Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Brambles Care Home Birchfield Road, Redditch, B97 4LX Tel: 01527555800 Date of Inspection: 27 February 2014 Date of Publication: April 2014 We inspected the following standards as part of this inspection. This is what we found: Care and welfare of people who use services Cooperating with other providers Assessing and monitoring the quality of service provision Met this standard Met this standard Met this standard Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Heart of England Housing & Care Limited Mrs Margaret Frances Hook Brambles Care Home is registered to provide personal care for up to 64 people. The home does not provide nursing care. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Cooperating with other providers 10 Assessing and monitoring the quality of service provision 12 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This inspection was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. The programme looked at how providers worked together to provide care and at people's experiences of moving between care homes and hospital. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 27 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and received feedback from people using comment cards. We reviewed information given to us by the provider. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. What people told us and what we found There were 60 people living at the Brambles when we carried out our inspection. We looked at how care was provided to people with dementia. We asked staff how many people had a diagnosed dementia. The registered manager told us that 24 people had dementia although not always diagnosed. The majority of people living with dementia lived on the top floor of the building. During our inspection we found that many of the people were not able to tell us about their experience of living at the home. However, we spoke briefly with some people living with dementia and with three relatives. We left comment cards at the home for people to complete. These were collected seven days after our inspection. We received a total of 25 comment cards. Comments received were positive and included: "Staff cope extremely well. They are very caring and treat him with dignity and respect" and: "The care she has received has been excellent in a safe and motivating environment. All the staff have been sympathetic". We observed that there were good relationships between the staff and the people with dementia. Staff were friendly and respectful when they spoke with people. We saw that Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 4
staff offered people assistance with their personal care discreetly throughout the day. Staff offered people choices during the day and these included how they wanted to spend their time. We saw that health and social care professionals were consulted with. We found that staff worked with other providers and professionals to ensure that people received the right care at the right time. Effective systems were in place to enable the quality of care provided to be assessed, monitored and improved. You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement How are needs of people with dementia assessed? The provider's service user's guide informed people that before they moved into the home 'A full assessment of your needs will be carried out prior to you moving in. Social services may also be involved in the assessment and in arranging for you to move into our home'. During our inspection we found that before people came to live at the Brambles their health and social care needs were assessed by one of the lead carers from the home. We were told that the assessments had been carried out in a variety of settings suitable to the person concerned such as hospitals or people's own homes. The assessment was to ensure that people's care needs were able to be met and identified any risks. We saw that the assessments involved the individual and where appropriate family members. We saw that the assessment covered people's medical and social needs as well as their mental health conditions. We were told that once the assessment had taken place the lead carer discussed it with the registered manager. The care records we saw confirmed these assessments had taken place and that other information had been obtained to assist in planning the person's care. We saw that information had been obtained from other professionals such as social workers and doctors. This meant that the staff team were able to make decisions alongside the person and or their representatives about whether the home was the right place for them to live. The registered manager told us that the initial placement at the home was reviewed to ensure that it was the right place for the person to live. We saw that reviews had taken place in the past to assess how people had settled in and whether needs were being met. This meant that the provider recognised that people's needs changed and that a system was in place to ensure that staff were able to respond accordingly. How is the care of people with dementia planned? Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 6
We saw that care plans were in place and that they described what support staff should provide. We saw that they were personalised for each individual and contained information about their needs, likes, dislikes and behaviours. The care plans we saw included areas such as mobility, communication, hygiene needs, nutrition and continence. One member of staff told us that they worked closely with families and advocates to build a real picture of the people they cared for. During our inspection we saw a variety of risk assessments for staff to follow. The provider may wish to note that we found some care plans and risk assessments had not been up dated to cover recent changes in people's care needs. We found a variation in the availability of some information and in some of the records such as body charts. However when we spoke with staff members we found that they had a good knowledge of the people who used the service. This meant that staff had the knowledge required to meet individual needs and people were protected against the risk of unsafe or inappropriate care and treatment. Are people with dementia involved in making decisions about their care? Some of the people who had dementia were unable to make important decisions about their own health and wellbeing. We saw in these cases that staff had assessed people's ability to make decisions. We saw that when people could