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 Unannounced Inspection 15th February 2006 10:00 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.V282175.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.V282175.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 Jeanette Chell 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.V282175.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. 24th August 2005 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 a library and dining room on the ground floor as well as the kitchen and reception area. The laundry is sited in the basement. A lift serves the ground, first and second floors however this is currently being extended to the basement, which will be developed to accommodate all service areas. 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 – although a mini bus is provided by the home and service users also use private cars, taxis or Dial-a-Ride services when they go out. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the third Unannounced Inspection of the Inspection year and was carried out over one day by one Regulatory Inspector. The atmosphere in the home was relaxed and feedback from service users was mainly positive. The home has undergone many months of re-development, which continues. Service users appeared not to be disrupted by this and were happy that the new lift is now fully operational. What the service does well: What has improved since the last inspection? What they could do better:
Prospective service users and their representatives may have difficulty gaining information they require in order to be able to make a decision about whether the service can meet their needs as the service user guide and statement of purpose are not written in an accessible format. A formal assessment process does not currently take place for prospective service users. Information is gained from the referring agent or a Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 6 representative when visiting the home. This does not always ensure that service users needs can be met by the home. One service user said ‘I asked for a cup of tea, as my mouth was very dry and I was informed that I have to wait until 10.30. It didn’t arrive until 11.30 and although I have a jug of water here, that isn’t changed very often.’ One service user was sitting in the lounge in her wheelchair without stockings or socks. The reasoning for this was not written the care plan, and as the service user was unable to express her wishes she was unable to state if her legs felt cold. Records pertaining to recruitment were patchy. Some references and CRB disclosures were unavailable for inspection. This does not comply with Regulations and ultimately places service users at risk. Records relating to training were also patchy. Although training is widely available as the company has an in-house trainer. 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.V282175.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.V282175.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 The Statement of Purpose and Service User Guide need to be simplified and made more easily accessible in order for prospective service users and their representatives to be able to make a choice about moving into the home. EVIDENCE: Although the Service User Guide and Statement of Purpose have been updated to reflect current information, it is very lengthy and contains a lot of ‘jargon’ relating to Regulations. Prospective service users and their representatives may have difficulty gaining information they require in order to be able to make a decision about whether the service can meet their needs. A formal assessment process does not currently take place for prospective service users. Information is gained from the referring agent or a representative when visiting the home. If service users are unable to visit the home prior to moving in, they do not get the opportunity to meet a member of staff from the home until they move in. A needs assessment must so far as practicably possible be carried out in order to ensure that service users meet the homes admission criteria and that their needs can be met.
Broad Oak Manor Nursing Home DS0000061180.V282175.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 & 10 Some information contained in care plans which is no longer relevant to service users makes current information difficult to access. EVIDENCE: Care practice observed was sensitive and service users appeared to be treated with dignity and respect. Although Care Plans contained a lot of information, the amount of paper work in the file made it difficult to determine the current plan of care. One service user was sitting in the lounge in her wheelchair without stockings or socks. The reasoning for this was not written the care plan, and as the service user was unable to express her wishes she was unable to state if her legs felt cold. One service user said ‘I asked for a cup of tea, as my mouth was very dry and I was informed that I have to wait until 10.30. It didn’t arrive until 11.30 and although I have a jug of water here, that isn’t changed very often.’ A service user on respite stated ‘The care is very good and the girls are very kind,
Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 10 however I would like a telephone in the room and more tea and coffee would be nice.’ Broad Oak Manor Nursing Home DS0000061180.V282175.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 The home does not have a dedicated activity co-ordinator, and although activities take place, these are organised mainly by the care team. Some activities are attended in the barn where service users living in the extra care units attend. This gives service users the opportunity to socialise with people who do not live in the nursing home. EVIDENCE: There is not a dedicated activity co-ordinator in the nursing home, and attendance to activities is the barn is fairly low. Although activities do take place in the home, these are usually organised by the care team. In times when staffing is low activities do not appear to take priority. Daily activity records are completed for all service users so that staff can monitor levels of stimulation. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 12 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): 18 Staff spoken to appeared to be aware of the Hertfordshire Protection of Vulnerable Adults Procedure and Whistle Blowing Procedure. Staff would be able to refer to this should they have any concerns. EVIDENCE: The manager stated that she would place a copy of the summary of the Hertfordshire Protection of Vulnerable Adults Procedure on the office wall, in order for staff to be able to gain quick access. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 13 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, 22, 23, 25 & 26 The completion of the installation of a new lift ensures that service users, staff and visitors can access the upper floors safely. New bedrooms offer a spacious, comfortable environment to service users. EVIDENCE: One service user was unhappy with the room she has been allocated and said that she has requested to move to a bigger room. The manager is due to meet with the service user to discuss this. Although a new sink unit had been fitted in the room there was no shelf on which to place toiletries. Bedrooms looked comfortable, were attractively decorated and contained personal possessions offering a homely feel. One service user had fallen out of her electrically operated armchair. Although a risk assessment had been in place, this was reviewed as it was felt that there could be further risks to the service user. The manager stated that she had discussed with the service user to obtain a specialist armchair that would reduce any further risks.
Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 14 The home looked very clean and tidy and although a lot of building work is being carried out this appeared not to affect the conditions within the areas where service users reside. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 15 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 Although staffing levels currently meet recommended levels, the future letting of new bedrooms will mean that these levels will require increasing in order to be able to meet service users needs. EVIDENCE: One service user stated ‘I have to wait a long time to get up in the morning and along time to go to bed in the evening, this is due to the lack of staff on duty.’ A requirement has been made for staffing levels to be reviewed with the increase of service users or the change of service users needs. Records pertaining to recruitment were patchy. Some references and CRB disclosures were unavailable for inspection. This does not comply with Regulations and ultimately places service users at risk. Records relating to training were also patchy. Although training is widely available as the company has an in-house trainer. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 16 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 & 35 The new manager appears to have settled in very quickly. As she is new to the country, her understanding of the National Minimum Standards and Regulations is limited. However, she is gradually picking this up. She has not yet registered with the Commission but plans to do this in the near future. EVIDENCE: Service users are responsible for managing their own finances and have a locked cabinet in their bedroom. Those who are unable to manage their finances are assisted by their representatives. It was suggested that a policy is drawn up in relation to this and emergency procedures considered. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 17 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X 2 2 X 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X X X Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement Service users must not be admitted to the home unless a suitably qualified person has assessed the needs of the service user. Food and drinks must be made available to service users at all times. Service users must have access to appropriate clothing such as stockings unless specified in the care plan. Adequate storage provision must be provided to service users. A review of staffing levels must be carried out on admittance of new service users or with significant increased needs. A copy of this must be submitted to CSCI. No person must work in the home unless satisfactory screening has been carried out and documentation received as per Schedule 2. The registered person must ensure that there is a staff training and development programme, which meets the
DS0000061180.V282175.R01.S.doc Timescale for action 30/03/06 2. 3. OP8 OP10 12(1)(a) 12(4)(a) 30/03/06 30/03/06 4. 5. OP23 OP27 23(2)(m) 18(1)(a) 30/04/06 30/04/06 6. OP29 19(1) 15/02/06 7. OP30 18(1)(c) 30/05/06 Broad Oak Manor Nursing Home Version 5.1 Page 19 8. OP31 9(1) 9. OP35 25(2) Skills for Care Occupational standards. The person currently managing the service must submit an application to register with the Commission for Social Care Inspection. A copy of the homes Procedure on Handling Service Users Finances must be submitted to CSCI. 30/05/06 30/04/06 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. 3. 4. 5 Refer to Standard OP1 OP7 OP12 OP18 OP22 Good Practice Recommendations The Service User Guide and Statement of Purpose should be simplified and made more easily accessible to prospective service users and their representatives. It is recommended that current information relating to service users needs is clearly accessible within service users files. It is recommended that a dedicated person is allocated to the organisation of activities. It is recommended that a summary of the Hertfordshire Protection of Vulnerable Adults Procedure is placed on the office wall for quick access. A suitable, safe armchair should be provided for one service user whose armchair is currently unsuitable. Broad Oak Manor Nursing Home DS0000061180.V282175.R01.S.doc Version 5.1 Page 20 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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