homes for Older People Page 17 of 25 Evidence: The staff told us that they all take care in the appearance of the home and assist the domestic to maintain a high standard. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are in safe hands and have their needs met by the numbers and skill mix of staff. People who use the service are supported and protected by the homes recruitment policy and procedure. The staff are now trained and competent to do their jobs. Evidence: The AQAA told us Many staff have worked at the home for many years and are very loyal and dedicated. They all promote the home and offer a high level of care. Recruitment policies and procedures are followed prior to employment. We try to take a cross section of staff from the local community to give diversity to residents. The home operates a staff appraisal and supervision tool. We saw that the staffing levels were based on meeting the needs of the people living in the home. Staff competency was considered whilst compiling the duties. Domestic staff are employed in sufficient numbers to ensure that standards relating to hygiene, food, meals and general issues in the home. We saw that recruitment policies and procedures were being followed correctly and staff were supervised and appraisals carried out. Staff training was given, however a few annual updates had lapsed for some staff. The manager had addressed this with training that was to be held over the next two months. We noted that NVQ trained staff was below the minimum ratio of 50 although several staff were in the process of completing their level two training Care Homes for Older People Page 19 of 25 Evidence: and six staff had their level three qualification. The manager is to commence her Registered Managers Award as soon as it can be arranged by the trainer. People that live in the home told us The staff are marvelous, they are kind and patient. They always have time for a chat and take pride in their work. One lady told us The staff have been here many years, that speaks for itself. They are very dedicated and go that extra mile which makes all the difference. Visiting relatives told us The reputation of the is home is due to the staffs dedication. They are very professional and sincere. Relatives commented The staff have always been kind, helpful and friendly. and The staff are great. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a home, which is well managed by a responsible manager. The home is run in the best interests of the people who live in it.People who use the service have their finances safeguarded by the homes procedures. The health, safety and welfare of people who use the service and the staff are promoted and protected. Evidence: The AQAA told us The home as implemented a quality assurance package that all residents and families have received. Regulation 26 visits are recorded and the AQAA submitted when required. The manager is the registered manager for the home. The proprietor attends the home on a regular basis both announced and unannounced. Residents can maintain their own money in a lockable facility in their own room. The home has recently had a Health and Safety visit (HSE) and those requirements left have been addressed. We saw the manager of the home is now registered manager and is due to commence Care Homes for Older People Page 21 of 25 Evidence: the managers award in the near future. The quality assurance system in place at the home has been a great success, positive feedback has been generally received and any smaller issues or concerns have been addressed internally. People living at the home can maintain Independence with their finances should they so wish and they have the use of a lockable facility in the room. The home does not keep any persons money. The health, safety and welfare of people using the service and the staff are promoted and protected by the safe working practices followed in the home. Staff training in moving and handling is on going to ensure staff are fully updated, fire safety training and food hygiene training is to be completed next month to ensure all staff are appropriately trained. Staff competency is discussed and reviewed through annual appraisal and staff supervision which was completed by the manager. We saw accident records which were reviewed and analysed by the manager and senior staff. Staff had all received induction training and the manager was considering introducing foundation training for those staff that were not NVQ trained. People living at the home told us The manager is a lovely person, very friendly but caring and professional. She has a wonderful team of staff that respect her. She comes to see us all when she is in the home, and my visitors think she is smashing. One lady told us The manager makes the home, she is very approachable and keeps her promises. Relatives spoken to said The manager has made this a very good home, the local reputation is second to none. We are more than happy, Mother is very settled and doing very well. She likes the staff, the food and her room. We have no complaints because the home is well managed. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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 1 9 Medication should be stored at the correct temperature and appropriate action taken when the refrigerator temperature is too high. Medication administration policies and procedures must be followed at all times. The manager must ensure that staff training updates are annually addressed and avoid training timescale being over due. She must arrange for the manager award training to commence. The planned training for Food Hygiene, First Aid and a Health and Safety refresher course must all be completed as per the in house training plan. 2 30 3 31 Care Homes for Older People Page 24 of 25 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. 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