Key inspection report CARE HOMES FOR OLDER PEOPLE Brampton View Brampton Lane Chapel Brampton Northampton NN6 8AA Lead Inspector Kathy Jones Key Unannounced Inspection 5th May 2009 05:00 DS0000073014.V375426.R01.S.do c Version 5.2 Page 1
This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 2
Reader Information Document Purpose Inspection Report Author Care Quality Commission Audience General Public Further copies from 0870 240 7535 (telephone order line) Copyright Copyright (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 3
SERVICE INFORMATION Name of service Brampton View Address Brampton Lane Chapel Brampton Northampton NN6 8AA Telephone number 01604 850700 Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration Avery Healthcare Limited Vacant Post Care Home No. of places registered (if applicable) Category(ies) of registration, with number of places 88 Dementia (88), Old age, not falling within any other category (88) Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 4
SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age not falling within any other category - Code OP Dementia - Code DE 2. The maximum number of service users who can be accommodated is: 88 Date of last inspection This is the first key inspection. Brief Description of the Service: Brampton View Care Home provides personal care and nursing care to older people and personal care for people with dementia. Brampton View Care Home is owned by Avery Healthcare, which is a company based in Northampton. The Care Home was purpose built in 2007/2008 and registered for operation in November 2008. The accommodation consists of a separate dementia unit to accommodate 26 people. All of the bedrooms are single occupancy and have en-suite shower facilities. Brampton View is located in Chapel Brampton, a few miles outside the town of Northampton. There is a bus, but currently this does not stop near the home. There is a car park shared with the retirement flats, which has some spaces allocated to the Care Home. A Public House which also serves meals is situated next to the Care Home. More information about the care home and the services provided in a statement of purpose which is available from Brampton View. The statement of purpose includes a fee guide which was dated 1 st May 2009. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 5
The fees are quoted as follows: Residential Care from 615 per week. Nursing Care 609 + CHC (106) = 715 per week. Dementia Care From 620 per week. Note CHC refers to Continuing Healthcare Funding, which applies to people who have been assessed as eligible. Additional charges are listed in the fee guide and include; telephone calls, chiropody, newspapers, dry cleaning, hairdressing, transport, escort, visitor s meals, aromatherapy, beauty treatments. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 6
SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Standards identified as 'key' standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for people who use the service. Inspection of the standards was achieved through review of existing evidence and an unannounced inspection visit. Prior to the inspection we reviewed the information we had received about the service through correspondence or contact with the service and people associated with the service. This information was collated and taken into account as part of the inspection. This unannounced inspection visit was carried out by one inspector over a period of a day. The inspection commenced early in the morning. We used a method of inspection called 'case tracking', which involves selecting samples of people s records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. To help us gather the views and experiences of people who use the serve an 'expert by experience' accompanied us. An 'expert by experience' is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The management of people s medication was checked through reviewing prescribed medication and associated records for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in safeguarding people who use the service and looked at the training staff receive. Shared areas such as lounges and dining rooms and a sample of people's bedrooms were looked at during the inspection. Verbal feedback was given to the manager during the inspection. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 7
What the service does well: People spoken with were happy with the care that they receive and staff were respectful of people s privacy and dignity and presented as being committed to meeting people s needs. People s choices and preferences in relation to daily routines and meals were respected. People were happy with the meals and staff gave appropriate help and support to people with their meals. People s rooms are of a good size and all areas of the premises are very comfortable and decorated and furnished to a very high standard. A good programme of staff training is in place, based around meeting the needs of people who use the service. What has improved since the last inspection? This is the first key inspection of this service which was registered in November 2009. What they could do better: Some improvements are needed with some of the care plans and care documentation to bring them up to a consistent standard which will then provide staff with clearer guidance in all cases as to the actions required to meet people s needs. Practice in relation to recording all medication received needs to be monitored to ensure that medication is always managed safely and in accordance with the requirements. While there appeared to be enough staff during the inspection and people s needs were being met in a timely way, there were indications that some people have concerns that this is not always the case. This indicates the need for closer monitoring of the staff rota and also more checks with people to see that their needs are being met. An application for registration of the manager needs to be submitted to the Care Quality Commission to meet the requirements of the Care Standards Act 2000 and also to provide stability and reassurance for people who use the service. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 8
