Care Home: Bramwell Care Home

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What the care home does well This is a well managed service and the home provides a warm safe environment for people, it is clean and well maintained and benefits from routine maintenance and good records of health and safety at work compliance. People are always assessed before they come into the home to make sure that the facilities and services offered can support their needs. The provision of a care plan enables people to participate and be consulted on what care they expect to receive and informs staff of the way people wish to be supported. People receive opportunities to take part in activities. The staff team receive training regularly and the topics consider the needs of those people they care for to ensure they know how to deliver the right care. People who live there and their relatives tell us they like the staff team, feel confident that there is enough staff with the right skills and that their dignity is upheld. What has improved since the last inspection? The service demonstrates that it is continually improving through keeping up with changes in legislation, regularly training staff to update their skills and through listening to people who use the service about what is important to them. What the care home could do better: We have not made any requirements as a result of this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bramwell Care Home Chilwell Lane Bramcote Nottingham NG9 3DU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Bramwell Care Home Chilwell Lane Bramcote Nottingham NG9 3DU 01159677571 01159076114 paul.ward@nottscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Nottinghamshire County Council care home 59 Number of places (if applicable): Under 65 Over 65 15 14 30 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 15 14 0 20 Cinnamon will have 15 beds in total for OP aged over 65 years to include up to 5 PD 55 years and over. Honeysuckle will have a total of 15 beds for DE(E) over 65 years to include up to 15 DE 55 years and over. Jasmin Wing will have a total number of beds of 14 MD(E) over 65 years to include up to 14 MD 55 years and over. Lavender will have a total of 15 beds OP over 65 years to include up to 15 PD 55 years and over. No long-term residents to be admitted to Lavender. Total number of residents must not exceed 59 Date of last inspection Care Homes for Older People Page 4 of 27 Brief description of the care home Bramwell Care Home is owned and managed by Nottinghamshire County Council Social Services; it is a purpose-built care home for 59 older people. The home is divided into four units caring for peoples different needs: older people (Cinnamon), older people with dementia (Honeysuckle), older people with mental health problems (Jasmine) and in intermediate care unit offering rehabilitation older people prior to returning home (Lavender). The accommodation is provided over two floors with two passenger lifts to assist independent access. All bedrooms are for single occupancy with ensuite toilet and shower facilities. There are well-maintained enclosed gardens, which are easily accessible by all people living in the ground floor accommodation. The weekly accommodation charges are £390.00. A copy of the most recent inspection report is available in the home. Care Homes for Older People Page 5 of 27 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 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 focus of inspections undertaken by the Care Quality Commission is about the outcome of the care provided to people using the service. This process considers the providers capacity to meet regulatory requirements and focuses on aspects of service provision that need further development. The main method of inspection used was called case tracking. This involves selecting the care records of 3 people and looking at the quality of the care people receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Care Homes for Older People Page 6 of 27 People living at the home, their relatives, members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided. A range of information was considered in planning this inspection, we looked at what the provider told us they were doing in their Annual Quality Assurance document (AQAA) that they sent to us last year and the most recent responses we received from our surveys to people using the service. We reviewed all the information we had received through complaints, safeguarding alerts and statutory reporting. 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 set out 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 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive an appropriate assessment of their needs which focuses on them receiving a positive outcome by ensuring the home has the appropriate equipment skills and services to meet the diverse needs of each person. Evidence: We saw how anyone wishing to come into the home is provided with plenty of information about the services provided at Bramwell and the standards they can expect. The information is made available to people in different languages and formats to suit different needs. The 4 separate units provide a range of services from intermediate care, assessment, short and long stay accommodation. Information on the specialist services provided by each unit is available and copies of the information are provided in each persons room. Care Homes for Older People Page 10 of 27 Evidence: The service has a sustained track record of ensuring that people receive a proper assessment of their needs before admission is agreed and this inspection found that staff continue to make admission personal and well managed. Relatives tell us that they also feel supported by the staff team. The intermediate care unit provides rehabilitation for people with NHS trained staff available to appropriately plan and supervise therapy and treatment. We saw that people have access to appropriate equipment to support their needs in keeping with their plan of care and rehabilitation. Staff were deployed from relevant professions including occupational and physiotherapists. Training records show that the staff team receive training in the needs of people that the