Inspection on 23/04/07 for Broad Acres Residential And Nursing Home

This inspection was carried out on 23rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Broad Acres Residential And... 04/06/06

Broad Acres Residential And... 16/01/06

Broad Acres Residential And... 18/04/05

Broad Acres Residential And... 20/01/05

Broad Acres Residential And... 05/05/04

Broad Acres Residential And... 28/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Broad Acres Residential And Nursing Home Leiston Road Knodishall Saxmundham Suffolk IP17 1UQ Lead Inspector Kevin Dally Key Unannounced Inspection 23rd & 30th April 2007 09:00 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 Broad Acres Residential And Nursing Home DS0000024345.V334955.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. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broad Acres Residential And Nursing Home Address Leiston Road Knodishall Saxmundham Suffolk IP17 1UQ 01728 830562 01728 830417 Broadacres@kowlessur.wanadoo.co.uk 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) Mrs N Kowlessur Mr K Kowlessur Mrs Caroline Sandra Manders Care Home 48 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (48), of places Physical disability (1) Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 20 in the category of Dementia Date of last inspection 4th & 5th July 2006 Brief Description of the Service: Situated in a village, within walking distance of the local shop, Post Office and Public House, Broad Acres is a care home with nursing, registered to care for 48 older people. This includes 20 places for people with dementia. The home consists of a single storey building, although set in large gardens, there is access to the enclosed gardens, as this is via residents’ bedrooms and an external gate. Mentally frail residents would need to be supervised using the large gardens, at the side of the home. However, there are courtyards, which can be used, which residents can freely walk about. There are 34 single bedrooms and 7 shared bedrooms. All bedrooms have a wash hand basin, 12 of which also have en-suite toilets. There are 4 bathrooms and a shower room, located close to the bedrooms. Communal rooms consist of 2 lounges, 1 dining room and 1 dining room/lounge. Some of the corridors are narrow, and would not be suitable for wheelchair users. Fees per week range from £375 - £410.00 residential and/or care of people with dementia, and £410 - £475.00 Nursing and/or care of people with dementia. Fees include care, nursing (where applicable), accommodation and food. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over 2 days on the 23rd and 30th April 2007, between 9am and 5pm on both days. This was a key inspection that assessed the core standards relating to elderly service users, some with dementia. The report has been written using all the information gathered prior to and during the inspection. During the inspection, time was spent with Mrs Kowlessur, the owner, Mr Christopher Banks, general manager, some of the nursing staff, senior care assistants, and care assistants, kitchen staff, the housekeepers and the administrator. All staff provided useful feedback and information about the home. Mrs Caroline Manders, the manager, was on sick leave during both days of the inspection. This inspection focused on the care and nursing support provided by the home, particularly for those residents with dementia. The daily routines and lifestyle outcomes for all residents were assessed, including opportunities for personal choices, and assessing if their care was provided in privacy, and with dignity. Residents’ care plans, risk assessments, needs assessments and accident and incident reports were checked for evidence of adequate care and management monitoring. The environment, meal provision, and medication practises of the home were also checked. Staff recruitment procedures, rosters and the numbers of staff on each shift were checked. The way the home was managed, including the management of complaints and quality assurance, were assessed. Comment cards were sent to residents, relatives, and staff to allow feedback on how they thought the service was run. Feedback was received from residents (15), relatives/advocates (19), and staff (22) and a selection of the views and comments received have been included throughout the report. Three staff members’ records were checked, including staff training and the supervision practises of the home. This inspection showed that of the 27 National Minimum Standards inspected, 14 were assessed as good, 12 as adequate and 1 as poor. Twenty-one of these standards are considered by the CSCI as key standards, of which the home met 11. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This inspection followed up on a number of concerns raised at the time of the last key inspection completed in July 2006, and 1 successive random inspection that took place after that time. A number of key issues had been raised around the way in which the home managed some of its more vulnerable residents with dementia, its practises around continence care, and the provision of daily activities. This inspection evidenced that the home and staff had worked hard to made a number of positive improvements since the last key inspection including • • • Improvements to meeting the needs of people with dementia Improvements to meeting the continence needs of residents Improved daily activities and lifestyle opportunities for residents The home now undertakes care mapping for people with dementia, and records were maintained of their progress. Staff were observed engaging more with residents and supporting them with their care needs. Residents were observed to be well cared for including good continence care practises. Daily activities were very much in evidence with personal and group activities being lead by the home’s activities coordinator. The staff group is now more stable, and the home was focusing on improved training