Care Home: The Bradbury Centre

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Bradbury Centre 68 Manygate Lane Shepperton Middlesex TW17 9EE     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: Date: 0     8 0 5 2 0 0 8 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. the things that people have said are important to them: They reflect 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Bradbury Centre 68 Manygate Lane Shepperton Middlesex TW17 9EE 01932 226698 01932 254573 bradbury@agecare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: The Royal Surgical Aid Society Age Care Mrs Lorna Veronica Brown care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: Minimum age of Service Users within catergories OP- DE- PD and SI from the age of 60 YEARS. 0 0 32 0 Over 65 27 26 32 6 Date of last inspection Brief description of the care home The Bradbury Centre is a purpose built care home with nursing for older people operated by a registered Charity. Situated in a residential area, the home is convenient for shops, churches and all community facilities. Service provision specialises in dementia care and frail elderly care. Respite care may be available, subject to vacancies.The building is single storey and fully wheelchair accessible, incorporating best - design principles.Car parking facilities are available. There are four living units Care Homes for Older People Page 4 of 32 connected by a large concourse. Each unit is domestic in character, affording all single occupancy bedrooms, assisted bathing facilities, kitchenettes, combined dining/lounges and separate sitting areas. There are two spacious en-suite bedrooms with overhead tracking for hoists. The home has an enclosed, attractive furnished grounds accessible from each living unit, with furnished patios, wide pathways, summerhouse, gazebo, vegetable plot and sensory garden. Care Homes for Older People Page 5 of 32 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 quality rating for this service is 3 star. This means people using the homes services experience excellent quality outcomes. Fees from 1st April 2008 range between £849 and 897 per week for placements in the Physically Infirm units. Dementia care units are from £940 to £994 per week. The inspection visits were unannounced, forming part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. They were carried out by one inspector over the course of one full day and part of a second day. The report will say what ‘we’ found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The deputy manager and dementia care specialist nurse facilitated the visits. Care Homes for Older People Page 6 of 32 Judgments about how well the home is meeting the national minimum standards for older people and about the quality of care are based on the cumulative assessment, knowledge and experience of this home since its last key inspection. The findings of a previous thematic inspection, focusing on the quality of dementia care provision at the home were taken into account. Also information provided by the manager in the annual quality assurance assessment we received. This is a self-assessment that focuses on how well outcomes are being met for people using services. It also gave us some numerical information about the home. The inspection process incorporated a tour of the premises in which all communal areas were visited and bedrooms were sampled. Records were examined also policies and procedures. Care practice was observed and arrangements for assisting people with their lunch. Discussions took place with people using services, staff and a number of visitors. We gained insight into the general state of well being of people using services who were unable to communicate their views and experiences of life at the home, through observations of body language, appearance, their interaction with staff and from reviewing records. Survey questionnaires were returned by five people using services and two relatives. The information provided is valued and contributed to judgments about the service. We wish to thank all who contributed information and participated in this process. Also people using the home’s services and management and staff for their time, hospitality and assistance during the visit. What the care home does well: People thinking about moving into the home and their representatives receive information to help them choose and decide about the homes suitability. A thorough pre-admission process enables them to be confident that their needs will be met. People using services stated they were overall considered themselves well cared for by kind and helpful staff. Staff are skilled and trained to meet health and personal care needs. Arrangements are in place to ensure health needs are met. The management of medication is efficient and safe. Nutritional screening is carried out and provision includes wholesome meals which offer choice of menu and ensure dietary needs are met. The homes atmosphere was was warm and welcoming and staff were professional, friendly and skilled in their interaction with people using services. An individualised approach to meeting needs was evident , with staff mostly well informed of needs. A comment received from a relative was, Staff know their residents, their likes and dislikes and skills and tailor services accordingly, they are very careful to ensure individual care is planned, focused and is flexibly to be able to respond to changing needs. Throughout the inspection visits visitors were observed moving freely about the home. Those consulted spoke highly of staff and of the quality of care. The importance of family involvement and their contribution to the wellbeing of people using services is recognised and valued by the homes management. One relative said, The Bradbury Centre not only cares for the individual living at