Inspection on 27/11/07 for Broadwater Lodge

This is the latest available inspection report for this service, carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Broadwater Lodge 25/05/06

Broadwater Lodge 12/01/06

Broadwater Lodge 20/06/05

Broadwater Lodge 16/11/04

Broadwater Lodge 25/05/04

Broadwater Lodge 24/04/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Broadwater Lodge Higham Road Tottenham London N17 6NN Lead Inspector Caroline Mitchell Key Unannounced Inspection 09:40 27 & 28th November 2007 th 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 Broadwater Lodge DS0000033332.V355782.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. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadwater Lodge Address Higham Road Tottenham London N17 6NN 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) 020 8808 6070 020 8493 0066 sylvia.beaumont@haringey.gov.uk London Borough of Haringey Miss Sylvia Anne Beaumont Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (45), Old age, not falling within any other category (45) Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection April 2007 Brief Description of the Service: Broadwater Lodge is a purpose built home run by the London Borough of Haringey, providing care for up to 45 people who are elderly. Some residents have additional physical disabilities and mental health needs associated with ageing. The home is on three floors, with two living units on each floor. One unit provides care tailored to the needs of Elders from the Caribbean Community, and one unit has been refurbished to provide nine intermediate care beds. The stated aims of the home are to enhance the dignity, self-respect and individuality of each resident. In addition to providing care for its residents, and access to medical professionals as required. Activities are provided by an activities co-ordinator. Placements at the home costs around £525 for each person per week. Residents are expected to pay separately for some toiletries. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to Residents and other stakeholders. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on an unannounced basis. The inspector had invited an “expert by experience” to be involved. The inspector took 2 days to complete the inspection and the expert by experience arrived at 10 am on the first day of the inspection and spent a morning in the home. The expert was shown around the home, and spent time with the residents. The things that the expert by experience noticed and commented on are included in this report. Regarding the visit generally, the expert by experience said, “Members of the staff as well as the residents were very cooperative. They replied to my queries with frankness. In addition to my guided tour of the premises I was given a reasonable time to roam about on my own. All this helped me to bring about an objective assessment. I had a great time doing my day’s work”. The inspector was shown around 1 of the units by 1 resident and was at liberty to visit the rest of the home alone. The inspector stayed for lunch on both of the 2 days of the inspection and sat with residents and chatted. The inspector saw a number of the written records that are kept in the home, such as the residents’ and staff members’ files, the complaints record, health and safety records, met several staff members, some visitors and was able to spend some time with residents. The inspector was made very welcome and noticed that in the reception area there was an active and friendly atmosphere, and it was calm and relaxed in the units. What the service does well: What has improved since the last inspection? There were 6 areas for improvement identified at the last inspection and 5 good practice recommendations. These had all been addressed. These included ensuring that people moving into the home, and their representatives are provided with a service user guide, revising the policy regarding Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 6 medication, ensuring that the vacancy for the activity co-ordinator be filled, and ensuring that 1-1 staff supervision is undertaken. What they could do better: 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. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 7 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 Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 8 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, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a Service user Guide. When requested the service can provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of the resident. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Prospective residents are given the opportunity to spend time in the home prior to admission. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 9 EVIDENCE: At the last inspection the registered person was required to ensure that people moving into the home, and their representatives are provided with a service user guide. At this inspection the inspector was able to confirm that this requirement had been met. The registered manager explained that this information is also placed in the reception area, along with various other leaflets providing information about council and advice services. The expert by experience suggested that a road map may be developed for the guidance of first time visitors to the home, particularly for the benefit of the relatives and friends of residents. A recommendation is made in respect of this being added to the service user guide. The inspector saw the written records for 3 people living in the home and in each had professional assessments, risk assessments and care plans in place. These had been provided to the home prior to each person being admitted. In-house assessment had been done, although in 1 person’s case this was still being developed as they had only very recently been admitted. The inspector also noted that people’s records reflected that their relatives had visited the home, to look around, prior to them being admitted and that family members accompanied them and stayed with them during their actual admission. The home does not provide intermediate care. It does provide respite stays, and this is in a separate unit, so as not to disrupt the quality of life for the people who live in the home on a permanent basis. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 10 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. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Personal support is responsive to the varied and individual needs and preferences of the people who live in the home. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about their personal care. People who live in the home have access to healthcare and remedial services, staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. People have the aids and equipment they need and these are well maintained to support both people who live in the home and staff in daily living. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. If individuals prefer or where they lack capacity, care staff can manage medication. Thought has been given to providing safe but sensitive facilities for keeping medication. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 11 Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. EVIDENCE: The inspector saw the written records for 4 people living in the home. 1 person was assessed as being at risk due to wandering, another was assessed as being at risk of falls and had dementia, and the third had some behaviour that were challenging to the service because of dementia, was diabetic and was not able to stand unaided. The forth person was also assessed as being at risk of falling and had some challenging behaviour associated with dementia and a poor apatite. Each person had a written care plan in place and these were reviewed monthly. The risk assessments that were in place reflected the risks pertinent to each person including moving and handling risk assessments. The risk assessments had been reviewed on a regular basis, and additionally, when there had been significant events. People’s goals had been identified and the home operates a key worker system. The key staff were involved in reviewing people’s well being, progress and care plans on a monthly basis. The inspector met all 4 of these residents and spent some time getting to know them. Members of the senior staff team told the inspector that a Psychogeriatrician was involved with the care of several residents and visits them in the home on a regular basis. The records seen by the inspector indicated that the Psychogeriatrician was visiting 2 of the 3 residents. Most of the 4 people had some health care issues, which were highlighted in their records and records indicated that they were receiving services from the appropriate health care professionals. The inspector noted that the person who had very recently moved into the home had bee signed up with local GP. The inspector saw monitoring records regarding the falls people had had in the last 6 months. These were carefully monitored and risk assessments updated appropriately. The home has access to support from the falls prevention project. There were thoughtful actions recorded in people’s risk assessments, paying mind to footwear etc. There was also evidence that the home had sought input from the Psychogeriatrician and GPs in relation to people falling, where appropriate. At the last inspection the registered person was required to revise the policy regarding medication to ensure that it is more robust in the area of accepting, recording medication whilst admitting a resident to the home. The registered person was required to ensure that all staff dealing with medication be made aware of the revised procedure. At this inspection the inspector was able to confirm that this requirement had been met. The registered manager told the inspector that the good practice guidance arising out of the lessons learned Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 12 (arising from a complaint that was being dealt with at the time of the last inspection) is to be shared across all of the Council run homes. At the last inspection it was recommended that all staff dealing with medication be provided with further training regarding the nature, special precautions, and possible side effects of the medication regularly prescribed to the people living in the home. At this inspection the inspector was able to confirm that this issue had been addressed. The expert by experience said, that the actions of 1 staff member when responding to the needs of 1 resident who needed assistance and nobody else was around conveyed the message that their first priority was with their client. They also said that the actions of another staff member, when aiding another resident indicated that they had built up a good rapport with the resident and could respond to their moods appropriately. The expert was told by a resident they don’t understand why I can’t sit down and added; “sometimes they do not understand immediately, but eventually they know what I want.” The inspector saw staff administering medication on 2 occasions during the inspection and on both occasions the staff were gentle and patient. A requirement is made for the temperature at which the medication is stored in the home is monitored to ensure that it is kept below 25°. The home has facilities to properly store controlled drugs. Additionally, the inspector noted that 1 staff member was struggling to carry medication around 1 of the units and a recommendation is made in respect of this. The inspector noted that 1 person went to the chemist and dropped off her prescription independently, and that this was cause for celebration in the staff team. At the last inspection it was recommended that the registered person review methods of protecting the privacy of one person, on the occasions that they become too distressed to accompany the nurse to their room for treatment and that the registered persons review methods of better protecting the privacy and security of residents’ bedrooms. At this inspection the inspector was able to confirm that these issue had been addressed. Throughout the inspection the inspector was able to observe the interaction between the residents and the staff whilst they were serving meals, giving out medication and providing support generally. The inspector noted that residents were relaxed and staff were caring, gentle and patient in their approach. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. People who live in the home have the opportunity to develop and maintain important personal and family relationships. The practice of staff promotes individual rights and choice, but also considers protection of individuals, supporting people to make informed choices. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritional and cater for people’s varying cultural and dietary needs. