Care Home: The Brambles

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Westmead

What the care home does well The home provided comprehensive information for prospective residents and their representatives, assisting people to make decisions, which were right for them. The residents were very complimentary about the care and support they received. Medication systems were well organised, efficient and safe, though minor adjustments needed were discussed. Mealtimes included a wide range of choices for each resident and included a full cooked breakfast each day for anyone who wanted this option. It was very positive that the cook was seen explaining the choices for lunch and teatime asking for each person`s preference. One resident having meals in her room explained that she had to be carefully with her dietary intake and needed lots of fruit, vegetables and brown bread. There was a wide range of organised and spontaneous activities for residents advertised on the notice boards in the home. The home has a supply of games, puzzles and quizzes, which were enjoyed by residents. There was an activities co-ordinator employed at the home and also people who came to the home to provide crafts, exercises and entertainments. Residents spiritual needs were met with visits from church groups to the home, and we were told that arrangements could be made to support any resident who wishes to go to church. The visitors we spoke to told us they felt welcomed, which was important so that residents could be encouraged to maintain contact with family and friends. The home was clean, comfortable, homely, and maintained to good standards comments from residents and relatives were positive. The large lounge, small lounge, dining room and conservatory provided residents with attractive, spacious communal areas. There were thirty bedrooms with en-suite facilities. All bedrooms viewed were colour co-ordinated, with good quality furnishings and extremely well presented bedding. The laundry staff took an obvious pride in high standards. The well stocked gardens, especially to the rear of the home provided obvious enjoyment for residents. They told us about the activities of the local wildlife, including squirrels and a wide variety of wild birds. The staff were caring, knowledgeable about the residents` needs and they were welcoming and friendly. Comments from the relatives included, "staff are friendly, welcoming and helpful." The management of this home demonstrated a strong commitment to training and developing staff, which means that the residents benefit from their skills and knowledge. The majority of staff had achieved NVQ care awards. A number of senior care staff had achieved the NVQ level 3 award. The registered manager was experienced and well qualified with the Registered Managers Award. The registered manager and deputy manager had put in place quality and monitoring systems, which actively involved residents, relatives and staff across a number of areas of the home, including how care was provided, menus, activities, and the environment. This inspection was conducted with full co-operation of the proprietor / deputy manager staff and residents. The atmosphere through out the inspection was relaxed and friendly. We would like to thank staff, and residents for their hospitality during this inspection visit. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The majority of staff had received training relating to safeguarding vulnerable people and to recognise aspects of violence and aggression. This was to help them to identify triggers for concerning behaviours and defuse situations that may arise. A weekend cleaner had been employed, resulting in improved cleanliness of resident`s bedrooms throughout the whole week. Residents, relatives and visiting professionals have commented on the improvements to the cleanliness of the home. The redecoration and refurbishments at the home have continued to make it a pleasant environment for residents. Other improvements introduced since the last inspection were: the new raised flower beds to the rear of the home, funded through a government initiative, distributed by Dudley Directorate of Adult and Housing Services. The home also had a greenhouse to encourage residents with gardening interests, such as home grown tomatoes. The registered manager had sourced and introduced a considerable amount of staff training. The staff training matrix clearly documented staff training. Staff were enthusiastic about participating in training and two staff were congratulated for achieving NVQ 2 competence on the day of this inspection visit. What the care home could do better: There was comprehensive information about the home however there were some aspects, which needed to be revised to accurately reflect recent changes, especially to the frequency of inspections and contact details for the CSCI. The registered persons were also advised to reconsider the policy relating to escorts for residents needing to go to hospital. The policy statement indicated no escorts would be provided during the night and relatives would need to give 48 hours notice if they could not accompany the resident, though the deputy manager told us this did not represent the actual practice. The registered person`s must take action to request a multi-agency review of the needs of a resident who had been cared for in bed for more than 6 months; and ensure any additional recommended furniture, equipment and training be put in place to give the resident an improved quality of life. Minor improvements were needed to make the home`s system of medication administration as safe as possible. We discussed with the home the need for complaints to be received and responded to in a sensitive proactive way and for any allegations, whichcontained any elements of abuse towards residents to be reported immediately to the appropriate agencies. We looked into complaints and allegations reported by persons who wished to remain anonymous as part of this inspection. These have been explored as fully as possible with information that was made available to us. There were areas of staff recruitment, which still needed further improvement, such as fuller employment histories on application forms to make sure there are no unaccounted for gaps in employment. References must also be checked to make sure they are authentic. These actions are required so that residents` safety can be assured. CARE HOMES FOR OLDER PEOPLE The Brambles 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA Lead Inspector Jean Edwards Unannounced Inspection 1st September 2008 07:40 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA 01384 379034 01384 396892 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Boota Singh Khangoure Mrs Melanie Nickolls Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 35 service users in the category of OP 14 can be PD(E). Date of last inspection 5th June 2007 Brief Description of the Service: The Brambles is a residential home providing 24-hour care and support for up to 35 people over the age of 65, 14 of which can have a primary diagnosis of physical disability. The home is located in a residential area of Amblecote opposite a new multi-agency health care centre and close to Stourbridge town centre. It is easily accessible by local public transport networks and there are a few parking spaces at the front and attractive gardens to the rear. A major refurbishment and extension has improved the home’s communal environment and enhanced bedrooms. Thirty bedrooms now have en-suite facilities. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding fee levels has not been published in the service user guide. People are advised to contact the home for up to date information about fees. Additional charges are applicable for services from the hairdresser and private chiropody. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission for Social Care Inspection (CSCI), undertook an unannounced key inspection visit. This means the home has not been given prior notice of the inspection visit. An inspector spent one weekday at the home from 07:30 to 19:20 hours. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements included: discussions with the registered proprietor / deputy manager and staff on duty during the visit, discussions with residents, observations of residents without verbal communications and examination of a number of records. We also spoke to relatives, and other people who visited the home. Other information had been gathered before this inspection visit including the home’s Annual Quality Assurance Assessment (AQAA), notification of incidents, accidents and events submitted to the CSCI. The CSCI sent out service user surveys, relatives surveys, health care professional and staff surveys and collated responses have been included throughout this report. There were 30 residents living at The Brambles. Formal interviews with residents were not always appropriate therefore other methods such as observations of body language, eye contact, gestures, interactions between staff and residents have been used. There was a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission, where possible. The quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. What the service does well: The home provided comprehensive information for prospective residents and their representatives, assisting people to make decisions, which were right for them. The residents were very complimentary about the care and support they received. Medication systems were well organised, efficient and safe, though minor adjustments needed were discussed. Mealtimes included a wide range of choices for each resident and included a full cooked breakfast each day for anyone who wanted this option. It was very The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 6 positive that the cook was seen explaining the choices for lunch and teatime asking for each person’s preference. One resident having meals in her room explained that she had to be carefully with her dietary intake and needed lots of fruit, vegetables and brown bread. There was a wide range of organised and spontaneous activities for residents advertised on the notice boards in the home. The home has a supply of games, puzzles and quizzes, which were enjoyed by residents. There was an activities co-ordinator employed at the home and also people who came to the home to provide crafts, exercises and entertainments. Residents spiritual needs were met with visits from church groups to the home, and we were told that arrangements could be made to support any resident who wishes to go to church. The visitors we spoke to told us they felt welcomed, which was important so that residents could be encouraged to maintain contact with family and friends. The home was clean, comfortable, homely, and maintained to good standards comments from residents and relatives were positive. The large lounge, small lounge, dining room and conservatory provided residents with attractive, spacious communal areas. There were thirty bedrooms with en-suite facilities. All bedrooms viewed were colour co-ordinated, with good quality furnishings and extremely well presented bedding. The laundry staff took an obvious pride in high standards. The well stocked gardens, especially to the rear of the home provided obvious enjoyment for residents. They told us about the activities of the local wildlife, including squirrels and a wide variety of wild birds. The staff were caring, knowledgeable about the residents needs and they were welcoming and friendly. Comments from the relatives included, “staff are friendly, welcoming and helpful.” The management of this home demonstrated a strong commitment to training and developing staff, which means that the residents benefit from their skills and knowledge. The majority of staff had achieved NVQ care awards. A number of senior care staff had achieved the NVQ level 3 award. The registered manager was experienced and well qualified with the Registered Managers Award. The registered manager and deputy manager had put in place quality and monitoring systems, which actively involved residents, relatives and staff across a number of areas of the home, including how care was provided, menus, activities, and the environment. This inspection was conducted with full co-operation of the proprietor / deputy manager staff and residents. The atmosphere through out the inspection was relaxed and friendly. We would like to thank staff, and residents for their hospitality during this inspection visit. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There was comprehensive information about the home however there were some aspects, which needed to be revised to accurately reflect recent changes, especially to the frequency of inspections and contact details for the CSCI. The registered persons were also advised to reconsider the policy relating to escorts for residents needing to go to hospital. The policy statement indicated no escorts would be provided during the night and relatives would need to give 48 hours notice if they could not accompany the resident, though the deputy manager told us this did not represent the actual practice. The registered person’s must take action to request a multi-agency review of the needs of a resident who had been cared for in bed for more than 6 months; and ensure any additional recommended furniture, equipment and training be put in place to give the resident an improved quality of life. Minor improvements were needed to make the homes system of medication administration as safe as possible. We discussed with the home the need for complaints to be received and responded to in a sensitive proactive way and for any allegations, which The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 8 contained any elements of abuse towards residents to be reported immediately to the appropriate agencies. We looked into complaints and allegations reported by persons who wished to remain anonymous as part of this inspection. These have been explored as fully as possible with information that was made available to us. There were areas of staff recruitment, which still needed further improvement, such as fuller employment histories on application forms to make sure there are no unaccounted for gaps in employment. References must also be checked to make sure they are authentic. These actions are required so that residents’ safety can be assured. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is Good. The home has a statement of purpose and service user guide and updated residents contracts / terms and conditions of occupancy. This has the effect that residents and their advocates have good information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. Standard 6 is not applicable – The home does not provide intermediate care services. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection visit we have looked at a sample of four residents’ case files, in depth and looked at aspects of other residents care. We also spoke to The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 11 a number of the residents, relatives, a trainer, and the staff on duty. We noted that the home had a statement of purpose and service user guide, which together with the complaints procedure and recent CSCI inspection Reports, and information about visiting times and advocacy services were located in the reception area. We discussed the statement of purpose and service user guide with the deputy manager and recommended that these documents should be revised to provide more accurate information about the home. There were some aspects, which needed to be revised to accurately reflect recent changes, especially to the frequency of inspections and contact details for the CSCI. We also recommended that the registered persons should reconsider the policy relating to escorts for residents needing to go to hospital. The policy statement indicated no escorts would be provided during the night and relatives would need to give 48 hours notice if they could not accompany the resident to hospital appointments during the day, though the deputy manager told us this did not represent the actual practice. The home had a colourful brochure, which the deputy manager told us was due to be updated. The home’s fees were not published in any of the documents shown to us. We strongly recommended that the range of fees charged should be published as a matter of good practice, with individual fees detailed in each person’s contract and / or terms and conditions of residence. There were 30 residents accommodated at the home, and discussions with the deputy manager and assessment of the information contained in the AQAA supplied by the home indicates that there is awareness that if and when residents deteriorate they may need care, which the home is not able and not registered to provide. Examination of residents case files and discussions with residents and relatives confirmed that they had been given copies of the homes statement of purpose, service user guide and complaints procedure. We looked at the care records of two of the residents most recently admitted to the home. The files contained information showing that families visited the home prior to agreeing the admission, the registered manager’s pre-admission assessment, together with the letters from registered manager confirming the home could meet the prospective residents’ needs. There were also copies of assessment information from the referral agencies, for example Dudley Social Services SAP10 form. The home’s assessments included information relating to activities, goals, and linked to the care plans. The staff spoken to demonstrated that they were aware of residents’ needs, and there were generally good records of each residents preferences such as rising, retiring, likes and dislikes, which reduced risks posed by reliance on verbal communication between staff. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is Good. The care planning, risk assessments and monitoring provides staff with the information they need to meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being well met. The home has effective arrangements for administration of medication, which safeguards residents health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home’s AQAA submitted on 12 June 2008 stated, what we do well: “Provide service users with access to health care services required (i.e. chiropody, optician, dentist, GP, district nurse). Provide a medication policy to ensure medication he safely adhered to at all times. Staff trained to respect service users rights, choices, privacy, dignity etc. Residents take an active part towards their care planning. Provide service users with a designated key worker. We hand out regular questionnaires to service users in this area.” The evidence claimed by the home was “Our evidence to show that we do it well: Care plans are reviewed monthly or when required, ensuring that health issues The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 13 such as nutrition (weight), falls, tissue viability is reviewed and any appropriate action taken. Staff who deal with medication are appropriately trained beforehand (updated when necessary). Appropriate risk assessments are put in place to ensure the well-being and safety of service users. The signature of service user or their advocates are documented in their care plan. We show results from questionnaires on residents notice board.” We examined a sample of four resident’s care files in depth, and various aspects of other resident’s care including a resident who had recently moved to another home. All residents’ files examined showed that residents had a plan for their care needs, though evidence of the involvement of the person