home provides care for to ensure they are fully up to date and that people receive appropriate care with positive outcomes. Care Homes for Older People Page 11 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work to a high standard to ensure that people have their health and personal care delivered according to their needs and wishes, and medicines are managed safely to ensure the health and wellbeing of people in the home. Evidence: We case tracked a person from each unit in the home and spoke with their key workers, in each case the staff had ensured that a care plan was in place which was written in a style that was easy to understand and showed that all areas of the persons physical and psychological needs had been assessed to form the plan of care. The staff had ensured that the health needs of people were regularly reviewed and any risks they identified had been addressed safely by the provision of equipment and referral to specialist services as required. The key workers we spoke to demonstrated a thorough understanding of each persons needs and recognised peoples individuality and methods of communication, which Care Homes for Older People Page 12 of 27 Evidence: ensures they would be alert to any changes in a persons general wellbeing and respond appropriately. Daily records of personal care delivery and the application of creams and ointments showed staff were diligent in their work. The staff training records demonstrated that training is seen as important in the delivery of care by ensuring the staff are trained in the needs of the people they care for. We spoke to people using the intermediate care service who told us how they had been helped to regain mobility and improve continence during their stay. Their care plans showed how trained nurses set rehabilitation goals in areas such as mobility and continence which the homes care staff use to provide the support needed to rehabilitate people safely. Records were consistently completed to a good standard. We spoke to 6 people using the service and each said they were very happy with the care they receive. People said they were afforded privacy with the provision of private spaces, lockable bedrooms and separate day areas. They said staff always respected their privacy and when providing personal care upheld peoples dignity. People told us that staff support the whole family not just the individual who is using the service, relatives told us they feel welcomed by staff and kept informed of any issues that may affect peoples wellbeing. We observed how staff interacted with people, taking time and care to maintain peoples dignity in situations that required patience and understanding of the persons individuality and health. We examined how medicines were being managed and found that staff work to recognised safe practices in the receipt, storage and administration of medicines to a consistently high standard. Staff told us how they had prompted the review of everyones medicines this year to reduce the medicines people were taking wherever possible. Staff told us they receive training in medicine administration before they undertake this procedure and we saw their training records upheld this. We did see slippage in ensuring that hand written medicines were signed and witnessed as is recommended to reduce the risk of error and also that medicine policies required updating to make sure all changes in legislation are considered and planned for such as numbered pages in a controlled medicine register that are tamper proof. Care Homes for Older People Page 13 of 27 Care Homes for Older People Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service shows a strong commitment to enabling people to develop and maintain their skills as individuals and promotes choices in activities. Nutrition is recognised as important by ensuring people have suitable diets to meet their preferences and to maintain their health. Evidence: We saw evidence that the service has a strong commitment to enabling people to live meaningful lives, providing a range of activities that suit them. Staff take time to find out about peoples previous interests and record these within their care plans, they are person centred and show what is important to the individual. From this information they then support people to take part in suitable activities, one person we spoke with was taking a flight to see a family member the next day, supported to the airport by staff. We saw within the minutes of meetings held how people had given their views on a recent fish and chip night, this had been thoroughly enjoyed and as a result another was planned. People had also requested a knitting club which we identified as being Care Homes for Older People Page 15 of 27 Evidence: organised. Each care plan we looked at contained a record of what activities they were taking part in and these were reviewed each month. Key workers were able to tell us about peoples preferences showing they were knowledgeable about peoples needs and safety. There are rehabilitation kitchens that people can learn domestic tasks before returning home. People we spoke with said they were able to have regular hairdressing in the homes salon or visit the coffee bar on the ground floor with their relatives. The garden area provided a safe enclosed space that people could access and enjoy. Staff told us they received training in nutrition and we saw how they record peoples weight regularly, completing an assessment that alerts them to any changes in the nutritional support they may require. Menus are posted on each unit and there are spacious, homely dining rooms for people to access. People told us they felt the meals provided were appetising and that they could choose something different if they wished. The home recently had an inspection of the kitchen by the Environmental Health Officers and we saw that within their report dated December 2008 they had found the food operation in the home was run to a very high standard in all respects which deserved credit. Regular church services are held in the units and dates of these are displayed on the notice boards. Care Homes for Older People Page 16 of 27 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. There are robust procedures in place to ensure