the home but supports their family. Another wrote in a survey received, We hear so much negative reporting about care homes in the media. Our mother has lived at The Bradbury Centre for over ten years. She is calm, peaceful and cared for by a very dedicated staff team. As a family we could not wish for a better home for our mother. The care environment is appropriately structured, enabling and supporting people using services to make informed decisions and choices in their daily lives, within individual capabilities. There is a good understanding of risk assessment processes. The care practice respects the rights and dignity of people using services. They are supported in exercising personal autonomy in their appearance and dress and in how they spend their time. A relative commented, My husband is treated as an individual and therefore keeps his dignity. The Bradbury Centre allows its residents freedom of movement, so he is never stuck in one place and as far as possible pleases himself. The interests and hobbies of people using services are established and an extensive range group and in-house, one to one activities is provided. The wide spectrum of needs and abilities of people using services is catered for. A diverse entertainment programme is offered, incorporating opportunities for outings and the involvement of relatives and friends of people using services welcomed. Couples suppers afford a facility and experience for people using services and their partners living in the community to socialise together at the home. A valentines supper with candles, romantic music, roses, good food, wine and chocolates was one of a number of similar events thoroughly enjoyed by participants. Last year was the first time the home had organised an escorted holiday for a small group of people with a one to one staff ratio, which was a great success. There are plans for another holiday this year. A person using services who went on holiday and is going again this year described how this Care Homes for Older People Page 8 of 32 opportunity had enriched her quality of life. The activities coordinator, Friends of the Bradbury Centre, staff and relatives engage in various fund raising events throughout the year. This money is used to supplement the social care budget, benefiting people using services. There is a stable workforce and a high level of commitment to staff training and development. Staff retention is good and various systems are in place for recognising the important contribution of staff to the homes success, ensuring they feel valued. One comment from a relative was, Training and appraisal for staff is a very high priority, the managers are very skilled and lead by example. Recognising equality and diversity is embedded in the homes culture, underpinning the policies and procedures, care practice and activities programme as well as staff recruitment and training. Staff consulted demonstrated understanding of the importance of equalities and diversity to meeting needs and promoting antidiscriminatory practice. People using services are listened to and enabled to offer suggestions for change. They are able to influence decisions about how the home runs and can access an effective complaint procedure. They are mostly safeguarded by the homes policies and procedures and practice. The environment is domestic in character, promotes independence, is comfortable, clean and mostly hygienic. The home is managed by a suitably qualified and experienced senior management group, led by an effective registered manager. What has improved since the last inspection? What they could do better: We were informed by a small group of people using services of their dissatisfaction with some aspects of night staffing arrangements and communication systems. It was positive to note that the homes quality assurance systems had already drawn attention to this and this was being followed up by management. The Criminal Records Bureau (CRB) must be consulted before any further placements take place for student nurses who are part of an established E.U. scheme, to clarify minimum requirements for vetting. Improvements are necessary to domestic kitchens in both living units, which were in a poor state of repair. It was stated that this had been recognised by the organisation and remedial action planned. A programme for replacing worn armchairs,carpets and curtains in the dementia care unit must be drawn up. In any future redecoration and refurbishment programme for the dementia units it is suggested this be guided by best-practice principles and research findings for maximising independence and reducing confusion for people with dementia. This can achieved through colour coding different areas and appropriate use of signage. The homes fire risk assessment had recently identified the need to fit door closures on all bedroom doors in the dementia units. The local fire officer had been consulted and agreement made to this work being carried out. The homes whistle blowing procedure was noted to require updating. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. 