Inspection on 24/08/05 for Broad Oak Manor Nursing Home

This inspection was carried out on 24th August 2005.

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

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

Other inspections for this house

Broad Oak Manor Nursing Home 10/05/06

Broad Oak Manor Nursing Home 15/02/06

Broad Oak Manor Nursing Home 14/03/05

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 Oak Manor Nursing Home Broad Oak Manor Broad Oak End Bramfield Road, Hertford Herts, SG14 2JA Lead Inspector Alison Jessop Unannounced 24 August 2005 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 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 I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01992 551900 01992 507950 Lance Adams Jeanette Chell CRH Care Home 27 Category(ies) of OP-27, TI(E)-3 registration, with number of places Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 27 older people who require convalescent or nursing care. Date of last inspection 14 March 2005 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 the 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 not well served by public transport – service users use private cars, taxis or Dial-a-Ride services when they go out. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day by two regulatory inspectors. On the day of the inspection re-development work was being carried out to many areas of the home. The lift was not in use as this is being replaced and extended, this will not be completed for at least five more weeks. Service users who are unable to use the stairs due to poor mobility are brought down on a Stair Walker. Several service users had chosen to remain in their bedrooms for the duration and therefore all meals were being served in their rooms. What the service does well: What has improved since the last inspection? The new barn conversion offers a comfortable, spacious area for service users to socialise. It also enables service users to feel part of the community as they can socialise with residents living in the Close Care units. Service users can also eat in the a la Carte restaurants and may invite friends or relatives to join them. Procedures in relation to medication have improved, however one requirement was made in relation this. Three new bedrooms are now occupied, all with en-suite facilities. New bathrooms, shower rooms and toilets have been fitted to the ground and first floors. A hairdressing salon has been created in the barn. This ensures that service users bedrooms are not used for communal activities and again offers a sense of community living. Correct moving and handling procedures were observed and all staff had received training on the use of the stair walker. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 6 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 I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 standard(s) None of the standards were inspected on this occasion. EVIDENCE: Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 &10 Consultation with service users and their representatives in relation to their Care Plan is minimal. This appears to have left service users feeling anxious and does not demonstrate how service users have choice and control over their lives. EVIDENCE: Care practice observed was sensitive and dignified and service users were spoken to respectfully. Service users looked clean and well presented. Although Care Plans contained a lot of information, the amount of paper work in the file made it difficult to determine what the current plan of care was. There was also a lack of evidence to suggest that service users had contributed and agreed to their care plans. Some individual risk assessments are required for the use of equipment such as electrically operated beds, lap belts and the stair walker. Several Care Plans observed made reference to dental, optical and other community health services. On the day of the inspection a service user, who had fallen the previous day was awaiting an ambulance to take her to A&E. The service user had complained of pain in her leg on the day of the fall, however a the service user did not attend hospital until the following day. Although an assessment of the Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 10 service user by a registered nurse had concluded that there appeared to be a shortening of the leg, dislocation of the hip and severe pain a decision was made for her to remain in the home as surgery would be unavailable until the following morning. It was decided that the service user would be more comfortable at the home. The GP had not been contacted immediately, relatives had not been consulted and the rationale behind the decision was not recorded. A requirement has been made for this matter to be fully investigated by the Registered Person. Procedures for the administration of medication were generally satisfactory although gaps were identified on MAR sheets with no explanations recorded. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 standard(s) 12,13,14 &15 The new barn conversion offers a pleasant and relaxing area for service users to socialise. The A La Carte restaurant and lounge offer a comfortable environment to service users who wish to use this facility as a social outlet. The area also offers space to be able to provide entertainment, activities and promotes integration with the wider Broad Oak community. EVIDENCE: Several service users spoken to felt that there is a lack of stimulation in the home. One service user stated ‘there is nothing to do here, I would like to do more walking so that I can keep my strength up.’ Another said ‘There’s not enough to do, time hangs heavy.’ On the day of the inspection carers were observed to encourage service users to do exercises however this was done individually and not as an organised group activity. No music was played and service users appeared disinterested. One service user said she enjoys getting her hair done on Mondays. A new hairdressing room has been provided in the barn. Records on care plans for activities undertaken by service users did not demonstrate that stimulation was being provided. ‘Transferred to wheelchair’ and ‘received visitor’ is an example of this. The manager stated that their had recently been a concert in the barn and coffee mornings are held with the residents from the Close Care units. A new Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 12 activity co-ordinator is due to start at the beginning of September; service users will be consulted about their preferences and interests. One service user has agreed to organise a regular discussion group where current affairs can be discussed and poems and rhymes are read to service users who have dementia. Residents meetings do not currently occur at the home. The menu was varied and choices offered. One service user stated that he gives the chef a list of his personal preferences and these are usually accommodated. The manager stated that she ensures that one particular service user receives his supper of choice. The A La Carte menu in the barn offers an alternative where family and friends are welcome to dine. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 standard(s) None of the standards were inspected on this occasion. EVIDENCE: Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25 &26 Although major re-development work in progress has caused disruption to service users, particularly those whose bedrooms are on the first and second floor, the work appears to have been well planned and alternative methods have been adopted to minimise disruption. EVIDENCE: The major re-development work currently underway at Broad Oak Manor has had an impact on service users staff and visitors. The lift is currently out of use and some of the service users appeared to be a little agitated. One service user said that she has enjoyed watching the work progress and has been quite entertained by the comings and goings. The Domestic Team Leader stated ‘things may appear to be disruptive but it has been planned really well, I don’t think it has caused too many problems.’ The duty manager must ensure that a Health & Safety inspection is carried out at the end of each day to ensure that all areas are made safe when contractors finish their work. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 15 New bathrooms and toilets have been fitted on each floor of the home, which are bright and clean, and each room has hand wash and paper towels available to prevent the spread of infection. The home looked clean and tidy and no malodours where detected. The new bedrooms on the ground floor are attractively decorated and offer a homely, spacious private area. Each bedroom has en-suite facilities with concertina doors enabling access for wheelchairs. Some of the finishing touches such as light shades and curtains were due to be fitted. Although a lot of the grounds are being used by building contractors, one service user stated ‘the grounds are nice, on warm days we can have our tea in the garden. ’ The home experiences regular power failures due to its location. Several power failures have occurred recently, one of which lasted several hours. This was during the night and although emergency lighting is available in the communal areas, bedrooms do not have any emergency backup. The telephone system is also operated by power not through telecom and the home was unable to call for assistance. This caused great distress to service users and staff. The manager stated that the home is now ‘red tabbed’ with the electricity board and are priority for a generator. All equipment including telephones, electrically operated chairs, beds, peg feeds and pressure mattresses are backed up by battery or have a manual override. Site-specific mobile phones are also available as further communication back up. A Requirement has been made for a risk management plan to be submitted to CSCI and all staff informed. Service users must also be consulted, as this will reduce anxiety levels for any future problems. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards were inspected on this occasion. EVIDENCE: Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37&38. Several service users expressed a lack of consultation and involvement in the running of the home. Regular Residents meetings could ensure that service users feel that their views, ideas and preferences are being taken into account. EVIDENCE: The registered manager, who has been in post for many years and has an indepth knowledge of the home and service users needs. A matron has been appointed with responsibility for the day-to-day provision of care in the home. The registered manager shares her time between the Nursing home, Close Care Units and Domiciliary Care Service. Registered nurses working in the home must be aware of the Care Standards Requirements and National Minimum Standards, one nurse spoken to was unaware of Regulation 37 reports. Two service users stated that they felt that the charges to stay at Broad Oak Manor appeared to be very high and that they do not receive ‘good value for Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 18 money.’ The charges have increased however service users did not appear to know what to expect and found this increase quite substantial. On those Service Users Contracts observed it was not explained how inflation rates are decided, several service users did not have a copy of a contract in their Care Plan. Meals are being served to service users who wish to remain in their bedrooms whilst the lift is out of use. Food must be served at temperatures recommended by Food Hygiene and Health & Safety legislation. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 2 2 x x x 2 2 Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? 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 7.6 7 Regulation 15(1) 13(4)(c ) Requirement Service users where practicable must be consulted in respect of any changes to their Care Plan. Individual Risk Assessments must be completed on the use of equipment including electrically operated beds and chairs, hoists, stair walkers and lap belts. The home must make provision for the care and treatment of service users and decisions made in consultation with service users and their families/representatives. An investigation must be undertaken in relation to the incident on 23/8/05. The results of this must be sent to CSCI. Reasons for gaps on MAR sheets and non-adminstration of medication must be recorded. The Registered Manager must ensure a structured activity plan is in place with regards to meeting the needs of service users. The activity plan must be drawn up in consultation with the service user. A Health and Safety inspection must be undertaken and recorded to ensure that the Timescale for action By 30/9/05 and henceforth By 30/9/05 3. 8 12(1)(a) &(b) By 30/9/05 4. 5. 9 12 13(2) 16(2)(n) By 30/9/05 and henceforth. On going. 6. 19 13(4)(a)& (c) On receipt of this notification Page 21 Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 7. 33 24(1)(a)& (b) 8. 38 37(1)(e) 9. 38 13(4)(c) environment is safe prior to building contractors leaving the site each day. The registered person shall establish and maintain a system for reviewing and improving the quality of care provided. This must include an explanation of how increases to charges have been decided. CSCI must be notified of any power failures at Broad Oak Manor reporting length of time without power and any action taken to reduce risks to Health and Safety. The Registered Manager must ensure the handling of all foods is in accordance with the Food Safety Act 1990 and Regulations 1995. The core temperature of all served foods in accordance with guidance. and henceforth By 31/12/05 On going. On receipt of this notification and henceforth. 10. 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 32 Good Practice Recommendations The registered person should ensure that all duty managers have an awareness of the National Minimum Standards and Care Standards Regulations. Broad Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ 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 Oak Manor Nursing Home I52 s61180 Broad Oak Manor Nursing Home v245053 240805 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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