and / or their family where appropriate, in the development and review of the plan, was variable and not all care plans were signed by the resident or their representative. One person, whose care we have looked at had complex needs, including stroke, vascular dementia and diabetes, and all identified needs were included in the care plan. The plans demonstrated how all needs were being met and provided detailed guidance for staff, for example details of foot, oral care, nutrition, and medication regimes. We spoke with one person cared for in bed in his bedroom. This person told us he had not been out of bed for about 6 months and had previously enjoyed the view of the garden from the bedroom window. There was a pressure relieving mattress in place but the resident told us he was uncomfortable, slipping down the bed and he was “going off his food because of the bed”. The bed was an ordinary divan bed, with a padded headboard. There was no suitable chair in the bedroom and the unused wheelchair was stored in the en-suite. We saw that he only ate a small amount of the appetising looking lunch of liver, onions and vegetables, which was his choice. This person was bed bathed and a hoist was used to change position. He was catheterised and told us he had a small catheter bag, which was full after two hours. We discussed the risk posed of a back flow of urine, which could contribute to urinary tract infections with the deputy manager and recommended that the continence service be contacted to review this person’s continence needs. We also told the deputy manager that action must be taken to request a multi-agency review of this person’s needs and ensure any additional recommended furniture, equipment and training be put in place to give the resident an improved quality of life. We saw evidence that generally the manager had implemented short-term care plans; to demonstrate changing actions to show how short term care needs were met. An example was when a resident had a chest infection and needed more care in bed in their own room, with a course of antibiotics and needed extra fluids. This demonstrated a positive approach to give staff additional guidance and ensure additional care needs were not left unmet. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 14 There were a range of risk assessments in place, including moving & handling, falls assessments, nutritional screening, and tissue viability assessments. It was positive that the assessments indicated what preventative measures were in place; such as pressure relieving mattresses for residents deemed to be at high risk. The nutritional scores and falls risk assessments, had documented interventions as needed. There were moving and handling risk assessments in place identified the level of assistance required. Examples were one resident required the assistance of one carer whilst walking around the home. One of the records examined noted that the resident could display aggressive behaviour and there were detailed written risk assessments and documented strategies to manage incidents, including the use of PRN “as & when needed” medication. We noted that there were no recorded incidents and there had been no use of any prescribed PRN medication for any residents with challenging or distressed behaviours during the past month, which was positive. We noted the positive action relating to a referral to the GP and community dietician, for investigation, support and advice for a resident with poor appetite and swallowing difficulties. Food choice records at the home were in place to indicate whether this residents food intake was adequate. There was documentary evidence that all residents have appropriate access to dentists, opticians, chiropodists and other community services. There was evidence that district nurses were appropriately involved in caring for residents requiring any dressings and managing diabetes. We spoke to the visiting GP who was mainly responsible for residents’ medical care. He spoke highly of the care and professionalism of the staff at this home. He told us that residents were always taken to their own rooms for consultations and examinations and they always looked well presented. He told us that the manager and staff were always welcoming and helpful; they were knowledgeable about residents and information was readily available. We looked at the MAR (Medication Administration Record) sheets, which were well recorded with a signature for administration or a suitable code to explain why medication was not administered. Random medication audits undertaken were accurate, and showed evidence that medication was being handled carefully and safely. The date of opening of medicine containers was recorded. This meant that accurate checks on medication could be made to ensure that medication had been administered to the people living within the service. Systems were in place to ensure that medication storage was secure and people who use the service were protected from harm. We looked at the home’s controlled drugs register, which was satisfactory, with accurate balances and two signatures for each administration. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 15 We have seen that each resident had medication listed on admission and there was evidence that this had been kept up to date with any changes as part of their care plan. The home uses the Lloyds MDS (monitored dosage) medication system and there was a contract in place and regular quarterly audits undertaken by the Pharmacy provider. We were told that all staff who administer medication had received medication training and there was a specimen signature list in place. We have advised the registered persons of additional improvements to make the medication system as safe as possible. For example one person was selfadministering her own inhaler, which was positive, encouraging independence, though we were told she sometimes needed assistance from staff. We recommended that a risk assessment be implemented for anyone who administers any part of their own medication and that staff sign the MAR sheet only for the occasions, where assistance was given. We were told that staff undertake blood glucose monitoring (BM) tests for a resident with diabetes. We have recommended that a written protocol is agreed with the district nurse and put in place together with guidance for staff about the results of the BM tests. It was very positive that the home had systems in place to ensure medication required outside the medication rounds was given appropriately. These included medication needed to control symptoms of Parkinson’s disease, given 5 times each day and medication required for osteoporosis needing to be given before first food and drink. From observations and discussions there was evidence that staff are aware of the need to treat residents with respect and they consider personal dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms any time they wish. One resident who told us they were 97years and liked to stay in the comfort of their bedroom, with their meals served to them on a tray. The residents say that are happy with the way that the staff deliver their care and show them respect. Comments from the relatives survey include, friendly, welcoming and caring. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. There are planned and spontaneous activities available on a regular basis, which give residents good opportunities to take advantage of and develop socially stimulating activities. Residents cultural and spiritual needs are well met. The majority of residents are able to maintain good contact with family and friends. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets residents tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home’s AQAA submitted on 12 June 2008 stated, what we do well: “We provide an activity co-ordinator (separate from care hours) to ensure service users are receiving a stimulating Lifestyle enabling them to choose activities of their preference. We allow service users to maintain contact with relatives - 24 hours open door policy, and join them for a meal if they wished. We also encourage relatives to participate in birthday parties and other organising events within the home such as relatives meetings. We provide excellent choice of meals and cater for any specialised dietary requirements. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 17 Provide regular questionnaires to service users and display findings on residents’ board. Our evidence to show that we do it well: We provide an activity folder and activity sheet as evidence on all activities that we carried out in the home. We have positive responses from relatives, the service users (questionnaires). Recently received the Dudley ‘ Food for Health’ bronze award certificate which demonstrates our high standard of food safety, availability of food offered and good environmental practices.” We were able to confirm the accuracy of the information detailed in the AQAA, through observations, examination of records and discussions with residents, relatives, staff and the deputy manager. We noted that a number of residents were registered to use the Ring and Ride service. This was very positive and facilitated residents to access local community amenities. The routines of the home were flexible allowing residents to get up and have breakfast at times to suit them. Some residents were up and having a range of options from a cooked breakfast to toast and cereal when we arrived at 07:30, and breakfast was still being served to late risers mid- morning. The staff and cook were heard to ask each person what they wanted to eat and drink. Residents we have spoken to told us that they could go to bed at the time of their choosing and have assistance with personal care generally at times to suit them. As part of the inspection we have talked to people about activities and we have been told that the activities co-ordinator had increased the amount of activities provided. There were activity plans and activity records on the majority of residents case files. We noted that there is a supply of large print books, games and DVD’s and craft materials, which the residents enjoyed. We saw a resident engaged with cross-stitching; she talked to us about the progress she was making. There was evidence of entertainers brought into the home, such as singers, with references in notes of residents meetings. There was evidence that efforts were made to maintain contacts with residents’ families and friends. There were a number of visitors to the home during the inspection and those we spoke to were very positive about the care, staff and management. We were given the following comments from two relatives who were visiting, “staff are obliging and helpful and always polite and so is the owner.” During the tour of the home we noted that residents were encouraged to have their personal possessions around them, which was very positive. Although the residents’ files sampled contained a list of personal possessions, they did not contain a complete inventory, nor were they signed or witnessed. We recommended that all residents have up-to-date inventories of their personal possessions, which are signed dated and witnessed by staff, the resident and / or their representative. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 18 At lunch time staff were seen to offer assistance to residents when needed in a discreet way. There were some residents who had difficulty using cutlery, and staff were aware of these residents and did not take away their independence in this area but allowed them the time to do this themselves, promoting independence. A menu was seen displayed in the dining room detailing a choice of meals at breakfast, lunch and tea. It was very positive that the cook was seen explaining the choices for lunch and teatime seeking the preference of each resident. One resident explained that she had to be carefully with her dietary intake and needed lots of fruit, vegetables and brown bread, which she had. She had chosen smoked haddock for lunch and she requested melon as an option for pudding. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is Good. Complaints are generally listened to and action is taken to look into them. There are systems to record investigations and outcomes. There are arrangements for protecting residents, with policies, procedures, guidance and staff training to provide residents with good safeguards from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA submitted on 14 February 2008 stated, “What we do well: We staff are trained in the protection of vulnerable people. All new staff are CRB and POVA checked before employment begins. Provide a policy on protection of vulnerable people. Provide a complaint/suggestion box to enable any persons (service user/relative) to remain anonymous if so wished. Provide regular questionnaires to service users/relatives. Our evidence to show that we do it well: Feedback from questionnaires showed that most of service users/relatives are aware of how to proceed with a complaint. Log all complaints in our complaints book and detail how procedures were carried out to meet the complaint made. We try to resolve any complaint in the appropriate timescale.” The home’s AQAA indicated that there had been 2 complaints in the past 12 months, which was resolved in 28 days and that there had been zero safeguarding of vulnerable adult referrals. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 20 We examined the home’s complaint log and found that the information recorded in the AQAA was not entirely accurate. There were records of complaints dated 30/3/08, which related to a lack of cleanliness in a resident’s bedroom. This was resolved and an extra cleaner had been employed at weekends. The second complaint dated 14/4/08 related to similar issues with the additional concern about staff attitudes being unwelcoming. The complaint was addressed to the registered provider, who passed it to the registered manager to deal with. The registered manager had sent a written response to the complainant in a style, which would not encourage concerns to be raised in the future. The registered manager had also allowed a member of staff to directly challenge the complainant about their comments, which was not appropriate. At a meeting on 12 September 2008 involving the Team Manager from Stourbridge Social Services we discussed these issues with registered manager who could see the sensitivity of the situation when we explored alternative strategies. The CSCI had received a complaint about the care of a resident who had subsequently moved to another home. The management of The Brambles told us they were unaware of any concerns or dissatisfaction. We looked at this person’s care records but could not find evidence to substantiate the concerns raised. We did not have sufficient detail to interview specific night staff but requested that the management of the home undertake discussions and monitoring with night workers to assure good practice at all times at the home. We noted that an incident had been logged at the home, which was from a resident and contained a complaint and allegation of verbal abuse relating to the behaviour of a member of staff. There was evidence that this had been investigated and action taken at the home but it was not recorded as a complaint or reported in compliance with The Care Homes Regulation 37 or the Local Authority’s safeguarding procedure. The deputy manager and registered manager acknowledged their error in this matter. There were also allegations by persons wishing to remain anonymous made to the Local Authority and reported to CSCI as part of the Safeguard and Protect procedures for vulnerable adults. The concerns raised were explored as part of the inspection visit. The deputy manager and large number of staff spoken told us they were unaware of any incidents or areas of concern relating to residents’ care. The registered manager, who was on annual leave during the inspection, was spoken to at a later date, she stated no other complaints or allegations of abusive practice had been raised with her. No evidence was found to uphold the allegations. The CSCI and Dudley Directorate of Adult and Housing Services closed the matter but requested that documented discussions be held at a full staff meeting in the near future. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 21 The registered manager had provided a locked box in the reception area of the home for complaints, compliments and suggestions. There were also quality assurance stakeholder questionnaires, which could be taken and filled out at any time. The home had a copy of the multi-agency procedure ‘Safeguard & Protect’, with guidance for the safeguarding of adults. Discussions with residents, relatives, and staff generally demonstrated that they were aware of how to raise concerns and make complaints and would do so if necessary. The majority of staff either had undertaken or were booked on safeguarding training provided by Dudley Directorate of Adult and Housing Services at Parkes Hall training centre. The registered manager and deputy manager had also attended the training. The home still needs to make progress to provide all staff with training to enable them to respond to any incidents involving residents with behaviours, which challenge the service. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 26 Quality in this outcome area is Good. The significant and positive changes to the décor and furnishings have continued and have contributed to creating a pleasing and pleasant environment for residents to live in. The grounds are maintained to provide a safe, pleasant and stimulating outdoor environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large detached building, which had been sympathetically extended to improve the communal areas and number of en-suite bedrooms. It was attractive, well maintained and clean throughout. There were communal areas including a large lounge, small lounge, dining room and conservatory. A new resident told us how much she enjoyed sitting in the conservatory and “loved watching the wild birds and the antics of the squirrels”. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 23 We undertook a tour of the premises, talked to staff and residents and examined documentation. In the main we found that improvements were continuing to be undertaken at The Brambles. For example there was evidence of a rolling programme of redecoration and refurbishment of the home. The registered proprietor told us he visited the home most days and as any minor repairs or maintenance was needed it was done immediately. The gardens were very attractive, with raised flowerbeds patios and paved areas so that residents could access the garden safely. There was a greenhouse and the residents had been encouraged to grow some salad produce, which they told us they enjoyed eating. The home had many attractive, features such a large fish aquarium situated between the dining area and lounge, a large wall mounted flat screen TV, focal fire place, with large ornamental over-mantle mirror and very eye-catching flower arrangements around the home. The home has range of equipment to increase residents’ independence and safety for examples a passenger lift; grab rails, large assisted toilets and specialist bathing equipment. We viewed a sample of eight bedrooms; the majority had en-suite facilities. The décor was appealing and there was good quality furniture, fixtures and fittings. All of the bedrooms were colour co-ordinated, with matching bedding and curtains. Many of the residents had their own personal possessions, pictures, TV’s and small items of furniture to make their room their own. There was a large