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 11 of 32 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 who may use this service and their representatives have the information necessary to enable a choice of home that meets their needs. There is a high value placed on responding to individual needs for information, reassurance and support as part of the pre-admission and admission process. A full assessment of needs is carried out before admission to ensure the homes services, facilities and staffing have the capacity to meet individual needs. Evidence: The homes services and facilities can meet the varying levels of need associated with ageing. Staff are trained in the provision of dementia care and care of the elderly frail. Service provision includes free day care for a maximum of three people with dementia, three sessions weekly. A number of new initiatives currently being planned Care Homes for Older People Page 12 of 32 include a project to provide support and training to carers of people with dementia, in their own homes; additionally overnight respite care at a subsidised fee, vacancies permitting, and holiday stays at one of the organisations homes with closed care cottages. Welcome packs have been produced, written in a person-centred style. These contain all required information and are given to prospective people using services and/or their representatives. They provide the information needed to enable an informed decision about the homes suitability to meet individual needs and aspirations. The welcome packs incorporate a copy of the statement of purpose which describes the person-centred care philosophy of the home. This underpins its management, dayto-day operation and the care practice. People using services and their relatives who returned surveys we sent to them said they had received sufficient information to help them decide if the home was right for them. A comprehensive needs assessment is carried out before admission by competent staff, with skill and sensitivity. This is an inclusive process, ensuring prospective people using services, their families and other professionals are consulted. This assessment focuses on achieving positive outcomes for people, ensuring that the facilities, staffing and specialist services provided by the home meet individual needs. The assessment process is holistic, covering all aspects of health, personal and social care. The files sampled included relevant risk assessments, life history information and details of communication needs, ethnic origin, religious and cultural needs, also personal likes and dislikes. Before agreeing admission the homes management carefully considers the needs assessment for prospective people using services and the homes capacity to meet their individual needs. The Bradbury Centre does not offer intermediate care services. Care Homes for Older People Page 13 of 32 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice in their day to day care including the management of dying and death. Medication policies and practices ensure the safety and welfare of people using services. Evidence: Care plans were sampled as part of the inspection process. These had been generated from comprehensive assessment of needs and risks in consultation with people using services, where possible, and their representatives. These were regularly reviewed and updated, reflecting current and changing needs. They included peoples preferred form of address, range of communication techniques and aids and equipment necessary to meet individual needs. Care records incorporated life-history information and details of likes and dislikes, interests, spirituality, personal and health care needs and other diversity information to ensure needs and wishes are accommodated. Care Homes for Older People Page 14 of 32 Feedback from people using services about their care and life in general at the home was mostly positive. Surveys completed by some individuals, confirmed their satisfaction with the care and support received. They stated that staff always acted on what they said and were available when needed. They were satisfied with their medical care. Relatives who returned surveys were equally as positive in these areas. One commented, Staff know their residents, their likes and dislikes and skills etc and tailor services accordingly. A number of visitors consulted during the visits expressed a high level of satisfaction with services. During the inspection visit examples of good practice were observed on all units. Where we had difficulty in understanding nonverbal forms of communication of some people using services , judgements about their wellbeing were formed from their general appearance, body language, behaviours and demeanour; also their response to staff and their environment. Records sampled and discussions with staff confirmed they were constantly monitoring pain and distress and other symptoms to ensure individuals received the care they need. The home works closely with general practitioners, other external professionals and specialists, ensuring a high standard of care and good quality of life for people using services. Service provision includes physiotherapy input from a physiotherapy aid, in accordance with assessed needs. Observations confirmed health and personal care needs and preferences were being overall well met. Relatives and friends are welcomed at any reasonable time and valued for their positive contribution to the wellbeing of people using services. The active involvement of family members is encouraged, if that is what they and people using services wish. Discussion took place with senior management about less favourable comments received from three people using services during the visit about individual staff who work on night duty. They were clear their remarks related to the attitude of a minority, complaining also about a shortfall in staff continuity at night. The senior nurse in charge of the elderly frail units confirmed that agency night staff were used. Effort was stated to be made to use agency staff who know the home, where possible. It was positive to note, in discussion with the dementia care specialist nurse, that internal quality management systems had noticed this area of dissatisfaction and was acting on this feedback. Staff are trained and competent in meeting health and personal care needs. Those consulted demonstrated insight into the views and preferences, the mood and sense of well-being of the people they cared for. The care practice observed indicated staff valued and respected the rights of people living in the