Care Home: Bransfield Manor Rest Home

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What the care home does well The home operates a structured admission procedure ensuring that only residents with a full needs assessment are admitted to the home ensuring that their needs can be met. Care plans outline the individual needs of residents. Staff have a good understanding of these needs and record care undertaken on a daily basis. There are good arrangements in place to meet the health and mental health care needs of residents. The staff team are competent and 99% of them have an NVQ level 2. They undertake their roles in a kind and caring manner. A resident said "the staff are very kind". A relative stated "all the staff are caring and kind". The home is managed well by a "hands on" manager who is a qualified mental health nurse with a good understanding of the needs of the residents in her care. Systems are in place to monitor quality assurance. Questionnaires are used to obtain feedback from residents, relatives, and other stakeholders. These are reviewed and action taken when appropriate. The health, safety and welfare of the residents and the staff are observed and promoted. What has improved since the last inspection? Since the last inspection residents files have been further developed. They now include contracts of occupancy and needs assessment which were stored in various locations previously. The provider has made environmental changes to the home. The former manager`s office has been relocated to the front of the home and a new en-suite bedroom has replaced this. A new chair lift has been installed to access the first floor. The shared room on the first floor is in the process of being transformed to a single en-suite bedroom, and a shaft lift is being installed next to this room. Further staff training has been provided and 99% of the care staff how have an NVQ level 2. The staffing levels have been reviewed to address the changing needs of the residents. The two carers employed on night duty now undertake a waking shift. The home has also introduced more external entertainers as part of the activity programme in place. What the care home could do better: The home continues to provide good care for the residents living there. The premises are old and require a high level of maintenance. There is an ongoing programme of refurbishment in place and this was discussed with the provider. Carpets in hallways need to be replaced and the programme of redecoration needs to be continued to enhance the environment for the residents. A requirement has been made with regard to the recruitment of staff. The registered person must ensure that all the required employment documentation is in place, and that staff are vetted and have a CRB (Criminal Records Bureau) disclosure prior to the commencement of employment. Key inspection report Care homes for older people Name: Address: Bransfield Manor Rest Home Bransfield Manor Church Lane Godstone Surrey RH9 8BW     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: Mary Williamson     Date: 1 4 1 2 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 26 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 26 Information about the care home Name of care home: Address: Bransfield Manor Rest Home Bransfield Manor Church Lane Godstone Surrey RH9 8BW 01883742927 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Family Care Private Company Limited care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17 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 : Dementia (DE) Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Bransfield Manor is a care home registered for provision of personal care for older people from the age of 65 years. The home has a combined total of six places for the care of older people with either a diagnosed dementia or mental disorder, excluding Care Homes for Older People Page 4 of 26 17 17 0 Over 65 0 0 17 Brief description of the care home learning disability. Additionally within the total numbers one placement may include an older person with a sensory impairment. The building is a large, detached Victorian property, situated in a semi -rural location, off a quiet country lane. The home is a short distance by car to Godstone village and accessible to larger shopping facilities in nearby towns. Bedroom accommodation is on three floors accessible by chairlift. Bedrooms on the second floor are only suitable for fully ambulant service users however. Communal lounge and dining facilities are available on the ground floor and assisted bathing facilities. Though the home has extensive gardens, the undulating, large rear garden is not suitable for use by service users. In fine weather service users enjoy sitting in a pleasant designated courtyard area to the side of the home or by the front door overlooking the car park. The fees at the home range from £398 to £475 per week. Care Homes for Older People Page 5 of 26 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 home is TWO STAR. This means that people using this service experience GOOD quality outcomes. This was a key inspection and was unannounced. The inspection was carried out by Mary Williamson Regulation Inspector. The registered manager Mrs Wanni Aylward represented the home for the duration of the inspection. Discussions took place between the manager, the provider, residents, staff, and relatives. A resident said I like it here. Records relating to the care of the residents and the management of the home were seen. These included needs assessments, risk assessments, care plans, medication recording charts, menus, staff training and employment files, and health and safety arrangements. Care Homes for Older People Page 6 of 26 The manager showed the inspector around the home and introductions were made to residents and staff. Residents were sitting in both lounge areas during the visit engaging in various activities and interacting with staff. It was possible to talk with the staff on duty and and explore the training they had undertaken. They were aware of the safeguarding procedures and felt confident with the manager support in place. The kitchen was visited and the cook spoken to. The menus were seen and lunch was observed being served. The manager completed an AQAA ( Annual Quality Assurance Assessment) that she sent to The Care Quality Commission prior to the inspection. This provided us with the information we asked for including some numerical information required, which has been used as part of the inspection process. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The home continues to provide good care for the residents living there. The premises are old and require a high level of maintenance. There is an ongoing programme of refurbishment in place and this was discussed with the provider. Carpets in hallways need to be replaced and the programme of redecoration needs to be continued to Care Homes for Older People Page 8 of 26 enhance the environment for the residents. A requirement has been made with regard to the recruitment of staff. The registered person must ensure that all the required employment documentation is in place, and that staff are vetted and have a CRB (Criminal Records Bureau) disclosure prior to the commencement of employment. 