Inspection on 04/06/06 for Broad Acres Residential And Nursing Home

This inspection was carried out on 4th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broad Acres Residential And... 23/04/07

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 Jill Clarke Key Unannounced Inspection 06:30 4th & 5th July 2006 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.V302436.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.V302436.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 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 Broad Acres Residential And Nursing Home DS0000024345.V302436.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 16th January 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 limited access to the enclosed gardens, as this is via residents’ bedroom and 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 toilet. 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 not suitable for wheelchair users. Fees per week as given in the Home’s Statement of Purpose, range from £360 - £390.00 Residential and £460 - £485.00 Nursing, and include Care, Nursing (where applicable), accommodation and food. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 1½ days which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. The home had no vacancies at the time of the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home at the beginning of May. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (10), joint relative/visitor (22), and staff (19) feedback cards have been included in this report. Throughout the inspection time was spent with the Registered Provider, Registered Manager, Nurses, Deputy Manager, Senior Care Assistants, Care Assistants, Housekeepers and Administrator, who were helpful and cooperated fully throughout the inspection. A tour of the building, took in all the communal rooms and a sample of 4 bedrooms, bathroom, laundry and gardens. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, Statement of Purpose, Menus and medication records. Previous visits to the home identified that people living at Broad Acres preferred to be known as residents, this report respects their wishes. What the service does well: One relative wrote (CSCI survey) ‘Broad Acres appears to be looking after (their relative) and other residents very well’, they also commented that they have seen ‘great improvements during the last year plus’. They felt that staff now spent ‘more time interacting with residents trying to keep them interested and responsive’. This was also reflected during conversations with relatives during the inspection, who felt that carers and domestic staff interacted well with the relatives, and had a good insight to their behavioural needs. Another relative wrote ‘the carers are extremely sensitive towards the changing needs/requests’ of their relative. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Broad Acres Residential And Nursing Home DS0000024345.V302436.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 Broad Acres Residential And Nursing Home DS0000024345.V302436.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, and 5. (Standard 6 not applicable, therefore not assessed) The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service can expect to have their needs assessed prior to admission, and be given information about the home. However, they cannot be assured that the home will not take extra people, in the category of dementia care, then they are registered for. EVIDENCE: The inspector was given a copy of the home’s current Statement of Purpose, a further copy was displayed in the entrance hall, with the previous CSCI inspection report. The document requires some further information to be more informative to the reader: • Range of needs met – does not mention that the home provides nursing care. • Does not give the number of residents they can look after in each category – the coding of dementia [DE] should reflect for over 65 years of age written as [DE,E] • The wording ‘including young children’ (Restrictions) does not relate to the age group. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 9 • • • • Civil Rights – does not include any information or contact numbers for advocacy services. As part of the management structure identify what areas the ‘nonclinical Deputy Manager’ are responsible for. The structure does not show where the trained nurses fit, especially taking into account in the managers absence, who has overall responsible for making clinical decisions. Does not mention how nursing care for residential, not assessed as requiring long-term nursing care, will be accessed if not undertaken by their own nursing staff. Information on which bedrooms and areas of the home are unsuitable for wheelchair users. Residents are given (although not looked in detail at this inspection) a ‘Welcome to Broad Acres Residential / Nursing Home’ handbook, which gives further information on the home including meal times. Time spent with relatives during the inspection confirmed that they had visited the home during the pre-admission period. They said staff had taken time to answer any questions they had, and given them information on Broad Acres. From the residents completing CSCI surveys, the majority (8 out of 10) said they had been given enough information on the home. Two of the 3 residents care records seen, did not evidence that a preassessment had been undertaken by the home. However, their care plans did show that the home had assessed their needs on the day they were admitted. The Manager stated that due to both admissions being classed as emergencies, this had not allowed time for a pre-assessment to be arranged. Care records did not clearly evidence that they had been emergency admissions. The inspector was shown the pre-admission assessment undertaken for the 3rd resident, although not undertaken by a qualified member of staff, the manager confirmed the assessment had been carried out under their supervision, as part of the member of staff’s development. The manager confirmed that an experienced, qualified person always undertakes the pre-assessments. One resident whose care was tracked, showed that they had been admitted under the home’s dementia care category, but since their admission their status had been changed to that of frail older people category (OP). In changing the status of the resident, and then admitting another resident who had a diagnosis of dementia, the home had exceeded the number of residents with dementia that they were registered to care for. The owner explained that Social Services had changed the status of funding for the resident, which had resulted in the resident being moved to the category of OP. Discussions with management identified that there were other residents whose mental health needs have changed since they were admitted to the home, however they believe their care needs can still be met at Broad Acres. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 10 Residents who had completed the CSCI surveys, 5 felt that they did receive the care and support they required, 4 ‘usually’ and 1 ‘sometimes’. From the relatives/visitors who had completed the CSCI comment cards, all but 2, had stated that they were ‘satisfied with the overall care provided’. One relative commented that ‘although staff appear caring, I am not sure how much group/individual time is given to those with mental illness as all resources seem to focus on nursing care’. This was also identified during the inspection, with resident’s being left alone for long periods of time, without interaction (see daily Life and Social Activities). Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service can expect to have their nursing and physical care needs written in their plan of care. However, residents cannot be assured that staff are always offering flexible care, around individual needs, promoting choice, and independence. EVIDENCE: Since the last inspection, staff had finished ‘streamlining’ the residents care plans, to make them more ‘user friendly’ by having information set out in sections. Five resident’s care plans were looked at during the inspection, and time was spent with 2 of the residents to identify if the level of support written in the care plan reflected the level of care given. Information held in the care plans included ‘dependency level chart’ and ‘care plan/ record of assessment’, which identified how staff would meet individual assessed needs. For example, a resident whose care was tracked, was identified as requiring support with their personal care. The staff had written that the expected outcome would be to ‘preserve (resident’s name) individuality and self-esteem and independence’. They went on to write that staff should ensure the resident’s privacy during care, and that the resident Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 12 required the ‘assistance of 1 carer to wash and dress’. Another identified goal was to support the resident to remain continent ‘ for as long as possible by maintaining their privacy and dignity’. However, observation showed that staff were not always observing this (see next section Daily Life and Social Activities). There was no guidance for staff in supporting the resident with their orientation, to enable them to locate where the toilets were. Some of the ‘information’, ‘needs’ and ‘outcomes’ on care plans used the same set phases. However, information given on the new ‘clients with special needs care assessment and planning’ was more informative and personalised. One resident’s care plan held notes written by the family, giving information on the resident’s daily routine, family history, likes and dislikes. This was seen as good practice, enabling staff to have a greater insight to the resident’s normal daily routines, when they may not be able to clearly say themselves. The home said that this was 1 area that they were trying to promote. Some of the information given by the family had been incorporated into the care plan. Risk assessments covered resident’s daily activities, however, staff had not always signed and dated the information. One risk assessment, which was assessed as a 4 (always appropriate in behaviour for social behaviour day and night time), conflicted with other information given in the daily records and ‘exclusive’ report, referring to the resident as being ‘aggressive’. The inspector on reading the report raised their concerns on how staff had handled the situation, by them trying to get the resident to return to their bedroom. The resident had then become annoyed/frustrated with staff, as they were unable to do what they wanted. This led to discussions with the manager over why, when they were promoting person centred care (meaning they offered a flexible approach to the resident 24-hour care needs, and not make them try to fit in with the home’s set routines), were staff trying to direct a resident back to bed, when clearly they did not want to go. Care plans also contained information on assessing resident’s skin, nutrition, mobility and were applicable, nursing needs. Completed ‘body charts’ gave information on any minor injuries the resident may have sustained. The manager confirmed that none of the residents had any pressure ulcers, and where a resident had returned from hospital with a broken area on their skin, this had now healed. Time spent talking to a resident, identified that they found their ‘air mattress’ comfortable. A resident whose care was tracked, was seen to be on bed during both days of the inspection, which was during hot weather. Their teeth had a coating, normally associated with a dry mouth. Staff said this was due to the resident not wanting mouth care. The resident was responsive, and needed assistance with drinks and meals. Drinks were out of reach – making them reliant on staff. A record of their diet intake was held in the staff office. This showed that although the resident was being given drinks, there were 1 – 2 ½ hour gaps Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 13 between these being offered. Good practice nutritional guidelines promote residents to be given 6 to 8 drinks (consisting of 200mls) during the waking day. Sometimes staff had just noted ‘sips taken’ or 50 mls of juice. There was no guidance as to how regularly, and how much fluids staff should be encouraging the resident to take. The home’s system for storing and dispensing medication was looked at. Concerns were raised at the last inspection that with only 1 Nurse undertaking the medication round, it was taking too long. This resulted in residents receiving their medication late, and affect the timing of their next medication. Time spent with the nurse on duty, identified that the manager covered 1 area of the home in the morning, whilst the duty Nurse covered the other 2 areas. However, at weekends, or when the manager was off, 1 nurse was still responsible for giving all the medication out. When asked how long it took for them to complete the medication round on their own, they said it could take up to 2 hours (8 – 10am) as it depended on the amount of interruptions they received. Information given in the resident’s service user guide shows that lunchtime medication is given out again at 12 mid-day. The home receives medication in weekly