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the person, making them feel comfortable and unhurried. EVIDENCE: The expert by experience observed that the residents seemed happy with the indoor activities. The expert added that they could watch television and order programmes they liked to watch. The expert noted that they also had access to various indoor games and that there were regular visits by an activity person. Music sessions were held every now and then. A resident told the expert that “some would get up to dance to the tunes of music.” the resident Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 14 who said this made a sign, and started dancing with the staff, keen to show the expert how it was done. At the last inspection the registered person was required to ensure that the vacancy for the activity co-ordinator be addressed, in order to ensure that the people who live in the home are provided with activities appropriate to their needs. At this inspection the inspector was able to confirm that this requirement had been met. The home has employed an activities coordinator, on contact through an agency, and the inspector noted that more activities were available since the last inspection. Feedback from residents was very positive. The inspector met the activities coordinator who showed the inspector the activities room, which is a good size, very pleasant and light and well resourced. They spoke about their aim to provide more activities to the people in the home who are less active and stay in the units. They said that most people love music and that the room is good for dancing. People also enjoy coming for tea and cakes on Friday afternoons. They added that nearer to Christmas, they would go and see the lights and have a Christmas party. At the last inspection it was recommended that the care plans for each person be expanded in relation to their needs around social, leisure and recreation. At this inspection the inspector was able to confirm that this issue had been addressed. The inspector saw the record of activities that residents had engaged in during August to November 2007. This indicated that emphasis is placed on supporting people to make choices from a range of activities. People had chosen from movies, puzzles, having their nails done, word games, singing and dancing, lets talk discussion cards, reminiscence, current affairs discussion, bingo, hockey with a soft ball and walks in the garden. In addition to the activities provided by the activities coordinator and care staff, someone comes in regularly to do chair based exercise with residents. Staff help out with this and the group is usually about 8 people. There was also evidence that birthday parties are arranged for residents and their relatives are invited. The expert by experience noted that supervised visits are sometimes arranged to the nearby park and the residents enjoy this. In addition to these visits bus rides are also arranged. However, the residents feel that they do not have enough of the outdoor activity. When probed by the expert, they suggested that frequency of these visits should increase. 1 said; “we should go site seeing.” a recommendation is made in respect of this. The inspector did note that several residents have some form of sensory impairment and staff have not had training in working with people with sensory impairment and a recommendation is made in respect of this. The inspector noted that there was lots of evidence that people’s Religious beliefs are respected and support is offered for people to celebrate these. A staff member told the inspector that some people are going out to church less as they get older saying that it is hard for them to get out because of aches and pains. The inspector met the pastor who visits regularly and conducts Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 15 service. On the second day of the inspection several residents went out in a minibus, with the activity coordinator and the Pastor, to a café in a local park. The inspector spoke to 1 resident who said they got out a lot to visit friends and family in various areas of north London, and went to the local shop daily. They said that they had been able to bring in lots of photographs of their family. The inspector met another resident, who was sorting out their Christmas cards. They said that they were going to ring a relative. Adding that, although they are a long way from each other, they keep in touch by phone. The records of the 4 people seen by the inspector indicated that they all had regular visits from family members. There were photographs of activities such as day trips on the notice board in the hall and poster advertising the Christmas show that was being put on in the home. There was plenty of fresh fruit in bowl on the table and the residents told the inspector that this was always available. I resident said “ I get my Caribbean food, not like in the other home.” Another person said they were looking forward to having turkey at Christmas. The inspector stayed for lunch on both days of the inspection and sat with people in the respite unit. The inspector noted that there were people living in the home who were vegetarian and they were provided with alternatives. The majority of residents had chosen lamb hot pot, and this was served with lots of fresh vegetables and mash. This was very appetising. Staff were encouraging gently, and trying different foods with 1 person, to find out what they preferred. A staff member gave 1 person assistance with feeding. This was done in a gentle way and at a nice pace. The staff member asked if the person was enjoying their meal. A staff member told the inspector that the residents who were staying on the respite unit at the time of the inspection were diabetic and the inspector noted that the food that was provided was appropriate. The registered manager showed the inspector a document that she had recently received regarding menu planning and special diets in care homes from the National Association of Care Catering. This provided guidance around different diets and suggested menus, including vegetarian, diabetic, blood pressure, pureed food and food fortification. She said that she intended to use this information to improve the current menu. The inspector visited the kitchen. It was well equipped and clean. There was plenty of storage space and fridge and freezer temperatures were monitored. The inspector was told that there are cooks who are able to provide European, Caribbean and Asian menus. The cook said that the equipment was in good working order. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Residents and others involved with the service say that they are happy with the service provision, feel safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand. It is displayed in a number of areas in the home. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. The home understands the procedures for Safeguarding Adults and will always attend meetings or provide information to external agencies when requested. Training of staff in the area of protection is regularly arranged by the home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. EVIDENCE: The inspector saw the record of complaints and none had been recorded since the last inspection. The inspector spoke to the relatives of 1 resident, they said that they had no complaints. They were confident that should they raise any issues, that these would be taken seriously and responded to properly. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 17 Several residents told the inspector that they felt confident to tell people if they were not happy about anything. 