home, affording choice in their day to day lives. Examples include flexible personal care routines capable of Care Homes for Older People Page 15 of 32 responding to individual needs and wishes, around meals, activities and choice of times in getting up and going to bed. The medication policy, procedure and practice guidance is efficient and staff all have access to this written information. The storage, recording, administration and disposal of medication protects people using services. It was positive to note improvement planned to medication storage in the dementia care units, which is currently at a premium. There are plans to convert a nearby shower room used for storage into a treatment room. Policies and procedures are in place for management of dying and death, encompassing dignity, privacy, choice, spirituality and ensuring a high standard of nursing care. Discussions with staff confirmed liaison with medical and palliative care professionals as appropriate. It was noted that end of life care is being further developed and improved. It is intended to implement a recognised system for advance planning of palliative and terminal care, ensuring the wishes of people using services are explored and central to care plans. Arrangements are being made for input to staff training from a palliative specialist care nurse. Care Homes for Older People Page 16 of 32 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. Links with families and friends of people using services and with the community,positively enrich the lives of people who live at this home. Imaginative and varied opportunities are available enabling them to enjoy a full and stimulating lifestyle. Routines and activities are person-centred, meeting the diversity of needs, supporting people in having control and choice in their lives, within individual levels of capability. People using services receive a wholesome and appealing balanced diet. Evidence: The homes ethos gives recognition to the therapeutic benefits of being mentally and physically active whilst respecting the wishes of people using services not to join in organised activities and social events. Throughout the course of the visits staff were observed being attentive to people using services, engaging them in social interaction whilst respecting rights to privacy and to be alone. Musical activities were in progress during both visits, facilitated by external entertainers. These sessions were well attended and evidently much enjoyed by people living in the home and those Care Homes for Older People Page 17 of 32 attending the day centre. There was a lot of humour and laughter as people sang along with the music. There were newspapers, magazines and books available in all lounges and televisions and music centres. During the visit appropriate music was softly playing in the background of lounges and individuals tapping their feet to the rhythm, humming along, indicating their enjoyment. The activities coordinator, staff and Friends of the Bradbury Centre continue to work exceptionally hard raising funds for the wide range of outings, entertainment and in-house activities provided. This included a holiday arranged last year which was enjoyed by three people accompanied by three staff to a holiday village on the south coast of England. A person using services described how much she had benefited and thoroughly enjoyed the experience to the extent she had booked to go again this year. The activities programme provides a wide range of group and one to one activities including activities to meet the needs of people with dementia and other conditions affecting recall and memory. The home has a good supply of reminiscence and sensory activities materials. The activity programme is updated monthly, incorporating suggestions from people using services, their representatives and staff. A newsletter is published three times a year to them and their representatives informed. The copy displayed incorporated a contribution from a person using services who shared her childhood memories. Also a photograph of a person celebrating her 100th birthday with staff and visitors. Reports from the matron/manager and the Friends of The Bradbury Centre, about their activities and fund raising achievements, items of staff news and a contribution from the activities coordinator all made this a stimulating and informative read. Numerous social occasions had taken place throughout the year. Examples of these included Couples Suppers. A gentleman visiting his wife and taking lunch with her, which he does once a week, described how much they both had enjoyed the Couples Supper provided by the chef on Valentines day. Other social occasions included the recent bi-annual Fayre, parties to celebrate birthdays and anniversaries, BBQs, themed days, Christmas pantomime and outings to local cafés, shops, restaurants and garden centres, to name just a few. The home has its own cat named Herbs. a Pat Dog called Slippy visits alternate weeks. There is a positive relationship between the home and the school next door. People using services benefit from musical entertainment provided by the young people at the home and at the school. A group of six people using services and staff had enjoyed a lunch and a show in London in the last twelve months. A hairdresser visits and a number of people using services expressed how much they looked forward to seeing her. The home has its own, equipped hairdressing salon. An aromatherapy therapist also provides a service if required.Arrangements are made to meet the spiritual and religious needs of people using services. Regular religious services and events take place in the home. Among the shared facilities is a room used as a chapel. Care Homes for Older People Page 18 of 32 Numerous visitors were observed in the home throughout the course of the inspection