for all staff. What they could do better: While it was noted that the home had improved a number of the aspects of its services for residents, a number of issues required attention. Vulnerable residents were able to gain access to the laundry room, which had excessive hot water tap temperatures. This situation was required to be risk assessed Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 7 and a solution provided to make the area safe. The COSHH cupboard, by the fire exit in the bungalow area, was required to be immediately secured, to ensure vulnerable residents did not have access to harmful substances. The cleaners’ equipment, including buckets, mops and vacuum cleaners had been stored near to the rear fire exit door in the bungalow area, and which may cause an obstruction to the fire exit. These were required to be immediately removed, and it was strongly recommended that the cleaner’s equipment and cupboard be relocated away from the fire exit. Some staff were observed using the draglift, which was not permitted and the residents moving and handling needs were required to be reassessed. The staff training and development programme was underway for 2007, but needed to be expanded to ensure care staff receive all core training and updates, and a training record be maintained for each employee. The home must maintain an accurate record of each staff member’s training. Care staff whose first language is not English must receive more communication skills training to ensure they can understand the needs of the residents. Systems must be provided to ensure that all medication can be appropriately audited by nursing staff. A record must be maintained of all Criminal Records Bureau checks, and identity checks and job descriptions must be undertaken for all staff. The home’s grounds must be better maintained, including repairing the boundary fence, and the doors and narrow hallway walls must be repaired and better maintained. Unpleasant odours must be identified and eliminated. The home must ensure that there are a number of suitably qualified care staff as recommended by the Skills for care Consortium. Staff must receive regular supervision and a record maintained on their file. 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. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 8 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 Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 does not apply to this service The quality in this outcome area is adequate. People using the service can expect the home to provide appropriate information, and would usually have the competency to meet residents basic care needs, including those people with dementia, although some overseas staff may not have sufficient communication skills to fully understand residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the previous inspection the Statement of Purpose did not include a number of key requirements so this was re-checked. This document now included the following missing information. • • • The range of needs met including the provision of nursing care. The number of residents registered, being 48 (total), over 65, with up to 20 Nursing, and 28 residential clients, of which up to 20 in either category may be with dementia [DE, E] The wording ‘including young children’, which did not relate to the age group, has been removed. DS0000024345.V334955.R01.S.doc Version 5.2 Page 10 Broad Acres Residential And Nursing Home • • The details of the management structure and responsibilities including the ‘non- clinical general manager’, nurse manager, nurses and care staff. Information is now provided on the bedrooms and areas unsuitable for wheelchair users. At the previous inspection it was confirmed that residents are given a Broad Acres Residential/ Nursing home User Guide, (clients handbook), which gives further information on the home, including meal times. Feedback received from 7 of 13 residents confirmed they had received a contract from the home. Six stated they had not received this, but may be because they were under a general Social Services contract. It is recommended that the home check that where a contract has not been issued for this reason, that they ensure that residents’ receive a “Statement of Terms and Conditions of business”, which is maintained on their records. Feedback received from the majority of residents (11 of 14) and relatives (18 of 19) confirmed that they had received sufficient information about the care home, before they moved in. This information had enabled them to consider if this was the right place for them. One relative commented, “My relative had previously visited the home, and gave a good report”. Two of 2 residents’ care records seen, evidenced that a care needs assessment had been undertaken by the home. This included an assessment of their previous medical history and needs, a client person profile, and a home assessment that assessed personal care needs, mobility needs, sensory needs, memory ability, and their social behaviour. Additional assessments of residents needs had been undertaken, for example nutritional needs assessments, and are fully discussed under standard 7, care plans. Broad Acres state they can provide a variety of services for elderly residents over the age of 65 years old. This includes places for residential and nursing care, and residents with dementia. Care staff comprised of around 8 registered nurses and 21 care staff, and evidence of their training and ability to care for residents with specialised needs was checked. Staff training records evidenced that nursing staff had received some specialised training, for example, dementia care, PEG feeding, stroke training, aggressive behaviour training, wound care, and catheterisation training. In response to the last inspection, the home had provided care staff with specialised training around dementia care, which was a very positive development. Further, training had been provided around pressure area care, palliative care, and Malnutrition Universal Screening Tool (MUST). Some training was found sporadic and required a full rollout programme for all staff members. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 11 Some staff members, including overseas staff, were spoken with about the training they had received in dementia care, and it was evident that this had usually been helpful for them when providing care for these residents. However, some overseas staff were unable to understand some basic questions around dementia, as English was not their first language. This raised concerns around their communication skills, and how much they had actually understood about residents with dementia. This was raised with the general manager, who advised that these staff were on an English language course. At the last inspection a number of concerns had been raised around how the home managed residents with dementia. Positively the home has been active in trying to address these concerns. This has included seeking help from healthcare professionals, with dementia care mapping expertise, in order to improve the long-term care and support for residents with dementia. This programme endeavours to map the presenting behaviours, and provide staff with appropriate solutions and strategies to manage these difficult care problems. Improvements in the care of people with dementia were noticeable including more staff engagement with residents, more regular activities, and improved ways of managing personal care. The home did access relevant specialist professionals and services, when this is required. For example, the McMillan Nurse had recently undertaken training for some staff members. The premises were adequate and entirely on the ground floor, but some areas were not wheelchair accessible. The home offered a basic range of programmes and activities for residents, including occasional social days out. On the day of the inspection, residents were being engaged in the daily activities programme, which was run by the activities co-ordinator. Residents who had completed the CSCI surveys, 11 stated they ‘always’ received the care and support they needed, 2 stated ‘usually’, 1 ‘sometimes’, and 1 ‘never’. From the relatives/visitors who had completed the CSCI comment cards, 13 stated that the care home ‘always’ met the needs of their relative, and 6 stated, ‘usually’. Two relatives provided the following feedback about the care provision. “The person I help is certainly happy and appears well cared for” and, “Broad acres appear to cater well for its residents, according to their individual needs”. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is adequate. Residents expectations of the service, including being treated with dignity, and respect, and having their nursing care and healthcare needs met, would usually be met, although some staff may not always follow recommended safe handling procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of 4 residents, including one with dementia, and one experiencing falls, were checked. Time was also spent with 2 of these residents to check the level of support written in the care plan, reflected the level of care given. Various assessments of individual needs had been undertaken including a medical history, a detailed home assessment, and any special needs. The client profile, particularly where residents were unable to communicate, provided staff with essential background information. The key support needs were summarised in one form, and presented in detail under a number of key headings. The information held in one care plan included a ‘nutritional assessment’ with detailed information around the resident’s diabetic controlled Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 13 diet. Further, the information included a nutritional risk assessment, and this had been updated on a monthly basis. Other records included a bruise chart, weight chart, personal hygiene needs, continence care, mental health, mobility plan, falls assessment, moving and handling risk assessment, and a pressure area risk assessment. The care plan also included information on funeral arrangements; a call bell assessment, a pain chart, and a professional contact chart. The records of the resident who experienced falls and dementia had a ‘falls chart’ and a lap belt risk assessment, and an agreement from the Doctor confirming the necessity for the lap belt. This resident was monitored throughout the visit, and staff frequently visited them, and ensured that they had access to the toilet, and assisted them to the dining room at lunchtime. A moving and handling risk assessment had been written which covered the resident’s daily activities, and stated the need for the use of two staff with a lifting strap. However, the notes stated, “…their mobility is getting worse and close supervision and 2 carers are required when walking”. The resident was observed being assisted with their mobility, but was unable to weight bear, so the staff members used the “drag lift”, which must not be used. This lift was also seen being used with another resident and so was brought to the attention of senior staff. During the 2 days of the inspection, the care of the residents was constantly observed and they were found neatly presented, well groomed and properly cared for. Although the smell of urine still lingered in some confined areas, no resident was observed as incontinent. Drink trays with cold drinks were located in each day room, and staff were seen offering residents drinks throughout the day, in addition to morning and afternoon teas. One resident’s toenails required trimming and attention, and this was brought to the management’s attention. The accident records were checked and were well maintained with evidence of management monitoring. During the period from April 2006 to March 2007, 164 accidents had been reported, an average of around 13 per month, and these were mostly