Care Home: Brenan House

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What the care home does well Staff comments, both written in surveys and given on the day of the inspection included the following:- "Put service users first" "Good diet provided at this home and good standards of care" "The service provides good support and care; a good living and working environment" "I always have support" "I`m always gaining experience and knowledge" "We support and care for each service user with their everyday needs" Comments from residents and their relatives included the following:- "My daughter found Brenan House and was very pleased with what she saw" "Brenan House had a good recommendation" "The staff are very good at Brenan House" "The meals are very good" "I consider Brenan House to be like home from home" "I am well satisfied" "The care here is excellent" "My son chose Brenan House and I am satisfied" "Staff are friendly" "Easy going regime" "After visiting my mother I can go home confident in the knowledge that she is in good hands" "Comfortable accommodation, good food, friendly staff and much more" "Very satisfied" "The care home is exemplary for pampering and caring" "Humour prevails which is so wonderful, such a tonic" "It gives me and my family security to know my mother is in good hands" Our observations on the day reflected that residents are treated as individuals and they are cared for and supported in the way they wish. Mrs Spicer demonstrated her awareness of diversity issues, including religion, disability and sexuality. What has improved since the last inspection? The care plans have been improved. Mrs Spicer has established relationships with specialist health care professionals. The cook has achieved NVQ level 2 and the menus have been broadened to give more options. They have installed curtain heaters in the lounge and conservatory to maintain the ambient temperature. Many areas have been re-decorated, re-carpeted and re-curtained to improve the environment. They have also installed a large screen TV with Freeview for the residents. What the care home could do better: There are no formal requirements from this inspection. We agreed with Mrs Spicer that she would look to build on the induction already in place by using the common induction standards from skills for care. She also agreed to look at using the AQAA to more fully reflect their own quality assurance system. Mrs and Mr Spicer are improving facilities within the home regarding en suite toilets. They have a programme in place for this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brenan House 21 Vale Square Ramsgate Kent CT11 9DE     The quality rating for this care home is:   two star good 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: Christine Lawrence     Date: 2 1 0 4 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 23 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 23 Information about the care home Name of care home: Address: Brenan House 21 Vale Square Ramsgate Kent CT11 9DE 01843592546 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) : sandy@brenanhouse.wanadoo.co.uk Mr David Barrie Spicer,Sandra Caroline Spicer care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 16 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 : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Brenan House is a large old building situated around an attractive tree lined square, close to the town centre with all of its amenities. The home is laid out over several floors and has a shaft lift to all the floors providing accommodation. The registered providers have installed en-suite facilities in some bedrooms and more are planned. There is a courtyard garden to the rear of the building. Fees are from: £340.00 £440.00 per week and information about the home, including a copy of the last inspection report will be made available on request. Care Homes for Older People Page 4 of 23 Care Homes for Older People Page 5 of 23 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: We, that is the Care Quality Commission (CQC) visited Brenan House without notice. We had previously sent out surveys for residents, their representatives or relatives and staff to complete. We received seven surveys from residents and their relatives and six surveys from staff members. Prior to this visit the providers had completed an annual quality assurance assessment (AQAA). Information from the surveys and the AQAA is used in this report. We also used information from the previous inspection report (April 2007) and the annual service review carried out in April 2008. During our visit to Brenan House we spoke to various members of staff and to Mr and Mrs Spicer. Mrs Spicer took us for a tour of the building and introduced us to residents. She gave us opportunities to talk to people who live at Brenan House and also some Care Homes for Older People Page 6 of 23 relatives who were visiting on the day. Comments from surveys, as well as talking to people on the day are included in this report. 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 23 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 23 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. Residents can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. Evidence: We looked at the pre-admission assessment for a newly admitted resident. This covered a range of needs as well as identifying what the residents thoughts about moving into the home would be. This assessment also contained information relating to wishes about religion and how that could be supported. At the end of the assessment is a summary and an action plan to identify what needed to be put in place when the person moves in eg care plan, particular risk assessments. We also saw evidence in this and other individual records that family are involved where appropriate and information sought from any care manager involved. Care Homes for Older People Page 10 of 23 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. Residents