visit. Those consulted spoke highly of the staff and standard of care and said they were always made to feel welcome. Effort is made to consult people using services in the operation of the home. There are small consultative groups to involve them in decisions about menus, entertainment and redecoration of the home. Regular meetings take place between the homes management, people using services and their representatives to enable them to make suggestions and voice opinions. Nutritional screening is carried out for all people using services and as necessary medical assessment and referrals are made to speech and language and occupational therapists and dietitians. The menu sampled demonstrated meals are well balanced and cater for varying cultural and dietary needs. Discussions with management confirmed arrangements in place for ensuring nutritional needs of people using services are met. The menus afford choice and the food served at lunchtime was substantial and nicely presented, including food pureed for people with swallowing difficulties. Survey returned by some people using services and consultation with others during the visit, confirmed an overall high level of satisfaction with meals. Care Homes for Older People Page 19 of 32 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 home has an accessible complaint procedure. People using services feel safe at all times and are protected from abuse and neglect. Evidence: We have not received any complaints about the home since the last key inspection. There is a simple and accessible complaint procedure that has been issued to people using services and/or their representatives. The comments, suggestions and complaints leaflet forms part of the statement of purpose and is available in the service users guide welcome pack. The complaint procedure is also prominently displayed in the home. The two complaints investigated under the homes complaint procedure were documented together with an audit trail of action taken and outcomes. Discussion took place with management about the need to record outcomes of action taken in response to complaints documented in the minor dissatisfaction book. For example, repeated complaints about meat being tough were recorded, and though the manager had recorded this had been reported back to the chef and the action he would be taking, a conclusion was not recorded to demonstrated the complaints had been resolved. During a discussions with a group of people using services a comment was made that Care Homes for Older People Page 20 of 32 complaints were not listened to or taken seriously. When requested for examples they said they were not referring to management but to some staff. They were critical of some night staff and with their agreement this was drawn to the attention of managers. Discussions with a senior nurse in charge of that unit confirmed she had not been aware of these concerns. The need to impress on all staff the importance of communicating complaints, however minor they may appear, to the person in charge of each shift was discussed with this nurse and with management. This will ensure people using services have confidence in the complaint procedure. It is acknowledged that feedback through surveys and discussions with some visitors confirmed their satisfaction with the approach to complaints. The home has an internal safeguarding adults procedure which feeds into the local multi-agency safeguarding adults procedure, a copy of which is available in the home. Areas of discussion with management included the need to expand on referral information in the internal safeguarding adults procedure, signposting the multiagency protocol for referrals. Discussions with senior staff however did established clarity of what action to take and of their responsibilities in this matter. Training records for staff confirmed they are in receipt of safeguarding adults training and refresher training. Interviews with the homes dementia care specialist nurse and two care assistants revealed a zero tolerance of abuse. They were awareness of indicators of abuse and f their responsibilities under safeguarding adults procedures and of the organisations whistle blowing procedure. Staff consulted had all read the whistle blowing procedure and copies were accessible to all staff. The need to update the whistle blowing procedure with the name and telephone contact number of the person nominated for staff to contact if they have concerns was identified. Discussions with people using services confirmed they feel safe. Recruitment and vetting procedures for employees have improved, affording increased protection to people using services. There is a need to consult the Criminal Records Bureau (CRB) before any further placements take place of student nurses who are part of an established E.U. scheme. This is necessary to clarify clearance eligibility requirements. Current vetting procedures for these students, who work at all times under supervision, include taking up references and carrying out police checks in their country of origin. Checks had not been initiated to ensure they are not on this countrys national data base of people unsuited to working with vulnerable adults (POVA list) and CRB disclosures had not been sought. Care Homes for Older People Page 21 of 32 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 physical design and layout of the home enables people using the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The building and gardens were observed to be secure, well maintained and fit for purpose. The buildings layout incorporates best practice design principles suited to the care of frail older people and people with dementia. The building and gardens are wheelchair accessible and suitable equipment provided. This includes hoists, grab rails, wheelchairs, overhead tracking in three