minor in nature. The management stated that any resident where there had been repeated falls, they were closely monitored. Falls risk assessments had been completed, and a strategy implemented, on a case-bycase basis. One resident with slight bruising on their face, their accident records were found which confirmed how this accident had occurred. The home’s system for storing, recording, auditing, dispensing and disposal of medication was checked, which was found adequately maintained. The home receives medication in weekly dossette boxes directly from the pharmacist; with any medication unable to be dispensed into the containers are sent in their original container. Medication received is entered onto the home’s Medication Administration Records (MAR) charts, which run for 12 Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 14 weeks, and should be signed, or an appropriate code entered each time medication is given out. Records checked showed that staff had signed these records during the 3-month period February to April. Although resident’s medication had been written on the MAR chart, including the amount received, no start date had been entered, so it was not possible to audit the number of medication currently in use. The Controlled Drug (CD) cupboard was found maintained securely, and a sample of CD’s was checked against the records and these were correct and accounted for. The nurse spoken with was able to answer questions on the various medication procedures, and why the residents used these. A fridge was maintained in the medication room for storage of medication requiring this facility, with appropriate temperatures and records having been maintained. The medication procedures were checked. During the 2-day inspection, the home was found to be calm and relaxed with adequate time provided to meet the residents’ needs. Residents were observed being treated kindly, and where assistance with personal care was needed, this was provided in the privacy of their room. Staff were observed to knock on doors, and promptly answer call bells, and meet care needs. In one situation where a person with dementia had become distressed, staff dealt with this in a caring and positive manner. Residents and relatives feedback was received around the care provided by the home, as follows. Residents (15) Do you receive the care and support you need? Do staff listen and act on what you say? (3 did not say) Are staff available when you need them? (1 did not say) Do you receive the medical support you need? (1 did not say) Relatives (19) Yes/ Always 11 11 8 4 Usually 2 Sometimes 1 1 2 No 1 10 3 1 Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 15 Does the care home meet the needs of your relative? Does the care home give the support or care to your relative that you expect or agreed? Do the care staff have the right skills and experience to look after people properly? Yes/ Always 13 Usually 6 Sometimes No 12 14 7 5 A selection of views and comments from residents and relatives about their care included the following views. “They attend to the needs of the people in their care”. “I get the medical support I need, don’t have any problems”. “The home has always responded to the needs of my client with sensitivity and kindness”. “I would like more support”. “I feel the home does most things well. I feel my relative is safe, warm, well fed, and generally well looked after by cheerful staff”. “I think the home does everything well. I always arrive unannounced and never find anything different”. “We feel that staff generally try very hard to ensure that our relative has a good quality of life”. “I find staff very friendly”. From the comments and views of the residents and relatives, it was concluded that Broad acres usually provide and meet the healthcare and support needs of the residents. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. The staff group would provide good lifestyle opportunities for residents at the home, including social opportunities, adequate meals, and contact with families and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the first day of the inspection, some time was set aside to talk with residents and staff, and observe the care received. The home atmosphere was calm and relaxed, and staff were welcoming. Residents were observed to be well groomed, neat and tidy, and most had completed their breakfast. Some residents, who needed assistance with feeding, were still being supported in an unhurried manner. The main day room by the main entrance had a number of more vulnerable residents present, with one in a specialised chair, with lap belt. Several wheelchair users were transferred to more comfortable lounge chairs. The television was on and the activities coordinator was seen to assist a resident read the newspaper. Later in the morning, a resident played some old favourite tunes on the piano, which was enjoyed by the residents. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 17 A number of residents were found up and dressed in their own rooms, and they confirmed it was their choice to be there. One resident whose room overlooked the garden, described how their family helped them maintain some pot plants outside their window, which gave them much pleasure. The resident confirmed that their whole family took turns to visit them on a regular basis, and that the family could visit at any time. Further, the resident confirmed that suitable activities were provided, and recalled a recent trip to the beach. The resident told me that staff were mostly ‘thoughtful’ and treated them with respect. They were always asked which choice of the main meal they wanted each day, and the meals provided were enjoyed. Further, they confirmed they were brought a cup of tea at 6am and staff would return around 8am to assist them with their personal care. Another resident told me they had been assisted to rise at around 8am, which was their preference. They were served a light