peoples views are taken seriously and they are protected from harm. Evidence: We could not examine the homes complaint records during this visit because the manager had taken them away to work on documents, however we saw that each person is supplied with a complaint procedure in their information pack that tells them about their rights and external agencies that can support them as advocates if they require this. The commission have not received any complaints about the service since the last inspection. People tell us they feel safe, listened to and taken seriously and we have seen that people have opportunities through meetings and care reviews to discuss any minor problems they may experience. Staff told us that they understand how to respond to any concerns they have regarding abusive practices and they knew about the local procedures to safeguard vulnerable people. Care Homes for Older People Page 17 of 27 Evidence: The homes recruitment practice was seen to be robust and protect people from anyone that may not be suitable to work in the home. Staff are trained to deal with any potential or actual aggression in a way that protects people from harm. There have been 2 safeguarding investigations since our last inspection, one is not concluded and the second was upheld with appropriate actions taken by the management of the home to protect people who are unsuitable to work with vulnerable people. Care Homes for Older People Page 18 of 27 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. The environment is well maintained and suitable for its stated purpose. Evidence: The 4 units were found to be very clean and well maintained throughout. The home provides single rooms only with shower and wash hand basin. Further bathing areas provide suitable hydraulic hoisting equipment to assist people as they require. The environment provides a safe place for people that may not recognise risks to their safety, there is regulated hot water to prevent scalding and covered pipes to prevent burns. Rooms that may contain hazards such as laundry and treatment areas are kept locked. The manager said he has completed an infection control audit in line with the guidance from the department of health and staff confirmed that they receive training in infection control practices. We saw a range of protective equipment in place for staff use that prevents cross infection. Care Homes for Older People Page 19 of 27 Evidence: There are safe systems in place to manage laundry and staff adhere to appropriate disposal of infected waste through clearly identified bins and waste disposal systems. Care Homes for Older People Page 20 of 27 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 benefit from a well trained staff team that supports dignity in care. Evidence: The manager ensures that a robust recruitment procedure is followed to ensure staff are suitable to work with vulnerable adults. We saw that further improvements could be made to ensure the original photographic identification of people is copied to their file. New staff receive a comprehensive induction that ensures they are not left in situations they cannot handle. The manager recognises the importance of a well trained staff team and over 75 of the staff have completed a National Vocational Qualification in care and all the staff receive training in the specific needs of people they care for which includes Dementia awareness and infection control. People we spoke with said they felt properly supported by the staff and told us that they are excellent. We found that staff spoken with and observed carrying out their duties, demonstrated a good knowledge of the principles of care and demonstrated positive communication, they were polite, allowed time for people and provided explanations and information to Care Homes for Older People Page 21 of 27 Evidence: allay fears. From record keeping standards, staff attitudes, feedback from people using the service and their relatives, we consider it clearly demonstrates appropriate staff resources and a positive culture. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed well and people are protected from harm. Evidence: The manager demonstrates within the AQAA that he works to continuously improve the service. He is very well qualified and continues to update his skills regularly. He shows us that he is competent in a range of areas demonstrating a high level of understanding of equality and diversity issues. Nottingham County Council regularly audit the services that the home provides through monitoring visits and satisfaction surveys. The manager completes internal audits to improve the quality of the service provided. Staff tell us that the manager is a good role model, he is always approachable and supportive and ensures that staff are regularly supervised. Care Homes for Older People Page 23 of 27 Evidence: The management of peoples finances is robust, provides suitable accounting records that ensure there are no financial irregularities which safeguards people in the home. We saw full and clear records of safety checks in the home including accidents and they ensure they report all incidents to the appropriate monitoring bodies such as the commission. There have been no preventable accidents reported in the last year showing that the health and safety practices are safe and suitably monitored. There is a nominated employee that has health and safety responsibilities and who is trained in his role, he showed a good understanding of his responsibilities and clear records of compliance checks on hot water regulation, fire prevention and emergency lighting. The fire risk assessments have been reviewed annually and there is strict adherence to fire testing, drills, evacuation and emergency lighting systems. Care Homes for Older People Page 24 of 27 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 25 of 27 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 2 3 9 9 16 Review medicine policies and obtain appropriate controlled medicine register that is numbered and tamper proof. Sign and witness all hand written medicines. Keep complaint records available for inspection at all times. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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