Care Home: Bramshaw House

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What the care home does well Bramshaw House provides a homely, safe and comfortable environment for the people who live there and people say they are very happy living there. To ensure that the home can meet the individual and diverse needs of service users, comprehensive pre admission and care planning processes are undertaken to ensure that people receive the care they need, people and their families are involved in writing a person centred plan of care. People have access to a variety of healthcare professionals and both their personal and emotional healthcare needs are being well met. The home is to be commended on the variety of educational, day care and social activities being provided for people and service users tell us that their lifestyle choices are respected and that they are treated with dignity and respect. To ensure people are kept safe there is a robust staff recruitment process in place and people are being cared for by a caring staff team who have the skills qualifications and training to support people with a learning disability. Service users tell us that the staff are kind, caring and friendly. The home is managed in the best interests of both service users and the staff team by a competent and committed manager and there are ongoing plans for future development and improvement of the home. What has improved since the last inspection? Since the last inspection the home has made improvements in several areas. These were outlined in the homes Annual Quality Assurance Assessment as follows; `The way in which the home manager reports back outcomes of service user meetings to the service users has improved. The risk taking procedure has also been streamlined which means implementation happens swiftly.` `An improved activity plan and better organisation has maximised the amount of time service users spend in the community pursuing leisure activities and interests.` `Consistency has improved and staff are more aware of the importance of communicating verbally at all times during personal care tasks to put service users at ease.` `Maintenance tasks have been completed improving the overall condition of the home. Extra lighting has been added to the kitchen to improve working conditions and a new floor laid.` `More frequent supervision and tighter management of staffing issues` `Staff training has improved overall` What the care home could do better: Bramshaw House should continue to develop the high quality care currently being provided and also continue to consult with service users and families about the future developments of the home Key inspection report Care homes for adults (18-65 years) Name: Address: Bramshaw House 13 Shakespeare Road Worthing West Sussex BN11 4AR     The quality rating for this care home is:   three star excellent 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: Beth Tye     Date: 1 0 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Bramshaw House 13 Shakespeare Road Worthing West Sussex BN11 4AR 01903238945 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: bramshaw@tiscali.co.uk Miss Rebecca Karen Ward,Mr Jonathan Shepherd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is ten. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Learning disability (LD) Date of last inspection Brief description of the care home Bramshaw House provides a home for ten adults with Physical and Learning Disabilities between the ages of 18 and 65 years. The service is based in a detached house in Worthing, which is fully adapted to meet the needs of the residents. Accommodation is split over two floors. A lift is available for residents to access both floors. The property is situated in a residential area close to the town centre, local amenities Care Homes for Adults (18-65 years) Page 4 of 30 10 10 Over 65 0 0 Brief description of the care home and sea front. Rebecca Ward and Johnathan Shepherd are the Registered Providers of Bramshaw House. Karen Brown the Registered manager of the home. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. In order to plan for this unannounced visit, an Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion and satisfaction surveys were sent to service users and professionals involved with the home. The AQAA was returned before the date it was due and contained very good information about the services on offer in the home. Service user, staff and professionals surveys were also returned and all made very positive comments about the care and support being provided. Comments from surveys have been used in this report. Care Homes for Adults (18-65 years) Page 6 of 30 During the visit to the service we looked at care plans and all supporting documents such as daily records and health plans and we spoke to the staff on duty about how they were aware of the needs and wishes of the people they are supporting. We looked at recruitment files, staff training files and evidence of supervision and we asked the staff about the training and support they receive. Records for the running of the business were seen and these included complaints and comments, incident and accident recording, health and safety records and the homes insurance and registration certificate. The Registered Manager, Karen Brown and the Registered Individual Rebecca Ward were present and received feedback following the visit from the inspector. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last inspection the home has made improvements in several areas. These were outlined in the homes Annual Quality Assurance Assessment as follows; The way in which the home manager reports back outcomes of service user meetings to the service users has improved. The risk taking procedure has also been streamlined which means implementation happens swiftly. An improved activity plan and better organisation has maximised the amount of time service users spend in the community pursuing leisure activities and interests. Consistency has improved and staff are more aware of the importance of communicating verbally at all times during personal care tasks to put service users at ease. Maintenance tasks have been completed improving the overall condition of the home. Extra lighting has been added to the kitchen to improve working conditions and a new floor laid. More frequent supervision and tighter management of staffing issues Staff training has improved overall Care Homes for Adults (18-65 years) Page 8 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were not accommodated in the home without a full assessment of their needs being carried out. The home does not offer intermediate care. Evidence: The AQAA said Prior to any potential admission, service users are encouraged to visit the home to meet the residing service users, staff and manager. They are given the opportunity to spend time in the home and take part in the daily routine and activities. Where appropriate overnight stays are encouraged. Evidence shows that Bramshaw House meets the needs and choices of each individual and continues to develop their care and social interaction. This is demonstrated through the person centred care plan and regular key worker meetings. Before being finalised, the care plan will be reviewed with the potential service user and their representatives. The plan will look at all the aspects of an individuals care; life history, communication, elimination, clothing, mobility, eating and drinking, sexuality and relationships, culture Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: needs, strengths, likes, dislikes, risk assessments and money management. We have also developed a pictorial service user guide for service users who understanding of written word is limited. We support and encourage service users to apply for and attend college courses. Since the last inspection there have been no new admissions to the home. Bramshaw House provides prospective residents with detailed information regarding the home prior to admission. This enables people to make an informed choice about moving into the home. Information is provided in a comprehensive Service User Guide and a Statement of Purpose. The manager stated in the AQAA (Annual Quality Assurance Assessment), that both documents are up to date. Residents fed back through surveys that they had made a choice to live at Bramshaw House and had received information regarding the facilities and services available, as well as the opportunity to visit prior to admission. The home does not offer intermediate care. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In order to guide the staff team to the needs and wishes of each person living in the home, there are good person centred care plans in place and people are supported with independence and choice in their daily lives. Evidence: The AQAA said Service users care plans and our activity programme demonstrates a commitment to individuals needs and preferences. Service users are supported to pursue individual tastes and preferences. As a service we ensure that individuals undertake the activities that they have requested, for example, day services, college courses, bowling, shopping, visits to home matches at Brighton and Hove football ground, and continued membership with a Ranger group in Croydon. Most service users have families who visit the home on a regular basis. Contact is encouraged and there is an open door policy whereby family and friends are welcomed at all times. On the day of the visit a resident had requested to go and visit his parents at short notice. Due to good staffing levels and flexibility in the daily programme this was able Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: to be accommodated. Worthing town centre is situated very close to the home, allowing access to the wider community for all service users. The close proximity of the town centre and good staff ratios enables service users to be spontaneous and access the community in the same way as those without mobility difficulties. All services users are well known in their community and are greeted by neighbours and staff in shops in the venues they visit. Bramshaw House has two adapted vehicles available, should service users which to access venues further afield. The service supports and encourages service users to maintain links with relatives and friends and to develop new friendships and social contacts. Each service user has their own room, decorated and furnished to individual preferences. Service users are included in the development of the menu, and the menu and times of meals can be flexible to suit each individual. Records seen and feedback demonstrate that care plans are updated on a monthly basis. These changes take into account information from service users key work sessions and house group meetings. The activity programme is reviewed on a weekly (sometimes daily) basis to ensure that the home offers flexibility and caters for the needs of each individual. It also allows for any specific local event to be included in the programme should the service user which to attend. There are detailed environmental and personal risk assessments in place. These are designed to aid peoples independence and choice. All are signed by staff and residents and are regularly reviewed to ensure everyone is aware of the exisiting agreeements. When required these are updated to suit residents requests and preferences. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Feedback from relatives and residents reflected positive views about the activities the residents took part in. Relationships outside the home are encouraged and supported by staff. The menu at Bramshaw House offers a range of healthy balanced meals. Evidence: The AQAA said We support the service users to develop their skills and promote independence and inclusion in the local community. Service users are supported to maintain a healthy lifestyle, through diet, exercise and social interaction. Staff are encouraged to act as role models for service users and support them to set and achieve individual targets. The town centre is very close to Bramshaw House that enables service users to take advantage of the social aspects of the town, and encourages them to be involved in their local community. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Bramshaw House has a flexible activity plan, that is revised each week, based on individuals needs. The staff support service users to maintain existing relationships and develop new social networks. Residents go on outings together and daily as individuals. These were seen recorded in daily diary sheets and individual files. Each activities plan is specific and flexible according to the needs and wishes of the individual. Examination of recording sheets, daily diary sheets and care records supported this information. The inspector noted that each activity is risk assessed in detail and residents abilities and limitations are considered. Some residents who gave feedback to the inspector said I can help in the kitchen when I like and stay up as long as I wish There are lots of activities and good choices There is good food on the menus and its very good Staff always treat me well They look after me very well Staff are really good and always help me I like my room Staff took me on holiday I like going out for trips with staff Activities attended by the residents are recorded as part of the care planning process. The inspector observed a relaxed and friendly rapport between staff and the resident during the inspection. Written feedback from families and residents confirmed family contact and relationships outside the home is promoted. Some residents have home visits on a regular basis. All contact visits are recorded in residents care plans. A visitors policy is in place to support this. The inspector examined menus for the home. A staff member stated if residents changed their minds on the day an alternative could be offered. A record of what the residents eat on a daily basis is kept in their care file along side nutrition assessments and weight monitoring charts. Care plans also reflect detailed information relating to dietary requirements and records showed residents are involved in choosing their menus on a weekly basis. The kitchen area was very clean and tidy. The inspector observed adaptations in place to ensure residents can participate in preparation and cooking of food safely. Residents are involved in all the domestic tasks on a level that is appropriate to their ability to participate. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care and support in the way they prefer, all aspects of this is detailed in their care plans. Medication is stored and labelled correctly. All staff receive training to ensure good practice is carried out. Evidence: The AQAA said Service users at Bramshaw House have high physical support needs. Staff are trained and assessed during their induction period to ensure that they are competent in moving and handling techniques. Services users are involved in developing their own personal care guide lines to ensure that their preferences are included in the plan. This is then documented and used as a working programme. Each service user receives a Health Care Assessment, which is carried out by the appropriate GP surgery. Any health care issues identified at these assessments are dealt with promptly. All service users are registered with a local GP, dentist and access the community teams for people with learning disabilities. At present all service users are supported with medication, but should the situation arise where a service user could self medicate they would be supported and a risk assessment would be developed. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Care files examined by the inspector held information relating to all aspects of healthcare and medication for individuals. These were divided under specific headings such as; Mental Health professionals information, personal care, behaviours, daily routines, GP contact sheets, diet, weight monitoring charts, toileting charts and MAR Charts. The records are all detailed and up to date. Management plans are in place to ensure consistency of personal care in line with assessed needs. All plans are detailed and correspond with information and preferences detailed on care plans. Bramshaw House has systems in place to monitor the following: food/drink intake, elimination, catheterisation, warfarin levels, behaviours, GP and dental appointments, wheelchair assessments, physiotheraphy. All information is recorded in individuals care plans and up dated regularly. Individual files showed residents have access to community health specialists. Records of all dental, optician, chiropodist and GP appointments are recorded on file in daily sheets and in the residents care plans. A key worker system is in place and records of these meetings were seen on individual plans. Following each meeting the care plan is reviewed and updated. Staff have a linked supervision for staff to reflect on issues and practice with the manager of the home. Residents preferences in respect of health issues and personal care are detailed on their files and up dated regularly following reviews or key worker sessions. Policies and procedures relating to all aspects of healthcare and medication administration are in place and up to date. Staff are trained at induction in the administration of medication and all medication is stored, recorded and administered in line with current legislation. Should a service user require specialist input, referrals are sent promptly to the appropriate service. Medication is administered using the Lloyds MDS system and all legislation procedures relating to the ordering, storing and recording of medication is followed and adhered to. All medication is kept in a locked cabinet and refrigerated medication is kept in locked chilled storage. Two members of staff must be present to administer medication and sign the MAR sheet. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their families can be confident that their complaints and concerns will be recorded and acted upon, peoples money is safely managed and the staff team are aware of their responsibilities regarding protecting people from risk of abuse or harm. Evidence: The AQAA said Any concerns and complaints are taken seriously and responded to with out delay. The management structure means that the home manager and provider are always available to address concerns promptly. This means the complaint does not escalate. Adult protection and abuse is a matter which is taken very seriously at the home. As with complaints, any suggestion of abuse (of any type) is fully investigated and addressed immediately. The home has a detailed procedure for complaints, which is included in the Service Users Guide and Statement of Purpose. All complaints information is printed in a format suitable for residents to ensure they are clear about their rights within the home. The complaints log was seen and there have been no complaints recorded since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Any incident in the home has been recorded and kept on file. A copy has also been forwarded to the Commission as a Regulation 37 report. Residents have monthly meetings. The minutes of which were seen on file. Adult Protection policies and procedures are detailed and up to date. Staff will use these alongside County Procedures and guidelines, which are available in the staff office. All staff have received POVA training in respect of working with vulnerable adults. Staff undergo appropriate recruitment checks prior to employment to ensure they are eligible to work with vulnerable adults. These checks are held on personnel files. Detailed risk assessments for individuals and the environment are under taken by the home. These were specific to individuals and where possible all possible risks had been identified and reduced or eliminated. Risk assessments seen are reviewed on a regular basis and up dated as required. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is of a high standard, offering safe and clean living space for residents and staff. The home is currently under going a programme of re-decoration. Evidence: The AQAA said We aim to provide a living environment that is homely and comfortable for the service users. We strive to maintain a clean and spacious home for the service users. The home is currently being re-decorated. A tour of the premise was carried out. Bedrooms were furnished and decorated to an extremely high standard. Residents have the opportunity to chose their rooms prior to admission and re-decorate to their own preference. The inspector observed residents have their own personal items and pictures in their rooms. Radiators throughout the house are covered. An on call system in bedrooms and communal spaces is in place so ensure a speedy response from staff should an emergency arise. There is a large modern communal lounge (with large flat screen TV, DVD and Hi-Fi), which has patio doors leading to the garden. The dining room is large and well lit with modern furnishing. The home has a large modern kitchen, where the residents were Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: observed spending time with staff while lunch was being prepared. The home has a large, mature garden with a lawn and seated patio area, for residents to make use of in the warmer weather. A sensory room overlooks the garden which contains lights, optic lamps and sensory stimulation. Residents are encouraged to use this space for relaxation. A laundry room provides a large washing machine with sluice facilities and tumble dryer this is kept locked for reasons of safety. The inspector noted there is sufficient storage space throughout the home. Staff training files contained Food and Hygiene and Health and Safety certificates. (Seen for staff on shift) The training programme also includes infection control and COSHH training for all staff. This promotes good practice in respect of hygiene and reduces the risk of infection spreading throughout the home. A fire alarm and emergency lighting system is in place. Records showed these are checked and serviced on a regular basis to ensure the safety of staff and residents. The inspector examined detailed environmental risk assessments for the premises. The registered manager has identified all areas within the home, which pose a risk to the occupants and identified ways for these to be eliminated or reduced. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bramshaw House has an efficient recruitment procedure in place. The staff employed to work at the home receive on going training to meet the assessed needs of the residents. The inspector concluded the residents benefit from a well supported and effective staff team. Evidence: The AQAA said Induction process at Bramshaw House ensures that all staff are trained in company policy and procedures before they begin working with service users. Staff are recruited form a diverse base which means the home benefits from a broad range of skills and experience. The home is fully staffed and we do not use agency staff. There is a low staff turnover which ensures consistency for the service users. Staff receive training and information from a variety of sources which equips them to understand the needs of the service users and requirements of the Care Standards Act 2000. Staff records hold appropriate POVA/CRB checks. Additional information seen demonstrated the homes recruitment procedures had been adhered to. Evidence of staff inductions and the on going training programme for staff members, including specialist training relevant to individuals assessed needs were evidenced on Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: individual staff files. Training records for staff indicated all staff to date have attended relevant training and records were efficient and up to date. Feedback from staff surveys supported these findings. Records of meeting minutes and feedback from staff confirmed they attend staff meetings. Staff comments praised the manager and provider for their supportive and inclusive approach. The inspector concluded, following observation and feedback from staff that they were clear about their roles and responsibilities within the home. The home currently has a full staff compliment, and does not employ agency workers to ensure consistent practice. Additional staff are available for shifts, which enables the home to offer flexibility to residents. For example if a resident wanted to undertake an activity at short notice, this could be arranged without disrupting the routine of others. Feedback, recording and observations led the inspector to conclude that the staff currently in post functioned effectively as a team and were supported by the management in doing so. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good practice in the home was evident. This is supported by an experienced management team and efficient administrative systems, which promote the health, safety and welfare of the residents in respect of their assessed care needs. Evidence: The AQAA said The managers office is in the heart of the building, allowing an open door management style for both staff and service users. This also enables the manager to be aware of the day to day running of the home and to be available should staff or service users require additional support. Quality assurance system is in place and is implemented regularly by the provider. This addresses the running of the home, ensures service user views are sought and provides a useful tool to develop future aims and targets. The manager oversees all health and safety matters and is aware of current legislation (and updates) in residential care. The manager keeps records of all incidents, accidents, training, policy changes and updates, environmental health visits and fire visits, etc. The registered manager has completed her NVQ 4, RMA qualifications and a City and Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Guilds training certificate. The deputy manager holds NVQ 4. The manager has 17yrs experience in care, 7yrs as a manager. The manager and deputy ensure policies and procedures are implemented and updated with changes in practice and legislation. All service users have a contract and the managers ensure that care standards are maintained and where possible exceeded. The managers support staff to develop skills and attributes which will enhance their work practice. The home is run in the best interests of service users, by a capable and competent manager who has the skills, experience and knowledge to manage a home for people with learning disabilities. Service users, the staff on duty and a family member spoke highly of the manager describing her as open, approachable and always willing to listen. Comments in returned surveys included, There is regular training and supervision Residents are offered a good range of activities Care plans are always well kept and up to date The care at the home is excellent The management listen to staff and residents The home has good links with outside agencies Some Health Professionals commented The manager is available and contributes to assessments The staff enable the service users to be heard and express themselves I am confident my recommendations and advice will be listened to From the evidence collated for this inspection it is clear Bramshaw House carries out good practice in all aspects of the home. This is promoted by experienced and committed management and staff who are supported by efficient administrative systems. This promotes the health, safety and welfare of the residents, in respect of their assessed care needs. There is an ongoing process of quality assurance, which includes Providers visits being carried out regularly and satisfaction surveys being sent to service users, families, health care professionals and others who have an interest in the home. The home offer regular meetings for staff, residents and their families to promote their input into the way the home is run. Policies and procedures to guide the staff team to the ethos and working practices expected by the home are in place and are introduced to new staff during the induction period. All staff are required to read and sign documentation relating to their role to demonstrate their compliance and understanding. Records for the running of the business and regular maintenance checks suck as hot Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: water temperatures and fire drills are carried out and up to date. Alongside the manager, a maintenance man undertakes regular health and safety improvements in the home. Records are up to date and environmental risk assessments are also regularly updated. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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). 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