bedrooms, profiling beds and pressure relieving equipment. A tour of the building and grounds took place. All communal areas were viewed also the laundry and a sample of bedrooms. Bedroom accommodation in the dementia units do not have en-suite facilities. Cleanliness and hygiene was of a high standard in all areas inspected and odour control was well managed. Infection control procedures and practice were effective and subject to regular audits. All living units were domestic in character and comfortable. A programme of Care Homes for Older People Page 22 of 32 improvements to the environment was ongoing. It was confirmed that the requirement made at the time of the last inspection had been met for a number of hot water valves to be replaced. This was necessary to ensure hot water temperatures in bathrooms and bedrooms are safe, minimising risk to people using services. In the past twelve months the kitchen and most public areas had been redecorated and the kitchen deep cleaned. Plans for improvement in the next twelve months include repainting external gutterings and pipes, upgrading the entrance foyer and replacing flooring in a corridor. A recent internal fire safety risk assessment was noted to have identified the need to fit self-closure on bedroom doors throughout both dementia care units. The assistant manager has confirmed with the fire officer that this is required and advised us that this work will be carried out. Whilst living units were homely in character, a number of worn armchairs were in need of replacement in the dementia unit also curtains and the carpets in some lounges and the main concourse. Discussions with the dementia specialist nurse included the need to consider an increase in visual cues in the environment, to aid orientation for people with dementia. This might include colour cues provided by decor and fittings and improvement to signage. A bathroom had been converted into a wet room since the last inspection and a further wet room was planned. A shower room in the dementia unit is also due to be converted into a multi-functional treatment room. This room will be used also for the storage of medication which is currently at a premium. Kitchen units were observed to be broken and in very poor condition in both the dementia and frail elderly living units. This was discussed with the assistant manager. It was noted this had also been raised with management during the two recent inspections carried out by the Environmental Health Officer; also other concerns in respect of the main kitchen environment that had been mostly addressed. It was a lovely sunny day and a group of people using services were sat outside, enjoying the weather in the well maintained gardens. Patios were nicely furnished and provision included gazebos for sunshade. Discussions with this group revealed they found their rooms to be comfortable and had been able to bring in small items of furniture and other items to personalise their private space. They said their home was always clean and fresh. Care Homes for Older People Page 23 of 32 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. Staff are trained, skilled and in sufficient numbers to support the people who use the service. Though positive to note improvement in staff recruitment procedures, equally robust procedures must be followed for student nurse placements. Evidence: The staffing records viewed also discussions with staff and management revealed good awareness of the staffing levels necessary, based on occupancy and dependency levels and the complex layout of the building. This ensures provision of safe and appropriate care. Day and night staffing levels and skill mix were evidently adequate at the time of the inspection, based on all available information. The practice and conduct of staff and observations of their interaction with people using services, indicated good team work and a friendly, professional atmosphere. Staff demonstrated good understanding of individual needs and a person centred approach to care delivery. A person using services who completed and returned a survey commented, I am happy living at the Bradbury Centre. There is a highly developed staff recruitment procedure that has the needs of people Care Homes for Older People Page 24 of 32 using services at its core. The recruitment of high calibre staff is achieved through a highly selective recruitment process. Improvement was demonstrated in vetting procedures for employees since the last key inspection. The need for advice to be sought from the Criminal Records Bureau on the required vetting for student nurses who periodically take up placements at the home has been previously referred to in the report under standard 18. The manager has been advised to ensure evidence obtained of POVA checks and CRB Disclosures before each placement of student nurses training with Surrey University. A new POVA checks and CRB disclosure is necessary before each placement. At the time of this inspection no student nurses were on placements at the home. The organisation has its own assessment and learning centre for staff training and trainers who deliver the training programme The home has its own training coordinator who is a registered nurse with some shifts dedicated to her training responsibilities. There is a high level of commitment to staff training and development and most care staff have achieved qualifications in health and social care. The staff training records evidenced a comprehensive induction and staff training programme. It was evident that management prioritise training and facilitate staff in undertaking qualifications beyond basic requirements. Staff retention is good and there are systems to demonstrate to staff that they are valued by the organisation. Examples include the excellent staff training and development opportunities, effective