breakfast of tea and toast. Further, their relatives visited them on a regular basis. The resident said they like the meals provided at the home, and they could take these in the dining room, or in their own bedroom. At the previous inspection concerns had been raised around the lack of social activities provided for residents with dementia. This inspection evidenced that interaction was being actively promoted by staff who engage residents with “30 second activities”. For example, staff will greet the person by name, and make eye contact and smile, or give a compliment etc. Interaction with dementia residents, no matter how short, was then recorded. Staff were seen positively engaging with dementia residents throughout both days. The home also acknowledged that there was still more to do. The activities co-ordinator was spoken with and confirmed they were undertaking a course in leading activities at Otley college. There was a planned programme of activities of events for each day of April and included newspapers, table games, reading to individuals, taking residents shopping, beauty therapy, singing, baking and menu choices. A number of residents told me they especially looked forward to the baking classes, as this reminded them of when they had their own home. Feedback received from 9 of 13 residents when asked, ‘Are there activities arranged by the home that they could participate in’, replied ‘yes, always’, 1 stated ‘usually’, and 2 stated ‘sometimes’. From the information received concluded that the provision of activities had continued to improve since the last inspection, but some staff may still need further training in supporting residents with daily activities. Feedback from residents and relatives was more positive about the standards of meals and food since the last key inspection. The home runs a rotating menu, copies of which were given during the inspection, and pictures of most menus choices were available in the dining room. Menu ‘choice sheets’, which Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 18 gives information on the menu choices, are completed for/by each resident on a daily basis, and recorded. Dinner on the first day of the inspection was a choice of mince dumplings or grilled pork chops or a vegetable cheese bake, served with vegetables and potatoes. Dessert was fruit flan and cream and ice cream. The meal smelt and looked appetising, and was enjoyed by residents. The range of main courses over the remaining week included chicken and mushroom, chicken burger, braised beef, ham and cheese salad, fried fish, beef pie, and roast pork. The Supper (Tea time) menu checked consisted of Soup Bread/Butter Jam, cauliflower cheese, poached eggs on toast, cheese and biscuits, jam tart or fresh fruit, Tea or Coffee. All residents visited in their bedrooms had a jug of water/juice, and good practice was seen with residents being encouraged to take drinks in the lounges throughout the day. A selection of comments received from residents and relatives included the following feedback. “The food is very good, drinks are always available, outings when possible including Christmas and the Easter fete. There is a happy atmosphere”. “Staff are always friendly and welcoming”. “The home provides a stable and good atmosphere, as they always have a caring attitude towards residents as a whole”. “The staff are always around during the day and organise activities for the residents, including knitting, scrabble and reading”. “I like doing my gardening near my room”. “I go on outings”. “Activities are advertised on the wall. We made hats for Easter and I go for walks in the garden”. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. Residents and visitors have access to a robust complaints procedure, and residents could expect they would usually be kept safe by access to the complaints and adult protection procedures, and by staff training in adult protection. Some staff recruitment lapses may expose residents to unnecessary risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s complaint policy is contained in the Statement of Purpose and User Guide. (Clients Handbook) The policy states that complaints will be processed within 10 working days or a shorter period. The guide informs the reader, that they can speak to a staff member, your Social Worker, the owners, or the Commission for Social Care Inspection, should they wish to make a complaint. Feedback received from 15 of 15 relatives said they knew who to talk to if they were unhappy and 10 of 14 residents confirmed they knew how to make a complaint. Four stated ‘No’. Seventeen of 19 relatives confirmed they were aware of the complaints procedures and positively, 14 of 14 relatives confirmed that the care service had responded appropriately, when they had raised any concerns about their relative’s care. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 20 Since the previous inspection the home had 3 recorded complaints in the complaint log. These were around one resident not being in their own clothing, one around a resident’s carpet and toilet not being adequately cleaned, and one of a more complex medical nature. Further, the commission were advised by the home of a 4th complaint, in which relatives had raised concerns over the possible loss of some of their relative’s personal money. This was investigated by the police, but was not able to be substantiated. The relatives’ family were made aware of the outcome. All complaints had been investigated, with 3 completed and 1 unable to be resolved. A selection of feedback received from some relatives included the following. “When we raised concerns about [this issue], the home got onto it the same day”. “I have not had to raise any concerns with the home”. Nineteen of 19 staff completing the CSCI survey confirmed that they had received training in the home’s adult protection policy. Three of 3 staff members’ records checked showed they had received training in adult protection. Three staff members’ recruitment records checked showed that the home had obtained a Criminal Records Bureau check (CRB) for each staff member. However, one employee’s CRB record only included part of the CRB document, which could not be verified, as a record of the disclosure number had not been maintained. One further employee’s CRB contained information relating to a reprimand, and it was strongly recommended that the home provide written evidence of their assessment of the suitability for this employee to work with vulnerable adults. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 21 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, 25,26 The quality in this outcome area is adequate. People could expect a home that was usually odour free, clean and hygienic. Although basic home maintenance is undertaken, more improvements would be required to ensure a well-maintained and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is set in large grounds with some trees, courtyards and paved areas. The grounds themselves could be better maintained and some consideration should be given to allow for improved access for people with mobility difficulties around the garden to the rear. The garden stocks could be improved. One boundary fence had collapsed, and must be replaced, to provide security and privacy for residents. Two inner courtyard areas seen provided secure outdoor access to some gardens, that residents’ could benefit from and enjoy. These courtyards were provided with a variety of outdoor furniture. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 22 Since the last key inspection, the owners confirmed they had re-decorated 6 rooms and provided new carpets for these areas. New carpets were evident in each of the 3 large lounges, and a variety of new dining tables and chairs have been provided in these areas for the benefit of residents. This provided a comfortable area for residents’ use and relaxation. The tables were seen in operation and were being utilised for meals and activities through out the day. The dining and lounge areas were fresh and clean and well maintained. The home does show signs of wear, tear and ageing, with wheelchair damage to some residents’ doors, particularly rooms 4,6,and 12. Consideration must be given to improve the general paintwork in the hallway areas, particularly in the 2 narrow hallways near the kitchen end of the building. Some residents have their own specialised chairs, but there was a large stock of available chairs, and these are gradually being replaced. A check of the laundry room found the door unsecured, and which may allow access for some more vulnerable adults to the hot water taps. The hot water was needed for the laundry but was in excess of 55 degrees Celsius. The home was therefore required to undertake a risk assess of this situation and provide suitable safeguards, to ensure that service users are not put at risk or harm by scalding. Feedback from relatives and observation of the home, confirmed that the cleanliness of the home continues to improve, with less noticeable unpleasant odours. However, some isolated areas were still noted to have some distinct odours, which must be identified and a way of addressing these must be found. Domestic staff were seen cleaning and working throughout the home at the inspection. Residents spoken with stated that the domestics vacuumed and cleaned most days. Staff stated that they vacuumed and clean every day. Shared bedrooms had mobile room dividers and these continued to be in use, to ensure residents privacy. Call bells are situated throughout the home in bedrooms and communal rooms, and these were seen in operation with staff answering these promptly. Residents (15) completing the feedback card, all stated that they felt that the home had been kept fresh and clean. A selection of residents and relatives’ comments included the following views. “I think Broad acres fulfils its role to the best of its ability”. “The only area for improvement is the garden. It could be better, including flowers outside the French doors”. “I don’t see they can do much more than they do now”. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 23 “The general decoration is poor in some rooms. The furniture looks tired and could do with improvement”. “They could improve cleanliness, and be made aware of certain smells. The décor could be improved”. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 24 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 The quality in this outcome area is adequate. People using the service can expect adequate staffing levels, with staff receiving some basic training. Recruitment procedures, while sufficient, could not always be assured because of inconsistent record keeping. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback received from residents, relatives, professionals, and the staff confirmed that there was now a more stable staff group at the home, than had been previously. Copies of the staffing rotas for the period 16th April to 06 May 2007 were given to me to be able to takeaway for checking. This showed that planned staffing levels in the morning were maintained at around 1 registered nurse, 1 senior carer, 6 carers, with up to 2 support carers (aged under 18 who do not undertake personal care). This provided a ratio of 1 care staff to 6 residents. The average staffing levels in the afternoon (2pm – 6pm) was 1 registered nurse, 1 senior carer and 5 care assistants, giving a ratio of 1 member of care staff to 8 residents. Staffing levels on night were, 1 registered nurse with 3 care staff. There had been a number of alterations to the rota, but these appeared to be due to sickness or providing cover for annual leave periods. Observation during the inspection showed that staffing levels provided limited time for staff to be able to sit and spend with the residents, but usually spent the majority of their time providing care. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 25 The manager usually worked Monday to Friday during office hours. The rotas showed that the general manager also worked as a Chef, carer, and maintenance person. Feedback received from 19 relatives /visitors felt that staff “always or usually” provide the support and care their relative needed. At the previous inspection it was noted that due to sickness/leave on 12 of the 14 nights, the staffing levels at night were 1 Nurse and 2 carers for up to 48 residents. This had now improved with only 3 of 14 nights checked, where staff cover had dropped to 3 staff members. Information supplied by the home showed that 3 carers currently hold a National Vocational Qualification (NVQ) level 2 award, with 1 holding an NVQ3. 6 other carers are currently working towards an NVQ level 2 or 3 award. The home’s Statement of Purpose, informs the reader that they aim to have 50 of their staff trained to NVQ level by 2007. As the home has 22 care staff the home must consider how is means to achieve the recommended standard of 50 workers having achieved an NVQ in care. Three staff members’ recruitment records checked showed that the home had obtained a Criminal Records Bureau check (CRB) for each staff member. However, one employee’s CRB record only included part of the CRB document and was unable to be verified, as a record of the disclosure number had not been maintained. One further employee’s CRB contained information relating to a reprimand, and it was strongly recommended that the home provide written evidence of their assessment of the suitability for this employee to work with vulnerable adults. While Protection of Vulnerable Adults (POVA) checks were now undertaken for all new staff members, some staff members employed by the home prior to June 2004, had never had a POVA check undertaken, and which is strongly recommended. Three employees’ records checked included 2 written references for each staff member, and identity checks had been provided for 2 of 3 staff members. Job descriptions were provided for 2 of 3 employees, and medical declarations for all staff. Copies of relevant training certificates were held on file, and there was evidence that 3 of 3 employees had been given the ‘in-house’ induction. New care staff complete a new ‘in-house’ training induction called ‘understanding the principles of care’. The general manager, who holds an NVQ 3 care qualification, undertakes induction training. The new induction programme is based on the Skills for care consortium and takes staff through training objectives, including Health & Safety and adult protection issues. Three staff members’ records checked evidenced that some training had been provided. Records checked for one nurse included Malnutrition Universal Screening Tool (MUST) programme 2007, phlebotomy training, stroke training, PEG feeding, adult protection training, moving and handling training, fire, caring for people with dementia, and training around funerals. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 26 One care staff member’s records checked evidenced induction training, adult protection, and personal care, code of conduct, pressure sores, health and safety, moving and handling training and English classes. Another staff member did not have a record of having received training, although the management confirmed it and which was required. Feedback received from staff members all thought they received sufficient training to assist the residents, and meet their needs. The staff training and development plan evidenced that the manager provided training usually each month. Feedback received from 19 relatives stated they thought that care staff ‘have the right skills and experience to look after residents properly’. A selection of comments received from residents and relatives about the staff included the following views. “Staff are very caring”. “Staff are very welcoming. They look after the needs of the people in their care”. “In my relative’s case, they are well looked after by caring well trained, good natured happy staff. They are kept well fed, and have activities daily to keep them occupied”. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 27 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, 35, 36, and 38. The quality in this outcome area is adequate. People using the service can expect an adequately managed and improving service, with safe systems in place for the keeping, and recording of residents’ monies, However some recent health and safety lapses could put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Mrs Caroline Manders is an experienced Registered Mental Nurse (RMN) and holds an NVQ level 4 in Management. Mrs Manders was on sick leave during both days of the inspection. Feedback received from relatives stated that the care service responded positively to them if there were any concerns. Residents spoken with and feedback received confirmed they felt the home “did a good job”, and this was also reflected by staff. Feedback received from residents (14) confirmed they Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 28 knew who to speak with if they were not happy, and 10 of 14 residents confirmed they knew how to make a complaint to the service. Seventeen of 19 relatives knew how to make a complaint. The home also positively communicated with residents and relatives about improvements to the home via the ‘Broad Acres News Bulletin’, and received feedback directly from relatives and residents. Quality assurance monitoring was last undertaken up to October 2006, but this will be checked as part of the next inspection. A selection of relatives’ opinions about the service was posted in the home’s news bulletin. A check was undertaken of 2 residents’ personal money held securely by the home on their behalf. Both residents’ money records balanced with the cash held. Feedback received from staff confirmed they received supervision from the home and supervision records were