If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Brampton View DS0000073014.V375426.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 Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 10
Choice of Home The intended outcomes for Standards 1 6 are: 1. Prospective service users have the information they need to make an informed choice about where to live. 2. Each service user has a written contract/ statement of terms and conditions with the home. 3. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. 4. Service users and their representatives know that the home they enter will meet their needs. 5. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. 6. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 1, 3 Standard 6 is not applicable as intermediate care is not provided. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive information about the service and an assessment of their needs helps to establish if their needs and expectations can be met. EVIDENCE: Information is available to people who are considering using the service or supporting someone who is. This information is available in the form of a statement of purpose and service user guide. We requested a copy of the statement of purpose which we have sample checked following the inspection. The statement of purpose is an important document in guiding the service and the people who use it. There is good clear information about the service and the needs that can be met, which helps people to decide if this is the right place for them. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 11
We spoke with someone who uses the service who told us that they had been visited by a representative from the Care home before their admission. These visits are carried out as part of an assessment of peoples needs which helps to determine if their needs can be met. It is also important that any additional information is gathered from any professionals who have been involved. We looked at the information that had been gathered for someone using the service which confirmed that the assessment was supported by information from health professionals about the persons needs. We found information that had been gathered as part of someone s assessment identified that a health professional had said the person needed a care home that provides dementia nursing care. The manager has confirmed that this has been checked with the relevant health professionals and that this was an error. Advice has been given to ensure that any discrepancies in information are checked prior to admission and that the summary of the assessment is clear about the category of admission and whether nursing care is required. Intermediate care is not provided; therefore standard 6 was not assessed. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 12
Health and Personal Care The intended outcomes for Standards 7 11 are: 7. The service user s health, personal and social care needs are set out in an individual plan of care. 8. Service users health care needs are fully met. 9. Service users, where appropriate, are responsible for their own medication, and are protected by the home s policies and procedures for dealing with medicines. 10. Service users feel they are treated with respect and their right to privacy is upheld. 11. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with the care that they receive, some improvements to care and medication records would provide better support and safeguards for staff in meeting people s needs. EVIDENCE: People spoken with were satisfied with the care that they were receiving. Some people due to their dementia were unable to tell us of their experiences, however observations during the inspection confirmed that staff were supportive of them and their personal care needs. We looked at a sample of people s care plans to see how their care is planned and supported. Care plans are considered important documents as they help to guide staff in the care they need to provide to meet people s needs. The annual quality assurance self assessment submitted by the manager tells us Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 13
that they involve people and their families in the care planning process. We found evidence within the plans that people and where applicable their relatives had been involved in giving information about themselves as part of the care planning process. We found that people had care plans in place. There was also a care plan summary which included what and who is important to me. Some care plans were very good and provide staff with clear information about how to meet people s needs. For example a care plan was quite detailed about the best way to communicate with an individual. However other care plans would benefit from more detail. We spoke with several staff about the needs of someone who uses the service. Some staff felt able to meet their needs while others didn t. A personal hygiene care plan for this person who was described by staff as being resistive to care and not liking people in their personal space did not guide staff as to the best way to meet these particular needs. Records and discussion with people confirmed that people have access to relevant health professionals such as the General Practitioner, Tissue Viability Nurse, Dentist and Chiropodist. Someone who uses the service confirmed that they have regular chiropody visits and that a staff escort can be provided for visits to the dentist. Information