arrangements for staff supervision and support, the advanced planning of rotas, a staff representative committee, an annual AgeCare Star Award and monthly staff recognition scheme in which staff are nominated for their good work by people using services, their relatives and visitors and other staff. Care Homes for Older People Page 25 of 32 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 management and administration of the home is based on openess and respect, has effective quality assurance systems implemented by a qualified, competent manager. The home is run in the best interest of people using services whose rights, safety and welfare are overall protected by its policies and procedures. Evidence: The inspection was competently facilitated by the assistant manager and dementia specialist nurse in the absence of the registered manager, who was on leave. The management structure comprises of a suitably qualified and experienced nurse Care Homes for Older People Page 26 of 32 manager who is overall responsible for the home. The senior management team includes an assistant manager who is responsible for the homes finances and general administration and hotel services. A dementia specialist nurse leads the staff team deployed in the dementia care living units and a senior nurse leads the team working in the elderly frail living units. A housekeeper is responsible for housekeeping staff and a head chef is overall responsible for catering services. The home employs a maintenance person. There had been no change within the management team since the last key inspection. The homes management is based on the organisations values that have the rights, safety and wellbeing of people using services at its core. The manager communicates a clear sense of direction to the staff team and operates the home to ensure best outcomes for people using services. They and their relatives and representatives who responded to our survey were evidently very satisfied with most aspects of the homes management and operation. In response to the question how could the service be improved, one relative commented, I cant think of anything, another suggested more money needed to improve facilities. The homes management recognises the importance of having effective quality assurance systems. These are highly developed, involving regular auditing and surveys to obtain the views of people using services and their families and visitors. It was suggested to management that an action place for improvements or changes made as a result of survey feedback be attached to the survey summary analysis document. Appropriate and effective support is provided to the homes management through the organisations external senior management. The Responsible Individual and other senior managers visit the home regularly for meetings and auditing purposes and to undertake statutory provider visits. Record keeping is of a consistently high standard. Records are securely stored and staff are aware of the requirements of the Data Protection Act. The managers, senior team and staff at all levels demonstrate good understanding of risk assessment processes. These promote independence, choice and autonomy. Overall the working practices are safe and falls and accidents are audited and monitored to ensure as much as possible, these are prevented. The homes management ensures all staff receive statutory training in infection control, fire safety, food hygiene and health and safety. There is a comprehensive range of policies and procedures that support the protection of people using services, employees and visitors. Records viewed evidenced regular safety audits and assessments and pro-active monitoring of fire safety and health and safety Care Homes for Older People Page 27 of 32 performance. Where deficiencies have been identified through internal audits, for example the need to fit door closures on bedroom doors in the dementia care unit, the assistant manager confirmed this work will be carried out. Remedial action has taken place for compliance with food hygiene shortfalls identified during inspections by the Environmental Health agency. The homes management is aware that the kitchens in both living units are unhygienic and must be upgraded. Staff do not routinely keep and administer personal finances for people using services. Arrangements continue for invoicing people using services or their representatives with fee charges and any additional charges, for example for chiropody or hairdressing and purchases made from the in-house shop. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 19 23 For a plan and programme to be prepared for compliance with the requirement to replenish carpets, curtains, worn armchairs and broken and worn kitchen cupboards in the kitchens in both living units. This will ensure the safety and comfort of people using services. 30/07/2008 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 13 19 In any future redecoration and refurbishment programme for the dementia units to take account of research findings to maximise independence and minimise confusion through use of orientation cues. Examples for consideration include changes in colour in different areas, use of plain carpets to prevent visual disturbance, provision of coloured toilet seats and use of pictorial signage ensuring these are at the correct height. For the registered manager to consult the Criminal Records Bureau for advice regarding clearance eligibility Page 30 of 32 14 38 Care Homes for Older People requirements for student nurse placements from the Czech Republic. A POVA and CRB Disclosures must be carried out in advance of all student nurse placements for students from Surrey University and a record kept to evidence the same. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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