dossett boxes direct from the pharmacist, with any medication unable to be dispensed into the containers (known as stand a lone medication) sent in their original or pharmacist container. Medication received is entered onto the home’s Medication Administration Records (MAR) charts, which run for 12 weeks, and should be signed, or an appropriate code entered each time medication is given out. Records looked at showed there was some missing staff signatures during May & June. Although a new resident’s medication had been written on the MAR chart, the amount received had not been entered. Staff were recording the weekly supply of medication received from the pharmacist, and now had systems in place for disposing of medications. The nurse was able to answer questions on what the different medications were used for, and why the resident was on them. A relative had expressed (CSCI survey) their concerns that ‘although medication prescribed for skin is signed as administered each day’ even when ‘on occasion the creams/ointments had run out’. It was noted that 1 resident had been refusing medication since the 31 May 2006. When asked what action was being taken, the manager said that the resident’s Doctor was aware, and felt nothing could be done, if the resident refused to take it. This led to discussions that the resident’s care plan should clearly state what action had been taken, and how they were monitoring the resident’s welfare. Controlled medication was stored securely, and a check of medication held, against records was found to be correct. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be served home cooked meals, however they cannot be assured that they will meet their individual choice and preference. The staff group is not sufficiently skilled to provide a range of suitable activities, to stimulate and promote residents independence. Although residents describe staff as polite, they cannot be assured that they will be treated with privacy and dignity at all times. EVIDENCE: The timing of the inspection was planned at 6.30am, due to previous concerns over the flexibility of the home’s routines. On arriving, the inspector could see 4 residents were already up in the first lounge located by the main entrance, 1 of whom was having their soiled continence pad removed by a carer. Once the inspector had introduced them self, the resident receiving personal care was quickly taken out of the lounge, whilst the inspector was signing-in. Six residents were up in the second lounge, 4 of whom had gone back to sleep. Another resident was up in a chair by their bed and was asleep. The resident (whose care plan identified that they required support with their continence), Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 15 was walking around, worried that they could not find a toilet, and asked the inspector to direct them. Whilst less residents were up and dressed at this early time, than in January 2006, it was noted 6 residents, had fallen back to sleep. Resident’s ‘night care plans’ give information on when residents preferred to get up. One resident whose care was tracked, was walking around the home in their nightwear, their night plan stated that they preferred to get up between 7.30 and 8 am. When asked if the resident would have liked to stay in bed longer, they replied they had to get up as it was so “noisy”, although it was observed to be quite at that time. Night staff were busy going about their duties when the inspector arrived, having at 6.30 am, already stripped and made some beds, dressed residents, and given drinks out. Some of the bedroom doors were wedged open (see Management and Administration), and several residents had their bedside lights on. Concerns were raised by the inspector, as to whether this was the resident’s choice, or to make the checking of residents at night easier. Two residents said that they had always preferred to get up early, however, residents who were unable to state their views, or had fallen back to sleep, it was unclear if they had been given the choice. There is an expectation that residents will have their breakfast by 9am, as part of the home’s routines. Discussions before the inspection identified that some staff would like to see more flexibility in the homes routines, but may not have the confidence to voice their ideas/opinions. During the last inspection (16 January 2006) the home was found not to have complied with a previous requirement, which asked for a social activity programme to be developed for residents with dementia. This was to supplement the activities already undertaken by the part-time activity therapist. The manager said since the last inspection, they had recruited a second activity therapist, who had more insight into residents with dementia needs. This was seen as a positive move to address the Commissions concerns. However, although staff praised the new therapist’s work, they had not been able to work for some time, and no alternative cover had been provided. Four out of the 10 residents when asked ( CSCI survey), if there were ‘activities arranged by the home that they could take part in’, 3 replied ‘no’ (1 of whom felt that did not ‘want to take part in activities’) and 2 ticked ‘ don’t know’. One relative did feel that staff spent ‘more time interacting with residents trying to keep them interested and responsive’, however, other relatives commented that they were not aware ‘of any activities taking place daily to stimulate residents who are active’ Staff had completed a social activity care plan sheet for 1 new resident. However, although staff had identified what activities the resident would like to take part in, the feedback sheet, to indicate this had happened was blank. The Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 16 manager said that staff did normally join in with residents singing, and undertaking activities. This led to discussions that this had not been evidenced during the 2 days, although it was noted that there was 2 large, specialist floor standing games in the lounge. The inspector was informed that the home has its own transport, which can take a small amount of people at a time for trips out in the community. During this and previous inspections, the inspector had observed a reliance on television to stimulate the residents. On arriving at 6.30am, residents were sitting in front of the television, in 2 of lounges. The ‘reality’ programme left on for residents to watch in the first lounge, may not have been what they would have chosen for themselves, if able to. The third lounge, which was previously television free, known as the ‘quiet’ lounge, had now been