CARE HOMES FOR OLDER PEOPLE
Broad Oak Manor Nursing Home Broad Oak Manor Broad Oak End Bramfield Road Hertford Herts SG14 2JA Lead Inspector
Alison Jessop Key Unannounced Inspection 10th May 2006 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 Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 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 Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Broad Oak Manor Nursing Home Address Broad Oak Manor Broad Oak End Bramfield Road Hertford Herts SG14 2JA 01992 551900 01992 507950 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) Lance Adams Jill Adams Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Terminally ill over 65 years of age (3) of places Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 27 older people who require convalescent or nursing care. 15th February 2006 Date of last inspection Brief Description of the Service: Broad Oak Manor is a period house set in 7 acres of grounds on the outskirts of Hertford. Accommodation is arranged on three floors and comprises both single and double rooms. There is currently a library and dining room on the ground floor as well as the reception area. The kitchen and laundry are sited in the basement. The grounds are attractively laid out with trees, shrubs, flowerbeds and lawns and there is a patio with garden seating for service users to enjoy. There is also a sensory garden. The complex includes a development of close care units, a converted barn offering a large lounge, a la carte restaurant with two dining areas and health and fitness facilities. There is a rail station a short drive away and Hertford town centre further distant. The home is served by public transport - service users use private cars, taxis, Dial-a-Ride services or the homes mini bus service when they go out. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and was carried out over one day by two Regulatory Inspectors. The atmosphere in the home was relaxed and the majority of feedback from service users was positive. The home has undergone many months of redevelopment, which continues. Service users appeared not to be disrupted by this and were happy that the new lift is now fully operational. A number of feedback forms were sent out to relatives, two were returned and feedback given was very positive. One survey was received from a visiting GP, feedback was positive. What the service does well: What has improved since the last inspection?
A number of bedrooms have been redecorated and new soft furnishings provided. The re-development of the home continues however this has caused very little disruption to service users. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 6 The Service User Guide and Statement of Purpose have been reviewed and are more user friendly. A new needs assessment has been introduced and all prospective service users are assessed by the matron prior to moving into the home. A new care plan has also been introduced and the auditing of some of the service users files makes information more easily accessible. A new recruitment procedure has been developed and an audit of staff files has been carried out. All staff working at the home have current CRB enclosure. The homes procedure for handling service user finances has been reviewed. 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 Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 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 Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 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 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The revised Service User Guide and Statement of Purpose enable prospective service users accessibility to make an informed decision about moving into the home. EVIDENCE: The service user guide and statement of purpose has undergone review and now offer clear and accessible information about the service provided. A new assessment procedure has been introduced and the assessment questionnaire ensures that all required information is gained prior to admission. Information is gained either directly from the prospective service user or their representative. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. High standards of nursing and general care were identified and service users health care needs appear to be met. EVIDENCE: Each nurse is allocated a number of service users for whom they are responsible for reviewing care and updating care plans. An auditing process has commenced and information no longer relevant in care plans is being archived. This ensures that staff can gain quick access to current information. Documentation relating to nursing care appeared to be very comprehensive. A physiotherapist was visiting the home and feedback gained was very positive. She stated ‘I know that if I ask staff here to assist people to do exercises this will be undertaken and everything is fully documented.’ Service users also have access to other visiting health services such as dieticians, optitions and chiropodists. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 10 Procedures relating to medication were satisfactorily maintained. One recommendation in relation to recording of stock balances has been made which will enable auditing to be carried out. Service users spoken to appeared to be treated with dignity and respect and some sensitive care practice and interaction was observed on the day of the inspection. One service user did however state ‘I don’t like it when staff don’t wait after knocking on my bedroom door, I am a very private person.’ Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 11 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 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although high standards of health care and nursing are maintained, some aspects of daily life and social activities could further enhance service users lives. EVIDENCE: Comments from service users in relation to social stimulation included ‘there’s no activities to speak of, and the place can be a bit dire at times.’ Another stated ‘when I go into the lounge everyone is sitting asleep or staring at the walls.’ The matron stated that a dedicated carer has been identified to organise activities in the home and is due commence this role soon. Comments in relation to the quality of meals was positive. A common theme gained from feedback received was in relation to the lack or choice of food available for supper. One service user said ‘I wouldn’t mind something like a sandwich or a slice of bran as I get a bit peckish at night, that’s what I used to eat at home, it’s something I don’t get used to.’ Another said ‘I can honestly say what they give us is a nice quality and if I didn’t like something they would do something else. But later in the day the old tummy can start to grumble a
Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 12 bit.’ Several service users said that they would like to be given a choice of tea, hot chocolate or Horlicks for the last drink before bed. The matron stated that supper is served at 5pm and a hot drink at 8pm with a couple of biscuits. Although it was acknowledged by the inspector that service users might forget what has been offered, or as service users would not ask for food if they felt hungry, better communication and consultation about food, particularly late supper is required. The home, due to its location occasionally experiences complete power failure. The most recent lasting almost five hours. Service users spoken to did not appear to be greatly affected by this and said that the staff did all they could to reduce concerns. A number of service users did however comment that hot drinks were unavailable throughout this period and felt this unsatisfactory. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 13 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have recently received training on Adult Abuse including domestic and catering staff and a copy of the Hertfordshire Protection of Vulnerable Adults Procedure is available in the nurses office, thus minimising risks to service users. EVIDENCE: One complaint has been recently received by the home in relation to a service users care whilst on respite at the home. The complaint was dealt with within timescales stated on the homes complaints procedure. However, the complainant submitted a copy of the complaint to the Commission for Social Care Inspection, as they were not fully satisfied with the response. The nature of the complaint was in relation to a mistake made by agency staff who admitted the service user to a room that was not fully inhabitable and instructions by care staff about the person’s care not being followed. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 14 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 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Re-development of the home continues to take place and although most of the work is complete some areas to small detail were identified in order to ensure the safety of staff and service users. Once these areas have been addressed the quality outcome for this area will be ‘good’. EVIDENCE: Many of the areas of the home have undergone complete refurbishment. The entrance hall has been attractively redecorated and looks bright and clean. Most of the bedrooms have been decorated and have new soft furnishings offering a bright atmosphere. The kitchen is sited in the basement and is accessed by the lift from all other floors. The laundry now has separate rooms for soiled and clean linen, reducing infection control. On the day of the inspection the finishing touches were being added to the new dining room. This will offer service users a spacious bright area to enjoy meals. The current dining area will be used as another lounge.
Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 15 On inspection of the environment there were a number of small items identified that require attention. Many of the taps in bedroom sinks were dripping and had no plugs. A number of tiles around sinks and baths had fallen off or were loose. In the communal first floor hallway an electrical socket was hanging off the wall with wires visible. The floorboards beneath the carpet in one bedroom were protruding beside the bed, which increased risks to the service user and staff, particularly as this lady has a history of falls. A requirement has been made for all commodes to be thoroughly cleaned and disinfected. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 16 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager has introduced a recruitment policy and procedure and carried out an audit of all staff files. This will provide a safer system for employing new staff. EVIDENCE: Staffing numbers at the home appear to be adequate however a concern was raised by a male service user about issues that arise when shifts are covered by same sex members of staff. The service user said ‘I do not wish to use the toilet when assisted by two female carers.’ Copies of the staff rota have been observed and most shifts appear to be covered by both male and female staff, although occasionally there may be times when this is not always possible. A recommendation has been made for the service user to be notified at the beginning of the shift if this is going to be the case. A dedicated training officer said that she feels good care is being provided in the home. She works with senior carers who also mentor new carers until they are competent. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 17 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, 34, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home does not directly manage or store service users finances, a new procedure has been implemented which ensures that staff are aware of the boundaries within their role, this may also prevent financial abuse to service users. EVIDENCE: The new manager has recently completed her Registered Managers Award and NVQ level 4. Her application for manager’s registration has not yet been received however this is in progress. The manager stated that she has devised a quality assurance questionnaire, which, she has sent out to relatives and other service user representatives. A copy of the report must be sent to the Commission for Social Care Inspection.
Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 18 Throughout the inspection a number of fire doors were observed wedged open. All fire doors must be held open using methods approved by the fire safety officer. On inspection of the water testing records it was observed that the temperature in one bathroom had regularly exceeded 68°C. A copy of the gas safety certificate was unavailable for inspection. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 19 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 X X 2 Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 20 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 2 Standard OP10 OP12 Regulation 12(4)(a) 16(2)(n) Requirement Staff must observe the knock and wait policy at all times. A regular programme of activities must be arranged on behalf of service users. An action plan must be submitted to CSCI. Consultation with service users must take place in relation to meals, particularly supper. Adequate meals must be provided at all times. The registered provider must be able to provide hot drinks to service users during power cuts. An action plan must be submitted to CSCI. The registered provider must ensure that the all areas of the home are kept in a good state of repair and safely maintained. Electrical sockets must be fixed to walls, hand-washing facilities must be available in the toilet on the first floor. Taps must be fixed and plugs provided. The floorboards in room 11 must provide an even, safe surface. All commodes must be thoroughly cleaned and
DS0000061180.V294209.R01.S.doc Timescale for action 10/07/06 10/07/06 3 OP15 16 (2)(i) 10/07/06 4 OP15 16(2)(i) 10/07/06 5 OP19 23(2)(b) 10/08/06 6 OP26 13(3) 10/07/06 Broad Oak Manor Nursing Home Version 5.1 Page 21 7 OP31 9 (1) 8 9 OP33 OP38 24 (2) 23(4)(a) 10 OP38 13(4)(a)& (c) 13(4)(a)& (c) 11 OP38 disinfected. The person currently managing the service must submit an application to register with the Commission for Social Care Inspection. (Carried forward from previous inspection report). A copy of the Quality Assurance survey must be submitted to CSCI. Fire doors must not be wedged open and methods approved by the fire safety officer must be used. A risk assessment must be carried out on hot water temperatures identified over 43°C. A copy of the gas safety certificate must be submitted to CSCI. 10/08/06 10/07/06 10/07/06 10/07/06 10/07/06 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 Refer to Standard OP9 OP27 Good Practice Recommendations It is recommended that stock balances of medication be carried forward from previous MAR sheet to enable auditing. It is recommended that if a mixed sex staff team is unavailable, service users be consulted at the beginning of the shift. Broad Oak Manor Nursing Home DS0000061180.V294209.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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