benefit from having an individual plan of care which identifies how their health and care needs are to be met. They are protected by the homes procedures for dealing with medication and they can be confident that they will be treated with respect. Evidence: We looked at four care plans for this inspection. The care plans are based on an assessment of individuals needs and wishes or preferences and they contain information for staff so they know how to provide the necessary support. We saw examples such as bathing and mobilising noted in guidance and the care plan objectives identify needs, actions and outcomes. More detailed information is given for some things for some people; these care plans are individual and vary according to what people can do for themselves and what they need help with. We saw lots of examples of residents health care needs being identified. This included looking after peoples skin, monitoring their weight, and providing access to healthcare Care Homes for Older People Page 11 of 23 Evidence: professionals. Each persons care plan contains a record of this eg GP visits, involvement of community nurses, speech and language therapists, chiropodists, opticians etc. Other specialist health professionals will be contacted as required and recently this has included palliative care specialists. The home gets special equipment if needed and we noted examples of people having special mattresses and cushions. We looked at how the home manages medications and noted that the storage and record of administration were properly done. Staff who give out medications have received appropriate training and Mrs Spicer informed us that she carries out an inhouse audit to ensure that medicines are correctly administered. We noted that a GP had been asked to visit a resident to review her medications. We observed staff to be polite and respectful in their interactions with residents. If anyone has a particular preference about what name they prefer to be called it is noted in their care plan. We saw staff knock on doors before entering rooms. In our survey/questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support (for example in the support plan)? All six people who completed a survey said that they always were. In our survey/questionnaire for people who live in the home we ask, do you receive the care and support you need? Everyone said that yes they do. Care Homes for Older People Page 12 of 23 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. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled and encouraged to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. Evidence: The AQAA gave us information about some of the activities and diversions provided at Brenan House. The home subsidises a qualified therapist to provide various things such as reflexology, head and shoulder massage and aromatherapy. During our visit we saw a resident receiving a massage which she clearly gained pleasure from saying ...that was lovely... when it was finished. A hairdresser visits regularly and one person said ...Im really looking forward to my perm.... A poster was on display and indicating that a musical entertainer visits approximately twice a month. We saw a selection of large print books available for residents to read. During the inspection Mrs Spicer told us that there is now a weekly session of Tai Chi type exercises. A member of staff said that many of the residents join in and seem to like it. Some people attend the local church and some people are visited by a representative of their preferred religion. The care plans we looked at contained information about residents past lives Care Homes for Older People Page 13 of 23 Evidence: and interests, current interests including whether or not to practice their religion and information about relationships. We spoke to two people who were visiting their relatives. They both confirmed that they were always made welcome by the staff. There is a lounge on the first floor which can be used for receiving visitors and one person confirmed that this is where she sometimes spent time with her relative. Mrs Spicer told us that people are encouraged to be as independent as possible and to make choices and decisions. We saw examples of this within the care plans such as people choosing what time to get up and what time to go to bed, and during the inspection. This included where to eat meals (own room, lounge or dining room), whether to be with people or on their own and what to eat. A relative of one of the residents said ...My relative chooses to remain quiet in [their] room and is allowed to do so, in this respect xxx lives the life [they] choose. On the day of our visit there were some difficulties due to the cook not being available. The administrator was able to step in and ensured that the planned meal - a roast lamb dinner - was still provided. The food looked and smelt delicious and we noted that residents really enjoyed it. We saw staff assisting people who needed or wished it, in a discreet way. There is an area between the lounge and dining room where drinks can be made. Lunch was relaxed and staff did not hurry people away from the tables but allowed them to go at their own pace. Residents comments included:- The meals are very good and one relative said They look after xxx well, ensure that he eats his meals. Another relative said ...I am made welcome; invited to meals, allowed to make beverages.... Staff comments included Good diet provided at this home. Care Homes for Older People Page 14 of 23 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. Complaints would be handled objectively and in keeping with the homes appropriate procedures and residents and their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. Evidence: The home has a complaints policy and residents and their relatives confirmed both through surveys and on the day of this inspection, that they know how to do this if necessary. One resident said ...Any worries that I have ..... are dealt with magnificently at that moment, however minute.... We were informed that staff have either received adult protection training or they were scheduled to do it soon. This was reflected in the training records see. There are policies and procedures in place relating to safeguarding people and this includes a policy about the disclosure of abuse and bad practice (whistle blowing). Care Homes for Older People Page 15 of 23 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. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. Evidence: We looked round most of the building and saw communal areas, some bedrooms and bathrooms etc. There is a lounge on the ground floor and a smaller lounge on the first floor which has French windows and a balcony area and overlooks the square at the front of the building. The dining room is a conservatory area. While scaffolding was in place to enable a roof repair, the outside of the home was painted. There is a courtyard style garden which has furniture for residents wishing to sit outside. Herbs, tomatoes and potatoes are being grown and some of the residents said they were looking forward to enjoying eating them. The home was clean and fresh on the day of the inspection and the surveys confirmed that this was the usual way the home was. Infection control procedures are in place, with good hand washing facilities. The laundry area is satisfactory. Care Homes for Older People Page 16 of 23 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. Residents needs are met by sufficient staff who are competent and trained. Residents are supported and protected by the homes recruitment procedures. Evidence: Mrs and Mr Spicer indicated that they carefully look at the needs of residents and the staff cover needed. They gave examples of how this has been changed and reviewed at different times. The staff are a mix of experience and background and there are also staff for cleaning and providing meals. Five people so far have a national vocational qualification in care at level 2 and Mrs Spicer confirmed that this is an ongoing part of the training programme. We looked at two staff records and noted that the homes recruitment procedure is thorough and includes application forms, interviews, POVAFirst checks as well as criminal record bureau checks, references, statements of terms and conditions of employment and the provision of a copy of the general social care councils code of practice. The home has a programme of training. Mrs Spicer showed us the new format for recording training completed and training required, which is currently being compiled Care Homes for Older People Page 17 of 23 Evidence: within the home. Induction training is provided which is satisfactory but we discussed with Mrs Spicer the advantages of using the Common Induction Standards devised by Skills for Care and she agreed to look at this. Some comments from residents either through surveys or talking to us, included the following:- The staff are always friendly and helpful when I call They are always there to hear any queries I may have and deal with them All the staff have time to talk The staff are very good at Brenan House The care here is excellent The following things were either said by members of staff on the day of the inspection or were included as comments in the completed surveys:I always have support Im always gaining experience and knowledge Yes I was pleased with my induction We keep up to date with training courses Care Homes for Older People Page 18 of 23 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. Residents benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. Evidence: Mr and Mrs Spicer are the registered providers and Mrs Spicer has day-to-day responsibility for the home. The AQAA informed us that she has NVQs at level 4 in management and care and she has achieved the registered managers award. We noted the relevant certificates on display in the office. She is currently studying for a Foundation Degree in Health and Social Care. There are regular residents meetings and a record is kept of these meetings. Mrs and Mr Spicer informed us through the AQAA that they have an in-house audit system which they use to look at what changes might be needed and to ensure they are Care Homes for Older People Page 19 of 23 Evidence: listening to the views of residents, their relatives and members of staff. Relatives we spoke to or who completed surveys with residents, commented that they were very confident about the service provided; they confirmed that Mrs Spicer was always receptive to their opinions and comments. Staff were also positive about the management. One comment was My manager is very supportive and would always make time to listen to staff members. We discussed with Mrs Spicer the opportunity to use the AQAA each year as a detailed quality monitoring document in which she could reflect the opinions and comments of the people using the service as well as any other interested parties. The content of the AQAA could then be used to effectively inform the homes own quality assurance. Mrs Spicer explained that the home does not get involved with residents finances other than to invoice for fees or to invoice when the home has paid for something on behalf of a resident such as hairdressing. Receipts are kept and provided to the person paying ie a relative, resident or someone acting on behalf of the resident. We did a spot check on maintenance and service contracts and these were seen to be satisfactory. Staff receive training in regard to health and safety. One staff member wrote in a completed survey (the home) provides a safe environment for all service users Care Homes for Older People Page 20 of 23 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 21 of 23 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 Older People Page 22 of 23 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 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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