maintained. Two of 3 staff members’ records identified that they had received supervision, but this had not occurred for some time, one staff member had no record of having had supervision for over a year. Staff records checked showed that staff had received some health and safety training, including moving and handling training, but some staff required further training, or updates around fire, food hygiene and infection control. Since the previous inspection the home has had a number individual door closures fitted, which now means they do not need to depend on door wedges. The COSHH cupboard, by the fire exit in the bungalow area, was not secured, and may allow some more vulnerable residents access to harmful substances. The door was required to be immediately repaired and secured. The cleaners’ equipment, including buckets, mops and vacuum cleaners had been stored near to the rear fire exit door in the bungalow area, and which may cause an obstruction to the fire exit. These were required to be immediately removed, and it was strongly recommended that the cleaner’s equipment and cupboard be relocated away from the fire exit. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 1 Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 18(1)(c) (i) Requirement Timescale for action 21/08/07 2. OP4 12(1)(a) 19(1)(a) 3. OP7 13(5), 13(4)(c). The staff training and development programme must include specialised training for all staff, for example dementia training, to ensure staff have the skills and competency to meet the specialised needs of service users. The home must ensure that care 21/07/07 staff whose first language is not English, have sufficient communication skills to understand residents’ requests. Residents’ moving and handling 21/06/07 needs must be reassessed to ensure they are mobilised in a safe way. Staff must only use accepted moving and handling techniques. This requirement is immediate. Residents’ personal care needs, including toenail trimming, must be met at all times to ensure their dignity is respected. A system must be in place to ensure that medication tablet numbers can be audited to ensure that residents have DS0000024345.V334955.R01.S.doc 4. OP8 12(1)(a)( b) 13(2) 21/07/07 5. OP9 21/06/07 Broad Acres Residential And Nursing Home Version 5.2 Page 31 6. OP18 7. OP19 8. OP19 9. OP19 10. OP25 11. OP28 12. OP29 13. OP29 14. OP30 received their correct medication. 19(b) The home must maintain Sch 2(7) evidence that CRB checks have been undertaken to ensure appropriate people are caring for the residents. 23(o) The grounds must be better maintained, and the boundary fence repaired or replaced to ensure the safety of residents. 23(2)(b) Doors and the narrow hallway walls must be repaired, repainted and better maintained to ensure residents are living in a well-maintained environment. 16(k) The origins of unpleasant odours must be identified and eliminated to ensure residents live in a pleasant environment. 13(4)(a)(c The laundry door was not 13(6). secured and may enable some more vulnerable residents access to the hot water tap. This area must be risk assessed and suitable safeguards provided to ensure that service users are not put at risk or harm by scalding. This requirement is immediate. 18(1)(a) The home must ensure that care staff obtain suitable qualifications as recommended by the Skills for Care consortium to ensure residents are cared for by a skilled staff team 19(1) Identity checks must be Sch 2(1) undertaken for all staff and a record maintained on their file to ensure appropriate people are caring for the residents. 17(2)Sch4 Job descriptions must be (6)(e)(f) provided for all staff members to ensure they are aware of their responsibilities. 18(1)(c) Core training including fire, food hygiene and infection control must be provided for care staff DS0000024345.V334955.R01.S.doc 21/07/07 21/07/07 21/07/07 21/06/07 21/06/07 21/08/07 21/07/07 21/07/07 21/07/07 Broad Acres Residential And Nursing Home Version 5.2 Page 32 15. OP30 16. OP36 17. OP38 18. OP38 to ensure the safety of residents. The home must maintain an accurate record of each staff member’s training to show that training is kept up to date. 18(2) Staff members must receive regular supervision and a record be maintained to show they receive appropriate support. 13(4)(a)(c The COSHH cupboard door must ), 13(6). be repaired and secured at all times, to ensure that residents do not gain access to dangerous substances. This requirement is immediate. 13(4)(a)(c The emergency fire exit areas ) 23(4)(b) must always be maintained free of any potential obstructions, to ensure a safe fire exit area for residents, at all times. This is an immediate requirement. 17(2) Sch 4(6)(f) 21/07/07 21/08/07 21/06/07 21/06/07 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. 7. Refer to Standard OP2 OP12 OP18 OP19 OP29 OP38 Good Practice Recommendations Where a contract is not offered to a resident, a statement of terms and conditions of business should be maintained on each resident’s records. The home should ensure that all care staff can provide appropriate activities support. Any reprimands noted on CRB records should be risk assessed by the home, and a record of their suitability to work with vulnerable adults recorded. Better access should be provided to the grounds at the rear, for people with mobility difficulties. Protection of Vulnerable Adults (POVA) checks for staff working at the home prior to June 2004 are strongly recommended. It was strongly recommended that the cleaner’s DS0000024345.V334955.R01.S.doc Version 5.2 Page 33 Broad Acres Residential And Nursing Home equipment and/or cupboard be relocated away from the fire exit, to avoid causing any obstruction. Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Broad Acres Residential And Nursing Home DS0000024345.V334955.R01.S.doc Version 5.2 Page 35 - 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. 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