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 9 of 26 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 10 of 26 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. Prospective residents and their relatives are provided with sufficient information to help them make an informed choice about moving into the home. Prospective residents are only admitted to the home following an assessment of their needs. The home does not provide intermediate care. Evidence: The home has a statement of purpose and residents guide in place. This is available to all prospective residents and their relatives providing them with sufficient information to help them make a choice about moving into the home. A relative stated that she had to choose the home on behalf of her parent but made the right choice. All prospective residents have a full needs assessment undertaken prior to being admitted to establish the suitability of the home and if specific needs can be met. The manager explained the assessment process and the format used. She undertakes all Care Homes for Older People Page 11 of 26 Evidence: the assessments in residents own homes or in hospital. Four assessments were sampled for residents with a diverse range of needs, and these are informative and detailed. Contracts of occupancy are in place. These outline the accommodation and support offered, the fees payable and the method and frequency of these. The contracts seen were signed by residents representatives. The home does not provide intermediate care. Care Homes for Older People Page 12 of 26 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. Individual care plans outline personal, health, and emotional care needs of residents and these are well maintained. The medication policy protects residents living in the home. Privacy and dignity are observed and promoted. Evidence: Individual care plans outline individual needs and choice. Four care pans were seen and these are written on information gathered from the needs assessment, involvement of the resident whenever possible and input from relatives. These are well maintained, reviewed and updated when needs change. Most people who live in the home are experiencing levels of dementia. The manager has a good understanding of individuals needs and is proactive in promoting their wellbeing. She has a good rapore with the local mental health team and seeks specialist guidance to meet individual needs. The Community Psychiatric Nurse (CPN) visits the home regularly. All the residents are registered with local GPs and are well supported by them. Occasionally it may be possible for a resident to retain their own GP with mutual agreement. There is a good district nurse input providing help and advice with skin care, continence, and Care Homes for Older People Page 13 of 26 Evidence: nutrition. They will also undertake blood tests and administer flu vaccines. Domiciliary visits from the chiropodist, dentist and optician are arranged. The home has a medication policy in place and all staff who undertake medication administration undertake training in this policy. The local chemist that provide the medication in the home also undertakes audits of medication. The most recent audit was undertaken on 20/11/2009 and a satisfactory report retained in the home for information. Medication safety awareness training can also be provided by the chemist or at the local NESCOT College. The medication recording charts (MAR) were seen and are well maintained. Currently there are no residents in the home that self medicate. Privacy and dignity are observed and promoted. Staff undertake their duties in a polite and professional manner. The staff on duty were seen to address residents respectfully, and interact with residents in caring way. Personal care is undertaken in private and staff knock on bedrooms doors prior to entering. Locks are provided for bedroom doors if required. Care Homes for Older People Page 14 of 26 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. The activity arrangements in place meet the needs of the residents. Family links are maintained and staff try their best to promote autonomy and choice. The nutritional needs of the residents are being met. Evidence: The home has an activities programme in place that reflect residents needs. The home does not employ an activities coordinator but engages the support of individual therapists for certain activity for example art and craft and exercises. The staff mainly facilitate other activities like bingo, games, crossword puzzles, scrabble and music. One to one support is also provided by staff to include reading newspapers, or books, hand massage, or manicures. Staff have a good understanding of the residents likes and dislikes and support them to participate in various activity. The Christmas party had taken the previous day and various decorations specially made for this were on display in the home. Family contact is maintained and relatives are welcome in the home at any time. They are also encouraged to participate in the care planning process, attend reviews of care and are invited to attend relatives meetings. Spiritual needs are supported and residents make arrangements to attend church. Visits from various clergy can be facilitated and Holy Communion is also available in the home. Care Homes for Older People Page 15 of 26 Evidence: Whenever possible residents are given choice regarding aspects of daily living. As much information as possible is obtained from relatives and included in care plans to help staff facilitate choice where dementia causes difficulty with communication. Residents can get up and go to bed when they wish, bath or shower and are supported to choose meals of their choice. Menus are planned by the cook with knowledge of residents likes and dislikes. An alternative choice is always offered and special diets are also catered for. Residents were enjoying chicken pie, mashed potatoes and vegetables for lunch, which was followed by rhubarb sponge and custard. Staff were supporting residents in a sensitive manner and were able to encourage residents back to the table when they wondered off during their meal. Some residents stated the food is lovely and its very nice. Care Homes for Older People Page 16 of 26 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. The complaints procedure and the safeguarding vulnerable adults procedure in place protect the residents living in the home. Evidence: The home has a complaints procedure in place. This forms part of the residents information guide and a copy is also displayed in the home. A relative stated that she would feel confident to make a complaint and felt assured that this would be delt with efficiently. With the level of dementia experienced by some residents it would not be possible for them to make a complaint and would relay on their representative or a member of staff to act on their behalf. There have been no complaints noted since the last inspection. There is a safeguarding vulnerable adults procedure in place. Staff confirmed during conversation that they had received training in this procedure, and would know what to do if they felt abuse was taking place. The home has a copy of Surreys multi agencies policies and procedures on safeguarding vulnerable adults in place. The manager agreed during the inspection to access updated training in these procedures at the earliest convenience. Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and homely environment. The ongoing refurbishment programme will ensure the improvement of the environmental standards. The standard of cleanliness is good and procedures are in place to minimise the spread if infection. Evidence: Residents live in a comfortably and homely environment. Communal facilities include a large lounge with a television that overlooks open countryside, a smaller lounge provides residents with the choice to sit quietly if they wish. The dining room ensures that residents can dine in relaxed surroundings. The carpets s on the ground and first floor hallways need to be replaced as they are very worn. The manager stated that this had been identified and included in the refurbishment plan. Bedrooms are personalised to reflect individual personalities. Two residents said that they were happy with their rooms. Mobility needs are reflected in the adaptations within the home. A new stair lift has been installed since the last inspection and a shaft lift is also in the process of being provided. There is a infection control policy in place and staff undertake training in this policy. The standard of cleanliness and hygiene is good. Arrangements are in place for the collection of clinical waste. The laundry is functional and during the inspection an engineer was unable to repair a Care Homes for Older People Page 18 of 26 Evidence: tumble dryer which is now going to be replaced. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are being met by a staff team employed in sufficient numbers and with the appropriate skills to undertake their roles. Shortfalls in the recruitment and vetting of staff do not fully protect the warfare and safety of residents. Evidence: The staff duty rota was seen and the staffing levels in the home discussed with the manager. Two care staff are allocated on duty throughout the day. The manager explained that since the last inspection two waking care staff are now employed to meet the changing needs of the residents. The home also employs a cook and a has access to maintenance support when required. One resident said the girls are lovely, and a relative said the care is very good and the staff are caring and kind. It was possible to meet and talk with the staff on duty who had a good understanding of the needs of the residents in their care. One member of staff lives in , and together with bank staff cover sickness and leave. The home has a staff recruitment procedure in place and this was discussed with the manager. However on examination of staff recruitment files it was noted that the home recently re-employed a staff member using their old employment file (2002). This person had a significant career break and worked in another care setting, but was employed without completing a new application form, obtaining references, and Care Homes for Older People Page 20 of 26 Evidence: undertaking a CRB (Criminal Records Bureau) disclosure. The manager and provider addressed this matter immediately and have taken action to obtain a POVA first check and take precautions until all the required employment documentation are in place. The other staff employment files seen were satisfactory. All staff have contracts of employment and job descriptions. Staff training is ongoing and evidence of this was seen on staff records. All staff undertake induction training that is overseen by the manager. They use a work book and are accompanied by a senior member of staff until assessed as competent . The manager stated that 99 of the staff have NVQ level 2 and that one staff member is currently undertaking this award at level 2. Mandatory training is updated accordingly and includes manual handling, first aid, food hygiene, health and safety, medication safety awareness and dementia awareness. Care Homes for Older People Page 21 of 26 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. The arrangements for the day to day management of the home are good ensuring that the home is well managed. Quality assurance is monitored to ensure the home is managed in the best interests of the residents. Financial interests are safeguarded and the health safety and welfare of the residents and staff are promoted. Evidence: The manager was present for the duration of the inspection. She is a qualified mental health nurse with several years experienced in the provision of care for people with dementia, and has a sound understanding of the needs of the people in her care. She has also undertaken her Registered Managers Award (RMA). Her role is very much hands on and she operates an open and inclusive style of management. Staff stated that they felt supported by the manager. A relative said that she can always discuss care issues with the manager and is kept well informed of any changes. Systems are in place to monitor quality assurance. Resident/relative questionnaires Care Homes for Older People Page 22 of 26 Evidence: are distributed with Christmas cards and feedback is acted upon. There is a suggestion box located in the main hallway and resident/relative meetings take place. Audits of care plans, health and safety audits, and medication audits are used as a form on quality monitoring. The home has a financial procedure in place. The home staff do not act as appointee for residents. Relatives are invoiced monthly for fees, which may also include chiropody and hairdressing costs. The health safety and welfare of the residents and the staff are promoted and observed. There are health and safety policies and procedures in place and staff undertake training in these during induction. Risk assessments are in place for all identified risks and to promote safe working practise. COSHH ( Control of Substances Hazardous to Health) procedures are followed, and staff are aware of keeping chemicals locked. Fire safety is observed and there is a contract in place for the maintenance of fire fighting equipment. All staff have regular training in fire safety awareness. Accidents and incidents are recorded and reported in an appropriate manner and acted upon accordingly. The AQAA indicated that all the required safety certificates are in place and renewed as required. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 29 19 The registered person shall 17/12/2009 not employ a person to work at the care home unless the person is fit to work in a care home and all the required documentation as outlined in Schedule 2 is in place. To ensure the safety and welfare of the residents 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 Older People Page 25 of 26 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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