well-organised kitchen, with a daily, weekly and monthly cleaning schedule in place. Individual items of equipment were seen to be in good condition and records were maintained for hot food, fridge, freezer and food deliveries. A good stock of food items was seen to be in place with the cook confirming all meals were ‘home made. We were shown ‘back up food stocks in a separate storeroom, which was extremely well organised. We were told food shopping for meat and fresh vegetables was done weekly, with supplies of fresh fruit purchased twice each week. The laundry was small but very well organised, clean and tidy. It was equipped with commercial machines and dryers. Flooring and walls were sound and appropriate for the control of cross infection. There were two sinks, one for staff hand washing purposes and liquid soap and paper towels were provided in this area, to prevent cross infection. There were laundry staff on duty each day who took an obvious pride in maintaining the high standards noted with the pristine bed linen seen in the bedrooms. We discussed the laundering of Kylie sheets and advised that they be laundered without the use of fabric conditioner in accordance with manufacturers instructions to preserve the absorbency. We saw evidence of good infection control practices, for example liquid soap, disposable paper towels and clear hand washing signage were seen in all The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 24 bathrooms and toilet facilities. We were told that all staff including laundry and cleaning staff had completed or were booked to undertake infection control training. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is Good. Satisfactory staffing levels mean that there are generally sufficient care staff available, ensuring that residents have care, support and needs for stimulation met. The staff recruitment processes are generally satisfactory, providing residents with safeguards. There is a strong commitment to staff training, support and development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA submitted on 12 June 2008 states, “We provide appropriate staffing level is to meet the needs of service users. Staff are well trained in all areas. Staff are in position related to their training, experience and knowledge. We dont allow anyone under the age of 18 years to undergo personal care. All new staff undergo an induction programme which will lead them to NVQ level 2 (if not already gained it)”. The AQAA stated, How we how improved “We have a more stable work team. We used less agency staff. More staff have gained an NVQ level 2 or higher.” The staffing information contained in the AQAA indicated, “Number of staff 27, 13 full time carers, 7 part time carers, 7 other staff and for the week of 12/06/08 646 care hours for personal care were provided. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 26 There were 30 residents accommodated at the home, with a variety of dependency levels and diverse needs. We assessed the staff rotas and spoke to staff and management and we established that staffing levels were provided as follows; 5 care staff (including a designated senior) on the morning shift and 4 carers on the afternoon shift each day and 3 wakeful night care staff. In addition to this the Registered Manager was on rota supernumerary to care 5 days a week and separate kitchen, laundry and domestic staff work 7 days a week. We discussed the night staffing arrangements with the deputy manager and recommended that the designated senior person responsible for the home during night shifts be identified on the staff rotas. We noted that one member of staff was referred to as an apprentice. We asked her about her role and she explained that she was supported by a college to gain experience and undertake duties at the home other than personal care due to being under 18 years of age. We saw evidence that the home had risk assessments in place compliance with The Health & Safety (Young Persons) Regulations. There had been an improvement in the number of staff with a National Vocational Qualification (NVQ) or were in the process of completing this. Of the 20 care staff 14 hold an NVQ level 2 with 5 staff enrolled and seniors holding or working towards NVQ level 3. This gave residents assurance that they were being supported by a qualified workforce. There was also good progress to ensure staff could undertake other courses. Assessment of the information on the AQAA, staff files and staffing rotas during the visit show that one full time and five part time staff have left the homes employ in the past 12 months. We examined a sample the recruitment records of 3 staff and found they contained the required documentation in order to protect residents. For example all contained evidence that staff have been issued with codes of conduct, that Criminal Record Bureau checks have been obtained prior to commencing employment along with references and completed application forms. We discussed the issue that the homes application form needs to be reviewed to ensure that applications provide a full employment history and that reference requests include validation of authenticity such as printed names in addition to referees signatures and use of company letterheads to offer further safeguards to residents. The homes training needs analysis and training plan and individual staff training profiles were in place and though these demonstrated a commitment to staff training and development. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 27 During interviews and informal discussions staff were willing to answer questions openly and they were knowledgeable about residents needs and how to meet them. There was a warm rapport with both residents and visitors. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 37, 38 Quality in this outcome area is Good. The home has good leadership and direction, which ensures continuity and consistency. There are systems for resident consultation at The Brambles, and there is evidence that efforts are made to ensure that residents’ views are formally sought and acted upon. The standards of record keeping and health and safety compliance at this home provide protection for residents from risks of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Melanie Nickolls, the registered manager had been in the post for a number of years at The Brambles. She had achieved her Registered Managers Award and was approved by the Commission as a fit person to run the home. The The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 29 registered manager was on annual leave and not present during this inspection visit. We received capable and competent assistance from the deputy manager throughout the inspection visit. Following the inspection visit we held a meeting with the registered manager and the team manager from Dudley Directorate of Adult and Housing Services in relation to complaints and allegations, discussed at the Complaints and Protection Section of this report. We noted that the registered persons had developed a comprehensive selfassessment and monitoring tool, which was in use to measure the home’s performance. Questionnaires had been circulated with responses collated in March 2008. The results were displayed on the notice board. Residents’ responses were 71 very satisfied, 22 quite satisfied and 6 not very satisfied. The only negative comment received from someone who had a respite short stay at the home and was about the bed not being satisfactory. The response was that if it had been raised during the stay, it would have been rectified at the time. A positive comment was, “I feel so much better after my stay. Really missed staff and everyone was so kind.” Comments from the stakeholder questionnaires included, “good co-operative working, lovely spacious garden” and from the local church, “am always happy to recommend this home.” We were told that the registered proprietor is at the home most days and we saw evidence of regular monthly Regulation 26 reports at the home. We noted that though the proprietor and registered manager have frequent informal meeting the registered manager does not receive regular formal supervision, which would demonstrate support and good practice. There was evidence of some staff meetings but these were not held at the frequency, which would aid effective communication. There was a staff meeting for day staff on 31/1/08 and a meeting for night staff on 23/4/08. We saw evidence of a residents meeting on 13/5/08, which stated 25 residents attended. A wide range of topics was discussed from suggestions for activities to food preferences. We checked a random sample of resident’s money held in temporary safe keeping by the home. We found that balances were correct and that receipts and two signatures verified all expenditure, which was positive as this ensured that residents’ finances were safeguarded. Staff that we have spoken to confirmed that they received supervision and support in order to fulfil their duties. This support was offered through induction, one to one supervisions and staff meetings, though the frequency should be increased. We recommended that staff sign the records of staff meetings as confirmation they understand any agreed actions. There was evidence that mandatory training is being sourced and provided for all staff on an on-going basis. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 30 The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. Generally the management of products in line with the Control of Substances Hazardous to Health is appropriate. Items were seen to be stored in a locked cupboard and the majority of products have both risk assessments and data sheets in place. The previous requirements have been met to restrict access to the laundry, increase frequency of hot water testing and ensure all electrical appliances brought into the home were suitable checked by a competent person before they are used. We have examined accident records and there were 44 recorded accidents involving residents since January 2008. The registered manager had introduced a system for auditing, analysing and evaluating accidents involving residents. This demonstrated effective measures were considered and put in place where necessary. The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 2 X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14(2) Requirement The registered persons must ensure referrals for reassessments of residents changing needs are made in a timely way The registered persons must ensure all staff have received training and can demonstrate an understanding and are able to respond to any behaviours from residents, which challenge the service or give concern. This is to ensure residents’ health well being and safety. The registered persons must improve staff recruitment; records must include a full employment history, written explanation of any gaps in employment and references must be authenticated and satisfactory. This is to safeguard residents from risks of harm Timescale for action 01/10/08 2. OP18 13(6) 01/11/08 3. OP29 19(1) Schedules 2&4 01/10/08 The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations That the statement of purpose and service user guide be revised and updated to include all topics identified in Care Homes Regs schedule 1, including the range of fees charged That there is evidence that residents and their representatives are actively involved in their care plans, such as their signatures That all care records are fully and accurately completed to reflect the level of personal care provided, examples are monthly personal care checklists It is recommended that a risk assessment be implemented for anyone who administers any part of their own medication and that staff sign the MAR sheet only for the occasions, where assistance was given. It is recommended that a written protocol for blood glucose monitoring is agreed with the district nurse and put in place together with guidance for staff about the results of the BM tests That each residents property inventory be fully completed on admission with clothing, furniture, valuables, hearing aids etc. and thereafter kept up to date signed and dated by staff, resident and / or relative. That all complaints be logged, investigated with reassurance to complainants that comments and complaints will receive a sensitive, proactive response. That all allegations of any abuse relating to the residents must be referred to the appropriate agencies with delay in compliance with the ‘Safeguard and Protect’ procedure; and reported to the CSCI in compliance with The Care Homes Regulation 37 2. OP7 3. OP7 4. OP9 5. OP9 6. OP14 7. OP16 8. OP18 The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 34 9. OP27 The registered persons must examine and explore reasons made about staffing in comments from service user and relative questionnaires to prevent service user dissatisfaction at any time. That the designated senior person responsible for the home during night shifts be identified on the staff rotas. 10. OP27 The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Brambles DS0000024978.V367410.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!