furnished with a television. One relative felt this was a shame, as they felt residents had lost “a quiet area”. The home located in a small village, benefits from having shops and a Public house within walking distance. This supports residents to maintain their contact in the community. A religious service was conducted at the home during the second day. Feedback from CSCI surveys, and time spent talking to relatives during the inspection, confirmed that they felt comfortable to visit at any time, and were always made to feel welcome. One relative praised the administrative staff who were ‘ always willing to talk on the phone and are extremely helpful’, they went on to say that this was ‘very important’ to them as ‘they lived some miles away’. Feedback from relatives was mixed over the standard of food, from ‘edible but basic’ to ‘good’. The home currently runs a 6-week rotating menu, copies of which were given during the inspection. Menu ‘choice sheets’, which gives information on the 7 days menu choices, are completed for/by each resident. Week 4’s menu showed a choice of 2 main courses for lunch, with an alterative of Salad, Pork Chop, Omelette, Corn Beef Hash or Gammon on request (giving 24 hours notice). The range of main courses over the week included Roast Lamb, Fish & Chips and Homemade Beef Pie. Over the 7 days, Vegetable Casserole or Vegetable Pie was given as a second alternative on 4 of the 7 days. The nutritional content of the vegetarian option will be looked at during a future inspection. The Supper (Tea time) menu looked at consisted of Soup Bread/Butter Jam, Cheese & Biscuits, Sandwiches, Bacon Fried Egg/Tomatoes, Jaffa cakes and Tea or Coffee. One resident commented that they had enjoyed a “nice kipper” the other night and would like to see it more often on the menu. A relative said that they would like to see more healthy options in the menu. When asked, the home was accommodating and would supply brown bread. Fresh fruit, Ice Cream, Jam tarts and cake, according to the menu, can be requested as an alternative dessert at lunch times. Residents with dementia, and who are physically frail, may not be able to ask staff for alternatives, or understand Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 17 these are on offer. How staff manage this situation will be observed at a future inspection. The format and size of print used on the menu ‘choice’ sheets, would not be suitable for all residents to be able to read and understand. Although time was not spent during this inspection observing lunchtime routines, 1 resident asked, said they enjoyed their lunch, but could not remember what it was. There were no menu boards seen in the dining room, to be able to prompt their memory. Three out of the 10 residents asked (CSCI surveys) if they liked the meals at the home, 3 replied ‘yes’, 2 ‘no’, 4 ‘don’t know’ and 1 had not written an answer. Relatives spoken with said that the roast dinners always “smelt and looked very good”. All residents visited in their bedrooms had a jug of water/juice, and good practice was seen with residents being given drinks in the lounges throughout the day. Information was given to the manager on the first day of the inspection, on where they could access copies of the CSCI guidelines ‘Highlight of the day?’, published in March 2006, which they requested and received the next day. Three relative’s raised concerns (CSCI survey) over the laundry system, and clothing getting lost. Comments included ‘we are concerned about the continual loss of clothing and there seems to be no solution to this (clothes marked with name tags)’, another stated that their relative ‘does not always get their own clothes – that they got other people’s so they are too large to small and not always clean’. A check of 2 resident’s wardrobes, showed that they all had the same name tag – or written in black felt marker pen, which at times showed through the material. The clothing were clean, and hung on hangers. However, further discussions with relatives, evidenced that clothing was not always being returned to their rightful owner. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and visitors have access to a robust, complaints procedure; however, elements of the complaint procedure need to be updated to reflect current practice. Staff receive training to support them in identifying any areas of abuse. However, their contractual arrangements with the employer, may restrict them from fully reporting their concerns to the appropriate agency. EVIDENCE: A copy of the home’s complaint policy is contained in their Statement of Purpose and Resident’s Guide. The complaint policy states that they will process all complaints within ’10 working days or shorter’. The home then goes on to inform the reader that they have the right without prejudice, to send their ‘complaint to the National Care Standards Commission’. The home needs to update their policy to reflect, that the Care Commission is not a complaints agency. However, concerns can be raised with the Commission, which can then be re-directed to the home to investigate, or advise given on the appropriate agency that should be contacted in respect of their complaint/concern. Although the home has given the correct title of Commission for Social Care Inspection in the address/contact section, there is still reference to the ‘National Care Standards Commission, which needs to be amended. All but 2 of the relatives/visitors were aware of the Home’s complaint policy. Six out of the 10 residents who had completed the CSCI survey, said they knew who to talk to if they were unhappy, and were aware how to make a Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 19 complaint. Discussions with a resident also confirmed that they felt comfortable to raise any concerns with the manager. Eighteen out of the 19 staff completing the CSCI survey, confirmed that they had received training in the home’s abuse policy. Training files looked at, held ‘learning objective’ question sheets on ‘Elder Abuse’, which had been completed by staff. This led to discussions that the Suffolk Vulnerable Adult team ran ‘Train the Trainer’ courses, to support managers in delivering vulnerable adult training ‘in-house’. Information on where to access the training was given. During the last inspection it was noted that staff are asked to sign, as part of their contract of employment, that they will not disclose any information to public bodies, and if they did, this would be viewed by the home as ‘gross misconduct’, which could lead to their dismissal. To ensure the protection of resident’s, the home was asked to amend their abuse policy and employment contract, to reflect who they should contact. Although this had been undertaken, a new member of staff had still signed the old contract. It was also noted that existing staff had not signed an amended copy of the conditions to make them aware of the changes. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are committed to ensuring the home is kept clean and odour free. However, staff are not always following safe infection control procedures, which could potentially lead to a risk of any infections being spread. There is insufficient signage to promote orientation and independence for people with dementia. With the narrow width of some corridors, and height of armchairs, not all residents can be assured that they will be able to access all areas of the home, or find an armchair suitable to their needs. EVIDENCE: A walk around the home identified decoration in busy areas showing signs of wear and tear, with marked paintwork. The arm of a chair in the lounge was worn, exposing the foam, also the protective material on a commode and worn through. Some residents have their own chairs; otherwise staff were observed to sit residents in whatever chair was available, not always taking into account their height. One resident who was tall, was placed in a chair, which was too low, resulting in their legs being bent. This was fed back to the management, Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 21 who said as part of their on-going maintenance plan would be replacing worn and unsuitable furniture. The home no longer has a dedicated maintenance man, instead the Deputy Manager has taken over this role. Aware that areas of the home need decorating /refurbishing, they have prepared an audit tool, which they will use to look at all areas of the home, to identify work that needs to undertaken. Once they audit has been completed, it will give the owners an overview of what work needs to be carried out, to enable them to prioritise what is undertaken first, as part of their business plan. Good practice was seen to support a resident in identifying their bedroom, by having a photograph on their door. However, throughout the home there was limited signage, using a suitable format to orientate and support residents to maintain their independence. Discussions with relatives confirmed that the cleanliness of the home has continued to improve, and they were no longer met with unpleasant odours when they arrived. They praised the domestic staff who, besides doing a good job, were also very “approachable”. Previous inspections have raised concerns over bedding not being changed as needed. The domestic staff now make the beds, which have not been made by the night staff. This was seen as good practice, allowing more time for care staff to be with residents. Domestic staff were placing soiled bedding straight onto the floor, which could spread the chance of any infection being spread through the home. On the first day of the inspection, a check was made of a resident’s bed, which at previous inspections although made, was found to have soiled sheets. Staff had previously informed the inspector that the resident made their own bed, so it had not been noticed. However checks would be put in place to monitor and ensure any soiled sheets were discreetly changed. Taking this into account, the bed was checked again on the second day of the inspection. This evidence that the bed had the same soiled sheets and had not been changed. Shared bedrooms had mobile room dividers in use, to ensure residents privacy. The home is set in large gardens, which have been planted to give colour. However the large enclosed garden to the back of the home can only be accessed through resident’s bedrooms, or go outside the home and access the garden through a gate. This restricts access for many of the residents, who would be reliant on staff being able to take them out, into the gardens at the side of the home by the car park, which are not enclosed. Residents were seen to use the small courtyards, although discussions with relatives identified that the doors to all the courtyards were not always opened, to enable residents to go out when they wished. Time spent with residents in 1 of the courtyards, which was furnished with chairs, table and sunshade. The residents said they enjoyed sitting out, and that staff had brought them drinks. The lighting in the home was found to be bright in some areas, but 1 of the corridors, even on a sunny day was not sufficient, resulting in staff leaving the lights on. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 22 Call bells are situated throughout the home in bedrooms and communal rooms. Some residents in their bedrooms, who could use a call bell, had been given extended leads to ensure they could call for help. Residents in bedrooms and sitting in the lounge, who were not able to use a call bell, were reliant on others calling for them, or staff awareness that they may want help. A relative discussed the hard work put in by staff, to support a resident in trying to keep their bedroom clean and odour free. Staff completing the CSCI comment card, all felt that the home had enough mobility aids to support resident’s needs. Whilst observing 2 carers start to move a resident, 1 carer positioned them self to use an underarm lift, which is no longer used. However, the second carer stopped them, and they proceeded to assist the resident/guide the resident to transfer in their wheelchair. No handling belt was used, although the carer was seen carrying one. Staff were aware that residents could become too hot, and were using blinds to try and keep areas of the home cooler. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service cannot be assured that the staffing levels will support their individual preferences, dignity, choice and promote independence throughout the 24hour day. EVIDENCE: Copies of the staffing rotas for the period 19 June to 2 July 2006 were given, to the inspector to be able to takeaway with them. This showed that planned staffing levels in the morning were 1 senior carer, 6 carers and up to 2 support carers (aged under 18 who do not undertake personal care). With many alterations it was sometimes unclear the exact number of staff who were on duty. The average staffing levels in the afternoon (2pm – 6pm) was 1 senior carer and 5 care assistants (giving a ratio of 1 member of staff to 8 residents). Observation during the inspection showed that staffing levels did not allow time for staff to be able to sit and spend time socially interacting with residents or promote independence. A Nurse was rostered to work each shift, with the manager, when available, also assisting in dispensing medication during the weekday mornings. The manager had also worked 1 weekend shift as senior carer when short staffed. The rotas showed that the deputy manager also worked as Chef, carer, and maintenance person. Eighteen relatives/visitors felt that there was enough staff on duty, 4, did not feel there was and another relative was not sure, as it could vary. Information gained from the CSCI surveys completed by 10 of the residents showed that 5 felt they ‘always’ received the support they needed, 4 said Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 24 ‘usually’ and 1 said ‘sometimes’. When asked if the staff were available when they needed them? 4 had answered ‘always’, 3 ‘usually’ and 3 ‘sometimes’. Due to a resident’s changing mental health, they had become agitated, and good practice was seen with 2 members of staff sitting offering reassurance, whilst their care needs were being reassessed, by visiting health professionals. On 12 of the 14 nights, the staffing levels at night were 1 Nurse and 2 carers for 48 residents, who have a range of mental health and nursing care needs. A visiting health worker raised concerns in November 2005, that staff were taking their breaks together. At the last inspection, assurances were given by the home that when staff had their breaks, there was still sufficient cover across the home. To ensure residents safety at night, and taking into account the layout of the home, the current staffing level does not allow for staff to be together on breaks. Information supplied by the home showed that 2 carers currently holding an National Vocational Qualification (NVQ) level 2 award, with 5 other carers currently working towards an NVQ level 2 or 3 award. The homes Statement of Purpose, informs the reader that they aim to have 50 of their staff trained to NVQ level by 2007. However, this was working on ’16 whole time equivalent staff’ where the home should be calculating using each member of staff, regardless to how many hours they work. Previous inspections had identified that the home does not always follow safe systems of recruiting staff, which led to further immediate requirements being made following the last inspection in January 2006. The files of 2 staff, employed since the last inspection were looked at. To address previous concerns the home had produced an information sheet, held on each file, which listed all the required paperwork to be obtained before the person started their employment. This was seen as good practice, as it gave the manager information on what had been requested, and the date it was obtained. Correspondence read showed that the member of staff had been sent a contract, and a letter confirming their start date, and that references and their CRB discloser had been obtained. Although the home asked for applicants to give a full employment history, 1 applicant had not fully completed their’s, and the CV they supplied showed gaps in their employment history. One file identified that the home had started the member of staff on 1 written reference. However, records showed that they had received a verbal second reference from a past employer, but although they had chased the employer, they had not supplied the requested written reference. Action taken was well documented, which resulted in the applicant being asked to supply a 3rd referee, which the home had been successful in obtaining a written reference. This led to discussions, that it was clear that the home had been proactive in Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 25 trying to obtain the second reference, but they should not have started the person before they were in receipt of 2 written references. Copies of relevant training certificates were held on file, and evidence that they had been given ‘in-house’ induction. New care staff complete a 6-week ‘inhouse’ training induction ‘understanding the principles of care’. The training is undertaken by the Deputy Manager, who although currently does not hold a care qualification discussed the recent training in using the ‘working Care Induction Standards Framework – reference and resource book’. They stated they were going to use the information from the book to produce their own module workbook. This led to discussions that they would need to ensure that the work book produced by the home, meets the skills for care, national occupational standards. Information was given on how to obtain a copy of the CSCI ‘Safe and Sound?’ guidance, which covers recruitment and gives further information for providers. Currently the 6-week induction programme, takes staff through training objectives, using a Health & Safety teaching package which includes Infection Control, and Advocacy ‘to act and support in favour’ as part of the staff’s duty of care. All the staff who had completed the CSCI survey, felt that the home had a good training and development programme to support staff in their role. Staff said they were enjoying the ‘distance’ training they were currently undertaking through Ottley college in dementia, which included person centred care. During the inspection, a specialist mental health support team, had been called in to support a resident, and offer guidance to staff whilst their care needs were being reviewed. Discussion about manual handling techniques with staff, confirmed an external trainer had carried out the staff’s training. Further discussion identified that staff had been informed that if a resident refused to be hoisted when they were unable to weight bear, staff would need to ‘lift’ the resident, as they had a duty of care. This led to discussions that staff should not be ‘lifting’ a resident, and the home would need to obtain further clarification from the trainer. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service cannot be assured that there are systems in place, using a suitable format to enable them to give feedback on the level of service they receive. The current arrangement for staff to be able to give their views or raise concerns, does not always promote a positive, supportive, open ethos, where staff know they will listen to, without prejudice. The home has safe systems in place for the keeping, and recording of residents monies held for safe-keeping. EVIDENCE: The manager Mrs Caroline Manders, is an experienced Registered Mental Nurse (RMN) and holds a NVQ level 4 in Management. Throughout the inspection Mrs Manders was co-operative, answering any questions and supplying further information on request. Relatives spoken with had confidence in the manager and felt the home was “well run”, this was also reflected in staff who had Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 27 completed the CSCI survey. Discussions with the manager identified that since qualifying that have taken no further training, to obtain a recognised qualification in the care of older people with dementia. Information was given on the ‘Commission Inspecting For better Life’, regulatory changes and information on accessing the CSCI web site, to keep their knowledge updated. Prior to the inspection concerns were raised that staff may not always feel comfortable to freely voice their opinion. It was also noted that some of the staff questionnaires had been returned to the commission together, and not in individual envelopes, which had been provided to ensure staff confidentiality and anonymity. During the inspection, the inspector brought to the manager’s attention, that with the office door closed, a raised voice could be heard coming from the office, which did not promote a homely atmosphere, especially as the voice carried to where the residents were sitting. Staff confirmed that they received regular supervision. Notes held on staff files showed how supervision was used to give feedback on staff practice. There was evidence of some quality assurance work being undertaken, with the owner writing monthly report, and new residents asked for feedback. The commission have not been sent any quality assurance report, taking in the views of all the residents, families, stakeholders and staff. Residents are encouraged (Residents hand book) to ‘keep small amounts of money’ in their room, however, for security reasons, residents are encouraged to keep larger amounts in the office. Where resident wish the home to look after their money, systems are in place to record and store residents monies held for safe keeping, securely. A review of the system showed that each resident had their own plastic ‘wallet’, which held their money and receipts. A separate record is kept of all transactions, which included witness signatures. A check of 2 resident’s monies against the records held, showed that the money was correct, and records had been fully completed. The home confirms in their Resident Handbook, that the ‘Company’s Insurance Limit for Residents personal items is £500’. The current business plan was not available for inspection, although the owner confirmed that they had been produced. Some documents including old staffing rotas, the inspector was informed were currently with the Accountant. Taking this into account, information to review the home’s financial viability will be looked at during a future inspection. However it was noted that the owners continue to invest in the home, replacing worn furnishing and fittings. Although staff have received training in infection control and manual handling, observations made during this inspection (see Staffing and Environment sections) identified further actioned needed to be undertaken to monitor practice, on a daily basis. Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 28 The Homes Fire risk assessment, last reviewed on the 16/5/06, showed that ‘Yes’ had been entered to the question ‘is the upholstery of furniture in good condition’. This needs to be updated to reflect the condition of some armchairs and commodes, which are worn and need replacing. Good practice was seen with the Fire risk assessment being updated 6-monthly. The Fire Log book gave information on regular checks of the fire call system and staff training. On arrival at the home on the first day of the inspection, some of resident’s bedroom doors were ‘wedged’ open, giving no protection to the occupant if a fire started in the corridor or adjoining room. This had been previously discussed and assurances given that individual door closures were being fitted. Staff confirmed that door closures had been purchased, and were systemically being fitted. Assurance was given that they would be fitted within the next few days. Once fitted, the care plans of residents, whose doors are left open (and lights left on by their bed) at night, must clearly state that this is their choice, and not for the convenience of staff in monitoring the resident at night. Staff kept a log of all incidents/accidents, which were not looked at in detail during this inspection. However it was noted that some residents had been taken to hospital, which the Commission had not be notified of. A relative (CSCI comment card) spoke of an ‘unfortunate incident when their relative had been attacked by another resident’, they carried on to say the home took action to ensure that it did not happen again. Broad Acres Residential And Nursing Home DS0000024345.V302436.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 2 X 2 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 3 2 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 2 2 Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 Schedule 1 14 Timescale for action The homes Statement of Purpose 20/09/06 must give clear accurate information, and cover all required information. The home must only admit to their registered numbers and categories. Where there is a dispute over which category, the decision must be based on the resident’s medical diagnosis and social care assessment, not to the amount of social care funding being allocated. The home must give guidance and monitor how much fluids residents are taking, to ensure that they are given enough, which takes into account their physical health and the hot weather. Staff must record all medication coming into the home. Medication Administration Records (MAR) charts must be completed accurately, to confirm that the resident has been given, DS0000024345.V302436.R01.S.doc Requirement 2. OP3 05/07/06 3. OP7 OP8 OP15 13, 16 05/07/06 4. OP9 OP37 13 (2) 07/08/06 Broad Acres Residential And Nursing Home Version 5.2 Page 31 and taken their prescribed medication, or as otherwise indicated by the code used on the MAR chart. 5. OP9 OP27 13 (2) 18 (1) Where there is not a second nurse on duty, the home must continue to monitor the length of time it takes to give medication out, and where required, take action to ensure residents are receiving their medication evenly throughout the day, within the required timescales. The home must ensure in the absence of the activity therapist, that suitable arrangements have been made to enable residents with dementia, to have access to suitable daily, one to one, and group activities, to enable residents periods of stimulation and interest. The home must ensure any personal care is conducted in the privacy of the resident’s bedroom, or bathroom. 