not make these decisions for themselves that appropriate representatives had been consulted. These people were mainly family members however if no family existed people such as a solicitor were in place. One person who used the service told us: "I don't deal with the paper work yet my daughter always speaks with me when making decisions". We saw example where family members had signed people's care plans to show that they had been involved in them. This meant that people's rights to make decisions were protected. Throughout the inspection we saw evidence where people were involved in day to day decisions, such as choosing food and drink. Staff we spoke with explained how they gained people's consent before they provided the care and support that they needed during their daily routines. Are people with dementia provided with information about their care? During our inspection we saw staff speak with people appropriately. We saw that this was done at a pace suitable to the individual and that it reflected people's communication skills and levels of understanding. We saw that people were provided with information about their environment such as signage to support individuals find their way to their rooms, toilet, and dining and lounge rooms. For example we saw that the signage on the toilet door included a number of different words for toilet such as loo, latrine and privy. This was important to ensure that people with dementia and communication needs had information that supported their specific needs and promoted their independence so that they were not disadvantaged in any way. We saw that many of the people who used the service had a memory box outside of their bedroom. These boxes were filled with objects that where special to the individual or their family. They were in place to assist people identify their own bedroom and ensures that people had important objects close by. How is care delivered to people with dementia? Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 7
All the people we spoke with and their relatives told us that they were happy with the care and support they had received from the staff. The comment cards we received also showed that people were happy with the level of care and support provided at the Brambles. One person wrote: "I have found the care and personal attention given to x (person concerned) first class. Care is consistently provided to an excellent standard throughout day and night. Every team member I have met delivers care with respect for x is friendly, open and compassionate. Another person wrote: "I have been consistently impressed by the professionalism and care given to x. It's genuine care. Staff show a high standard of care and respect at all times". A third person wrote: "We have been very happy with the home especially the people who work there. Everyone is so helpful and really show care when looking after my x". During our inspection we observed different examples of how staff responded to people's individuals care and support needs. We saw that staff provided support to people as discreetly as possible and staff showed patience towards people. We saw staff assist people to the bathroom. The care provided was supportive, dignified and showed that the staff cared. We saw staff use suitable techniques when they assisted people from their chair. We heard staff spoke with people throughout the transfer while they explained what they planned to do and how they needed people to assist them. For example we heard staff say: "Can I help you", "Would you like to go to the toilet before dinner" and: "I will help you up and support your back". We spoke with staff who had a good knowledge of the people they cared for. Staff told us that they would recognise if people who were unable to verbally communicate were in pain or distress by their body language. This meant that staff understood the non-verbal communication of the people they supported. Staff told us that they did not ask people what they wanted for their meals in advance because people may forget. We heard one member of staff say: "Are you ready for your lunch"? We saw staff offer people a choice of meals so that people were able to choose when they visually saw what the choice was. We saw that staff were patient while they waited for people to respond and make their choice. If people needed assistance with their meal this was done discreetly. We heard staff inform people what the food was and they checked that people were alright with their meal and the support they were received. We observed that some people were encouraged and supported to take part in a range of engagements with staff during the day. We saw staff to be in laughter and encouraged people to join in. Some people were seen to take an active part while others tapped their feet in time to the music. The provider may wish to note that all the activities we saw take place concentrated down one end of the lounge. As a result we saw that some people were actively encouraged to participate while other people were withdrawn and isolated. Some people told us that often there was a lack of activity and engagement on the top floor where the majority of people with a dementia. Is the privacy and dignity of people with dementia respected? We observed staff treat people with dignity and respect. People were dressed in clothing appropriate to the season and their gender. Care plans showed that some people preferred to have female carers. When we spoke with staff they were aware of people's wishes. One relative told us: "The most important thing about this home is that it is very clean and I am very pleased to see my x dressed up nicely". Another relative wrote on a comment card: "Superbly supported during the transition and treated with sensitivity, Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 8
dignity and great care. She always looks happier and more confident and I am very happy with the care she is receiving". This meant that people were treated with dignity and that staff respected people who used the service and their choices. We brought to the attention of the registered manager that while some people who needed assistance had their meal another member of staff vacuumed the area where they sat. This did not appear to have a negative impact on people however it removed some of the calm atmosphere that we had witnessed beforehand. We saw that each person had their own room. We saw staff knocked on bedroom doors before they entered. This meant people had somewhere private and personal to go. Also staff we spoke with described what they would do to ensure they respected people's privacy and dignity. We saw items and objects displayed along the corridor areas of the home. These included old record sleeves, newspapers of world events and pictures of the area and surrounding places. These were in place to assist people orientate independently around the home and provide interest and stimulation. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 9