within the fee guide shows that there is an additional charge for escort services. We noted that the tissue viability nurse had visited someone with a pressure ulcer. On one of their visits they had found that the pressure relieving mattress was on the incorrect setting for the person s weight. We did not identify any concerns about the setting during the inspection, however advised that the correct setting is detailed in the persons care plan, which then provides clear guidance to staff. We spoke with someone receiving wound care, which they were satisfied with, however from review of the care records, improved record keeping regarding dressing changes and wound progress would provide clearer information and confirmation of the improvement of wounds. The annual quality assurance self assessment identifies that over the next twelve months there are plans to continue with staff training and support in relation to documentation and to continue with regular auditing of documentation. This should help to ensure that all care plans and associated records are sufficiently detailed to guide staff in the care to be provided. Someone who uses the service told us that they always receive their medication on time. We looked at a sample of medication and records to see how medication is managed. The medication we looked at was for a recent admission. The person was admitted from another care home. We found that Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 14
the full quantity of a medication received had not been entered in the medication records. Staff advised that this had not been recorded as there had been a query about the quantity of this liquid medication and intended to seek further advice from the pharmacist. The issue relating to the recording of a medication was addressed during the inspection and following the inspection the manager has confirmed that detailed supervision sessions have been held with the registered nurses regarding the incident. We have also received a copy of an internal memorandum dated 6 th May 2009 sent to all home managers in the organisation reminding them of some of the expectations regarding the safe management of medication. Observations during the inspection confirmed that staff are respectful of people s privacy and dignity. Someone told us that staff have changed bedding promptly where necessary and made them comfortable. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 15
Daily Life and Social Activities The intended outcomes for Standards 12-15 are: 12. 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. 13. Service users maintain contact with family/ friends/ representatives and the local community as they wish. 14. Service users are helped to exercise choice and control over their lives. 15. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have choices in their daily lives and routines and are happy with the food provided. EVIDENCE: This inspection visit commenced shortly after 5am. We found that people were, where required assisted with washing and dressing as and when they woke. We saw that as people on the dementia unit started making there way to the dining area staff made them a hot drink. People were offered choices for breakfast and staff appeared to be aware of individual preferences when giving these choices. Staff were aware of which people had been up during the night and wanted to stay in bed later. Staff told us that one person had been given a cup of coffee in their room and time to come round before they assisted them with washing and dressing. Staff had established that this routine was important in Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 16
the person allowing them to assist with personal care. This demonstrates that staff are considering and taking account of peoples preferred routines. From review of someone s care file we found that there was some information about their life and some key moments in their life. The annual quality assurance self assessment identifies the development of peoples life history and a social interest s record as an area for planned improvement. This is important in helping staff to understand the person and provides a basis for planning social activities and stimulation. People have a programme of the week s activities in their rooms. There are some activities each morning and afternoon between Monday and Friday, which include games and exercise sessions, a film show, beauty treatment and feeding the chickens of which there are four. The listed activities included the hairdressers visit. A hairdresser visits twice a week and people are able to book appointments. One person told us that they continue to use their previous hairdresser. We saw some people enjoying an exercise activity during the inspection which is based around people s particular needs. Several people told us that they preferred to read or to watch the television and everyone had a television in their room. Someone from the library visits to bring and fetch the books and sort out which books are required. A member of staff spoken with told us that church services are held, however the people we spoke with during the inspection had not attended any of the services. The annual quality assurance self assessment (AQAA) tells us that there are visits when requested by the local Church of England Rector and other Church ministers. The AQAA also tells us that plans for improvement includes several outings a month as the weather picks up. During the inspection we were told that a golf buggy had been purchased which would hold up to four including a driver and this would enable visits to be made to the local farm shop a short distance away. A new pavement was in the process of being constructed which would allow this to happen. Staff are respectful of people s routines and choices. We heard a cleaner asking people if they could clean their room. One person responded that they wished to have a rest. This was respected and the cleaner arranged to go back later. Visiting arrangements are flexible and people are able to have visitors at any time. People also told us that they are actively encouraged to go out with relatives where possible. Menus were displayed outside the dining rooms. There is a four week rotating menu, which shows varied and multiple choices. People are able to choose Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 17