1 person said they had told assistant manager about an issue and that this was dealt with to their satisfaction. The inspector saw a number of thank you cards and letters that had been sent to the home by residents’ relatives. No adult protection issues have arisen since the last inspection. Records reflect that staff have received training in safeguarding people from abuse. The inspector noted that several staff have had training in dealing with challenging behaviour. The 3 staff that the inspector spoke to in depth demonstrated that they were clear about their responsibilities in terms safeguarding people. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 18 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, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet the needs of the people who live in the home. The home is a very pleasant, safe place to live the bedrooms and communal rooms meet the NMS or are larger, most bedrooms have en-suite facilities. Where appropriate the lay out and design of the home allows for small clusters of people to live together in a non-institutional environment. People who live in the home are encouraged to personalise their bedrooms. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who live in the home, and are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy; they seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the homes policy to reduce the risk of infection. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 19 EVIDENCE: The expert by experience said that they came to know that the home has been given a grant to develop the garden. Residents thought this was a good idea, as it would greatly add to available activities at the home. 1 resident drew the curtain to show the expert the garden area. The expert said that the home seemed gloomy, as it was a dull and grey wintry day, and that the grant seems to be a great opportunity to counter this situation and that erecting colourful non- bio structures along with plants and flowerbeds can transform the scene. The inspector toured the building and found that the home is divided into smaller units, Hibiscus, Holly, Primrose, Rowan lower, Rowan ground and Main Rowan. Each unit has dining/kitchen/lounge areas, bath/shower & toilet rooms and single bedrooms. Hibiscus is a specialist unit supporting residents from an Afro Caribbean background. All units have been decorated to a high standard and are well maintained, which provides aids and equipment to meet the care needs of the residents. Each resident’s bedrooms are decorated also to a high standard and generally reflected individual style and taste. The premise is kept clean, hygienic and free from offensive odour. All staff are aware of the policies and procedures relating to ‘Control of Infection’ this was observed by the inspector on the day. The laundry room was found to be good order. Clinical waste is properly managed and stored. It is recommended that the registered person consider providing another washing machine, because of the numbers of people who are living in the home. 1 staff member said “It can be a bit of a struggle to get everyone’s washing done”. The expert by experience said that colour and design had been put to good effect in the home. The expert suggested that the home put pictures on doors to help people to better understand what rooms were behind each door. A recommendation is made in respect of this. The inspector spoke to 1 resident who said that they had been able to bring in lots of photographs of their family, and various pieces of furniture to make their room more homely. The resident added that the staff member who usually puts up the Christmas decorations was on holiday, so it would be done when they got back. The inspector noticed that the unit was made more homely by use of pictures and ornaments. 1 resident showed the inspector around Holly unit. They said, “Sylvia (the manager) is very good at getting new things. When the toaster broke she got us a new one straight away.” The resident also pointed out the chairs and television, saying that the manager had got them as well. The resident said that they feel settled and considers Broadwater Lodge their home. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. People who live in the home have confidence in the staff that care for them. They report that staff working with them are skilled in their role, and are consistently able to meet their needs. There are enough staff available to meet people’s needs, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for the people using the service, and is not led by staff requirements. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for residents. The service puts a high level of importance on training and staff report that they are supported through training to meet people’s individual needs. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for people’s protection. There are clear contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Staff meetings take place regularly. Supervision sessions are regular and staff find them helpful. Notes are taken of meetings and sessions. EVIDENCE: A member of the staff accompanied the expert by experience on a guided tour of the home. They told the expert that their job was very demanding but they liked it. Another employee told the expert; “This work is self rewarding”. At the last inspection it was recommended that the registered persons undertake a review of the deployment of staff at key times, in order to ensure Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 21 that sufficient staff are available to meet the needs of residents at all times. At this inspection the inspector was able to confirm that this issue had been addressed. The registered manager told the inspector that there are always 2 staff on duty in the unit where people’s needs are highest, and that there is the flexibility to deploy staff from other units to help each other out. It was evident that the registered manager is committed to ensuring that staff are provided with training that ensures that they can meet the needs of the residents. She explained that NVQ training is progressing well and that 2 staff were attend training to improve their English in preparation for undertaking NVQ training. Another has recently passed and is now going NVQ 2. 1 staff member is has doing NVQ 3 and another is doing it. The inspector spoke to 3 staff members and it was evident that very much emphasis is placed on Broadwater Lodge being a proper home for people, and that staff think that residents should be treated with care and respect. This was also reflected in all of the practice that the inspector saw during the inspection. At the last inspection the registered person was required to ensure that the activity worker undertakes training in dementia care based on appropriate activities for residents with dementia care needs. At this inspection the inspector was able to confirm that this requirement had been met. The inspector saw evidence that high numbers of staff had been booked on refresher courses in first aid, infection control and manual handling. It is recommended that the registered manager continue to work to her planned schedule to ensure all staff have received all of the necessary core training, and that the training monitoring record is kept up to date to enable this to be monitored more easily. 