10/08/06 6. OP4 OP12 12 (2) 16 (2) (m) 01/09/06 7. OP10 12 (1) (a) (4) (a) 05/07/06 8. OP10 OP26 16 (2) (e) (j) The home must ensure that they 05/07/06 have systems in place for staff to monitor and change any soiled linen on resident’s beds. The home must ensure any furniture which is showing exposed foam, or worn protective coating, making it unhygienic, must be repaired or replaced. The home as part of their infection control procedures must ensure soiled linen is put in a suitable container, and not placed on the floor. DS0000024345.V302436.R01.S.doc 9. OP19 OP26 16 (2) (c) 23 (2) (c) 01/09/06 10. OP26 13 (3) 14/07/06 Broad Acres Residential And Nursing Home Version 5.2 Page 32 11. OP27 18 (10 (a) The home must review their staffing levels over the 24-hour period, to ensure that they have sufficient cover to meet the current residents physical, mental and social needs. This must also take into account staff breaks at night to ensure a minimum of 2 staff available at all times. The home must obtain a full employment history for all new staff. Where staff have worked with children or adults previously, the home must try to confirm the reason for them leaving. (This is a repeat requirement 18/04/05 and 16/01/06) The home must ensure that they are in receipt of 2 written references prior to staff commencing their employment. To ensure the safety of residents and staff, the home must clarify with the manual handling trainer, what information has been given to staff around ‘lifting’ residents, and if required seek further advice. The home must complete a review of the quality of service provided in consultation with residents, relatives, staff and, stakeholders at least annually. The results of which should be published, shared, and made available to residents and relatives using a suitable format. The home must give the commission without delay notice of any occurrences as given in regulation 37, which includes DS0000024345.V302436.R01.S.doc 01/10/06 12. OP29 19 (1) 2 (b) 02/08/06 13. OP29 19 Schedule 2 13 (5) 02/08/06 14. OP30 OP38 14/08/06 15. OP33 24 (1) (2) (3) 01/10/06 16. OP37 37 14/08/06 Broad Acres Residential And Nursing Home Version 5.2 Page 33 any event in the care home which adversely affects the wellbeing or safety of any resident. 17. OP38 23 (4) Where residents have requested 20/08/06 to have their bedroom doors left open during the day or night, the home must finish fitting the automatic fire door closures, which meets the required fire safety legislation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations To be more informative to the reader, the Home’s Statement of Purpose should give guidance on the staffing levels during each shift. The home should look at the wording/language used in care plans to see if it can be more personalised and informative, rather than use the same set phases. The home should ensure that staff date and sign all information held in care plans. In undertaking this, it will clearly state who has made the entry and give an accurate chronological order of events. To support the home in being able to obtain as part of their formal quality assurance feedback on level of support given to residents who have dementia, and be offered any supportive feedback, it is recommended that the home arranges for 2 ‘dementia mappers’ to visit and complete a report. Repeat recommendation from the 16/01/06. It is recommended that staff date and sign all information in the care records, to give a clear chronological order of events, which will support staff in monitoring any changes DS0000024345.V302436.R01.S.doc Version 5.2 Page 34 2. OP7 OP8 3. OP7 OP37 4. OP12 5. OP7 OP37 Broad Acres Residential And Nursing Home in physical and mental health. Repeat recommendation from the 16/01/06. 6. OP10 The home should have monitoring checks in place to ensure residents receive and wear their own clothing, which has been processed through the home’s laundry system. Where residents have requested to have their bedroom light left on, and their bedroom door left open during the night, this must be clearly documented in their care plan, including what action is being taken to ensure their privacy is maintained. The home should look at, on an individual basis, how they can involve residents in daily living activity tasks, linked with the outcomes in their care plan. The home should undertake a service review of their meals, as part of their quality assurance system. This would enable staff to gain feedback from the people using the service to ensure it meets their needs and preferences. The home should also look at how residents currently choose their meal options, and if the formats used are suitable for mentally frail people to be able understand, enabling them to make an informed choice. The home should review their complaints policy to ensure if reflects that the CSCI is not a complaints agency, and any reference to the National Care Standards Commission is amended to read Commission for Social Care Inspection. The home should ensure all staff receive and sign the amended terms and conditions of employment, to ensure they are aware that they can report any concerns to a public body, without it being viewed as a ‘gross misconduct’, would could result in their dismissal. The home should monitor where the tall resident, identified during the inspection prefers to sit, and take action to increase the height of the chair if necessary. Repeat recommendation from the 16/01/06. The home should review their signage around the home, to ensure it meets resident’s needs, in being able to locate the toilets. Staff were observed wearing disposable gloves when walking with a resident or transferring them into the DS0000024345.V302436.R01.S.doc Version 5.2 Page 35 7. OP10 8. OP12 9. OP15 10. OP16 11. OP18 12. OP20 13. 14. OP21 OP26 Broad Acres Residential And Nursing Home dining room. To ensure residents dignity is maintain and that staff are following safe infection control procedures, management should monitor the proper use of wearing gloves (when coming in contact with bodily fluids), and take action where needed to remind/re-train staff as appropriate. Repeat recommendation from the 16/01/06. 15. OP30 The home should ensure on completion of the their new training work book, that it meets the current changes in induction and occupational standards. It is recommended that the manager undertakes further training to gain a recognised qualification in dementia care. 16. OP31 Broad Acres Residential And Nursing Home DS0000024345.V302436.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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.V302436.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!