where they eat their meals. We noted that many of the people chose to have their meals in their rooms. One person told us that they found the dining room very quiet so after a couple of times they chose to have their meals in their room. The majority of people said the food was good and we observed people to be given appropriate support with their meals by staff. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 18
Complaints and Protection The intended outcomes for Standards 16-18 are: 16. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. 17. Service users legal rights are protected. 18. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 16, 18 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who to talk to in the event of a concern and staff are aware of their responsibilities in relation to safeguarding people who use the service. EVIDENCE: There is a complaint procedure in place and details of how to make a complaint, suggestion or comment is detailed within the statement of purpose. People spoken with, while they didn t specifically recall the complaint procedure said they would talk to the staff/nurse in charge or I talked to the manager. It is important that people feel able to raise concerns and know that these will be addressed. We looked at complaints that have been received by the Care Quality Commission and its predecessor organisation the Commission for Social Care Inspection. Where complaints have been received they have been referred to Avery Healthcare for investigation under their complaint procedures or have been referred to Northamptonshire County Council through safeguarding vulnerable adult procedures. Avery Healthcare have co-operated with safeguarding investigations, inspections and where requested have looked into and responded to complaints. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 19
Discussion with the manager confirmed an awareness of the need to continue to review and monitor issues raised in complaints whether substantiated or not to help identify and address any issues of concern at an early stage. The manager is aware of safeguarding adult procedures and has made referrals to the safeguarding team at Northamptonshire County Council where appropriate. We did advise that the safeguarding team should be notified of an incident we saw in a record involving two people who use the service. We spoke with staff about their understanding of what they would be expected to do if they witnessed or suspected any abuse. Staff were clear that there was an expectation that they would report any concerns that they had. We also looked at the policy in place to guide staff in the actions that they should take. The policy informs staff that they are able to seek advice from professionals. We gave advise to include details of the contacts for Northamptonshire County Council safeguarding team, which would direct staff immediately to the appropriate people to advise or to accept a referral. This would help to avoid any unnecessary delays in the event of any concerns arising, helping to provide better safeguards for people who use the service. Further staff training has been scheduled for staff on safeguarding vulnerable adults. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 20
Environment The intended outcomes for Standards 19 26 are: 19. Service users live in a safe, well-maintained environment. 20. Service users have access to safe and comfortable indoor and outdoor communal facilities. 21. Service users have sufficient and suitable lavatories and washing facilities. 22. Service users have the specialist equipment they require to maximise their independence. 23. Service users own rooms suit their needs. 24. Service users live in safe, comfortable bedrooms with their own possessions around them. 25. Service users live in safe, comfortable surroundings. 26. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 19, 26 People using the 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 premises are purpose built, new and decorated and furnished to a high standard, providing people with spacious accommodation and a comfortable place to live. EVIDENCE: Brampton View is a purpose built nursing home with a separate dementia care unit. The building was completed in 2008 and was registered to operate in November 2008. All areas were found to be light and spacious and decorated and furnished to a high standard. From a sample check we observed that people s bedrooms are of a good size. The statement of purpose says that they all have above Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 21