Cooperating with other providers Met this standard People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Reasons for our judgement How does the provider work with others when providing care to people with dementia? People who used the service were not always able to remember and share information relating to their health and wellbeing needs due to their dementia. We saw information on people's files which had been sent to the Brambles at the time of admission. This information was on health and social care needs such as medication and the involvement of relatives. This showed how the provider and the hospital had worked in partnership to ensure a safe and effective admission into the home. We were told that when people were transferred to hospital from the home important information that related to their health and wellbeing was sent with them. We were told by the registered manager that people's relatives were contacted if hospital treatment was required. We were told by the registered manager and staff members that an escort would be provided whenever possible if hospital treatment was required to ensure that people with dementia were not transferred to a different and unknown setting on their own. This meant that there was a system in place to share information about people's needs with other providers. Are people with dementia able to obtain appropriate health and social care support? We found that care records held details about when people who lived at the home were last seen by health care professionals. These included chiropodists, doctors, community nurses and hospital appointments. We saw that staff had recently brought a concern to the attention of the community nurse who visited the home on a daily basis. Staff we spoke with told us that they believed they had a good working relationship with the community nurses. On the day of our inspection a doctor visited. We had the person's care plan at the time. This was requested back from us so that the doctor could see the relevant records. One relative told us: "If anyone requires urgent care they (the staff) contact the doctor at any Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 10
time". One relative wrote on a comment card: "We are all very pleased with the care and attention x receives. It has taken a huge load off our minds knowing she is safe and well cared for. Particularly pleased with the systems in place and prompt medical advice and attention given to any of our concerns". Another person described medical care as: "Prompt and professional". This meant that people's health and wellbeing were being monitored and reviewed to provide staff with advice to meet people's needs. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 11
Assessing and monitoring the quality of service provision Met this standard The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Reasons for our judgement How is the quality of dementia care monitored? In the provider's statement of purpose they wrote that they aimed to provide people who used the service with 'the highest quality of care services through care treatment and support to meet their individual needs and maintain independence.' This meant that the provider had identified a number of aims and objectives to ensure that people were provided with a quality service. Staff we spoke with told us how the specialist training they received, like 'See Me' had helped them understand how to support people with dementia better. We saw there were sufficient staff on duty to assist people as needed throughout our inspection. We saw that staff had received regular supervision. This was confirmed by the staff we spoke with on the day of our inspection. Staff told us that they were confident that they could speak with the deputy manager and the lead carers about any concerns they had in relation to people who used the service. People who lived at the home were asked for their views about their care and treatment and they were acted on. We saw minutes of a recent meeting between people who lived at the home. The registered manager assured us that they intended to speak with relevant people such as catering staff about the issues discussed. The provider had several processes in place to monitor the quality of services they provided. We saw an audit had taken place at the end of January 2014. On the day of our unannounced inspection the regional manager arrived shortly afterwards to carry out a quality audit on behalf of the provider. Due to our inspection they stated that they would carry out their audit on another occasion. This meant that the provider had systems in place to analyse the quality of the service provided and look for ways of further improvements by the provision of an action plan. How are the risks and benefits to people with dementia receiving care managed? Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 12
We found that incidents that had occurred at the home were investigated and acted upon. Accidents and incidents were recorded electronically and were able to be reviewed by the regional manager. Risk assessments were in place and we found that these had been reviewed to protect people who used the service as well as people who visited the service. We found that risk assessments were individual to the individual. This meant that systems were in place to monitor accidents and incidents in the home in order to reduce reoccurrence. Are the views of people with dementia taken into account? Some of the people who used the service were not able to tell us if they were happy with the care provided to them due to their dementia. One person who used the service told us that they did like to go to the lounge they told us: "I prefer to stay in my room to do what I want to do and staff respect my wishes". The provider regularly sought the views of people who used the service through meetings. We saw that notes had been taken following the most recent meeting and the registered manager told us that they intended to speak with the relevant people regarding the comments received. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Brambles Care Home April 2014 www.cqc.org.uk 19