1 staff member that the inspector spoke to said they enjoy their work, have access to good training, know the value of good communication and appreciate the team work in the home. The inspector reviewed the written records of 6 staff working in the home and spoke to 3 staff in some detail. It was evident that the registered persons ensure that all staff employed, including agency workers, have proper preemployment checks and an Enhanced Criminal Record Bureau (CRB) check in place before commencing work in the home. It was evident that the care staff that had recently started employment were supported appropriately as evidence indicated that supervisions and induction programmes were in place. It was evident that the management team have been working very hard throughout the past few months to ensure that all staff have had an annual appraisal, that these are meaningful and constructive, identifying training undertaken and training needs and seeking opportunities to meet these. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 22 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, 32, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualifications and experience and is competent to run the home. The registered manager has knowledge of the Council’s strategic and financial planning systems and the operational or business plan for the home links into these. The registered manager works to continuously improve the service and provide an increased quality of life for residents with a strong focus on equality and diversity issues. There is a strong ethos of being open and transparent in all areas of running of the home. The registered manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who live in the home. The registered manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. The service has sound policies and procedures, which the registered manager effectively reviews and updates, in line with current thinking and practice. The registered manager ensures staff follow the policies and procedures of the home, and the Council. The staff team are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 23 adherence to policies and procedures during their practice. Management processes ensure that staff receive feedback on their work. The home works to a clear health and safety policy, all staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Local practise and guidance reflects the Council’s health and safety policies and best practice. Records are of a good standard and are routinely completed. All the necessary insurance cover is in place to enable the home to fulfil any loss or legal liabilities. EVIDENCE: The registered manager holds the an NVQ level 4 in Management and Care certificate and comes across as very committed to improvement, open and frank. There are clear lines of accountability both within the home and with external management. Discussion with staff suggested that they see the registered manager as open and approachable. During the tour of the building, interaction with residents was warm, with the registered manager showing detailed knowledge about each person. Records examined indicated that staff meetings are held regularly. There are regular residents meetings. It was evident that the commitment is made to ensure equal opportunities and meeting individual’s diverse needs is a part of the ethos of the home. There is an effective quality assurance and quality monitoring system, based on seeking the views of residents. The majority of residents either control their own money or have their financial affairs managed by their families. Health and Safety certificates were examined. Portable appliance testing (PAT), lift service, fire extinguishers, fire drills and checks, water temperature checks, hoist & bath chair and emergency lighting checks were all in place. An environmental risk assessment, which includes a fire risk assessment, was in place. Core training around moving and handling, food hygiene, fire safety first aid and infection control is regularly updated by the organisation to ensure staff are clear about their responsibilities around heath and safety in the home. At the last inspection the registered person was required to ensure that 1-1 supervision is undertaken, at least 6 times per year, with the activity person and records of this must be kept on file. At this inspection the inspector was able to confirm that this requirement had been met. In some people’s records, feedback was included from their relatives and this indicated that the relatives thought the home well run. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 24 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 3 Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 25 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. 1. Standard OP9 Regulation 13 (2) Requirement The registered person must ensure that the temperature at which medication is stored in the home is monitored to ensure that it is kept below 25°. Timescale for action 28/02/08 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. 2. 3. 4. 5. 6. Refer to Standard OP1 OP9 OP12 OP12 OP19 OP26 Good Practice Recommendations It is recommended that a map be added to the service user guide in order to help people locate the home. It is recommended that a better method of transporting medication around the home be found. It is recommended that staff be provided with training in working with people with sensory impairment. It is recommended that more activities be provided to residents in the community. It is recommended that the home put pictures on doors to help people to better understand what rooms were behind each door. It is recommended that the registered person consider providing a third washing machine. DS0000033332.V355782.R01.S.doc Version 5.2 Page 26 Broadwater Lodge 7. 8. OP30 OP30 It is recommended that the registered manager continue to work to her planned schedule to ensure all staff have received all of the necessary core training. It is recommended that the training monitoring record is kept up to date to enable staff training to be monitored more easily. Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Broadwater Lodge DS0000033332.V355782.R01.S.doc Version 5.2 Page 28 - 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. 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