seventeen square metres of useable space which is well above the National Minimum Standard of twelve square metres. People spoken with were happy with their rooms. The annual quality assurance identifies that over the next twelve months staff will continue to help people to personalise their rooms. The premises are fully accessible throughout to people with physical disabilities and have appropriate adaptations and specialist equipment. There are several lounges, dining rooms and bathrooms throughout the home. On the day of inspection we found that the majority of people chose to stay in their rooms unless there was a particular activity that they were taking part in. The accommodation provides people with the choice as to where to spend their time. The dementia unit has an outdoor enclosed area which allows people safe and independent access. The area also contains four chickens which provides people with an interest. There was evidence that maintenance issues are dealt with and that there is a programme for servicing and maintenance of equipment. During the inspection some plumbing issues were being addressed and it was confirmed that some action had been taken to remove gaps around all of the fire doors. Some work was still to be done on the less critical doors. Just prior to our inspection the fire officer had requested more information to support the fire risk assessment. The manager confirmed that this was being addressed and advice acted on. The whole complex looked clean and tidy and there were no unpleasant odours. The annual quality assurance self assessment submitted by the manager identifies that the majority of staff have received training in infection control. A sample check of staff files confirmed that training had been provided. Staff were observed to use protective aprons and gloves and hand sanitising gel and washing facilities were available throughout the home. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 22
Staffing The intended outcomes for Standards 27 30 are: 27. Service users needs are met by the numbers and skill mix of staff. 28. Service users are in safe hands at all times. 29. Service users are supported and protected by the home s recruitment policy and practices. 30. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): People using the 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 recruitment and training help to ensure that staff have the knowledge and skills to meet people s needs. EVIDENCE: The Commission for Social Care Inspection were concerned in February 2009 that there had been several complaints which included concerns about staffing levels. As a result we carried out a random inspection on 24 th February 2009 to look at the sufficiency of staff to meet people s needs. The findings of that inspection were that although there appeared to have been some staffing problems things were improving and there were no major concerns. We spoke with several people who use the service throughout this inspection in different areas of the home. Three people said that there is Not enough staff. Several people said that the Staff do not have time to talk. People said they were regularly told by staff that they were very busy. This was supported by discussion with some staff and review of the rota. We discussed the need for more clarity in the staff rota during the inspection in February 2009. Review of the rota on Valley Mews the dementia unit for the night of 4 th May 2009 indicated that a member of staff was working who we Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 23
later found out had left. We checked which staff were on duty against the rota and found that staff had phoned a colleague and asked them to come in as there were only two staff rather than the usual three on the dementia unit. Staff advised that there were people with quite challenging behaviours which required two staff and given that the unit covers two floors they could not meet people s needs with only two staff. We had mixed feedback from staff about the sufficiency of staff, some felt there were enough staff to meet people s needs, while others said this was not always the case. Overall the feedback received about staffing levels identifies the need to regularly check that people s needs are being met in a timely way. The number of staff required may vary according to people s needs at the time and the skills and experience of staff. We noted from the staff rota that some staff appear to be working a lot of hours. The manager confirmed that she would monitor this to try and ensure that staff were not becoming over tired which then makes it difficult for them to meet peoples needs. People spoken with were on the whole cheerful and appreciative of the help given. One person said that she had difficulty in understanding staff because of their language and she was not sure of the attitude. She had, however, spoken to the nurse in charge about this and now had a good relationship with that particular staff member. Staff spoken with presented as being committed to their roles in meeting people s needs. The need to continue to recruit staff until all vacancies have been filled has been identified in the annual quality assurance self assessment. We discussed staff turnover and were informed that there has been a period of trying to ensure that all staff are able to meet the required standards which has resulted in some turnover. The annual quality assurance self assessment identified that eight out of thirty care staff had undertaken a National Vocational Qualification (NVQ) in care. The manager advised that a further six have achieved the qualification since that time and that the expectation would be that all staff work towards this qualification. This qualification provides staff with knowledge and skills to meet the needs of older people. Staff told us that they receive training and the manager told us about some recent training that had been received and more that has been scheduled. Recent training undertaken includes movement and handling, food hygiene and basic life support. Training that has been booked includes safeguarding vulnerable adults, infection control, fire safety, food hygiene and movement and handling, wound care and pressure area care. The manager also advised that all staff will be doing a dementia care training course called yesterday, today and tomorrow. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 24
The training being scheduled is important in helping to ensure that staff have the knowledge and skills to meet peoples needs. The annual quality assurance self assessment indicates an understanding of the importance of ongoing training and more training on the ageing and disease processes has been identified as an area for improvement. A sample check of two staff files confirmed that criminal record bureau clearances and references are obtained prior to people starting work. These checks are important in helping to protect people who use the service. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 25
Management and Administration The intended outcomes for Standards 31 38 are: 31. 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. 32. Service users benefit from the ethos, leadership and management approach of the home. 33. The home is run in the best interests of service users. 34. Service users are safeguarded by the accounting and financial procedures of the home. 35. Service users financial interests are safeguarded. 36. Staff are appropriately supervised. 37. Service users rights and best interests are safeguarded by the home s record keeping, policies and procedures. 38. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a manager who is aware of her responsibilities in relation to working in the best interests of people who use the service. The management arrangements now need to be formalised through the registration process. EVIDENCE: Standard 31 relates specifically to the role of registered manager. As there was no registered manager in post at the time of the inspection, this standard has not been assessed as such. However the management arrangements are considered critical in the quality of care and in safeguarding the health and welfare of people who use the service and are therefore reported on in that context. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 26
The registered manager in post at the time of the registration of Brampton View has since left. The current manager started work at Brampton View on the 19 th January 2009. An application for registration has not yet been received. The manager advised that she was collating the necessary information to accompany the application. The Care Standards Act require that anyone managing a care home must make an application for registration, therefore it is important that this application is submitted without further delay. The manager was co-operative with the inspection process and receptive to advice given. Discussion indicated an awareness of her responsibilities as manager in working in the best interests of people who use the service. The company has a range of quality assurance tools to measure the quality of care; for example someone from the organisation carries out unannounced visits to look at the quality of care provided. These unannounced visits are a requirement of the Care Homes Regulations 2001 as it is considered important that organisations are overseeing the quality of care provided to people using the service and should be carried out monthly. We looked at a report of a visit carried out in March and found that they confirm that views have been sought from people who use the service and staff. They also look at a range of areas including health and safety, accidents and incidents, medication and care planning. Feedback has also been sought from people who use the service and their relatives via meetings and questionnaires. We were informed that an action plan based on the results of the recent questionnaires would now be developed. An annual quality assurance self assessment (AQAA) was submitted by the manager in March 2009. All areas of this were completed; however we would have expected a greater level of detail and more openness about the issues that have affected the service in some areas. For example there is no mention of the concerns that have been raised about staffing levels or of any action taken to monitor this. Our expectation is that the AQAA acknowledges and is fully reflective of the issues that have affected a service and actions taken or planned to address them. No health and safety concerns were identified during the inspection. Staff receive training in safe working practices which helps ensure that they are aware of their responsibilities in keeping themselves and people who use the service safe. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 27
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 (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 ENVIRONMENT Standard No Score Standard No Score 1 2 19 4 2 X 20 X 3 3 21 X 4 X 22 X 5 X 23 X 6 N/A 24 X 25 X HEALTH AND PERSONAL CARE 26 3 Standard No Score 7 2 STAFFING 8 2 Standard No Score 9 2 27 2 10 3 28 3 11 X 29 3 30 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score MANAGEMENT AND 12 3 ADMINISTRATION 13 3 Standard No Score 14 3 31 X 15 3 32 X 33 3 COMPLAINTS AND PROTECTION 34 X Standard No Score 35 X 16 3 36 X 17 X 37 X 18 3 38 3 Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 28
Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 1. OP8 12 (1) (a) Clear records must be in place 30/08/09 for wound care, documenting dressing changes and demonstrating regular evaluations of the treatment. 2. OP9 13 (2) A record must be made of all 30/07/09 medication received. 3. OP27 18 (1) (a) Staffing levels must be kept under review and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. 30/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 OP7 Work should continue to achieve a consistent good standard of care planning and care records. This is to help ensure that staff have in all cases sufficient detailed information to be able to meet peoples needs in the most appropriate way. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 29
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Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Brampton View DS0000073014.V375426.R01.S.doc Version 5.2 Page 31