Inspection on 16/11/09 for Broad Oaks

This inspection was carried out on 16th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broad Oaks 12/11/07

Broad Oaks 11/10/06

Broad Oaks 20/01/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Broad Oaks 30 Gaul Road March Cambridgeshire PE15 9RQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shirley Christopher     Date: 1 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Broad Oaks 30 Gaul Road March Cambridgeshire PE15 9RQ 01354656202 01354656934 broadoaks@schealthcare.co.uk Notavailable Active Care Partnerships Ltd care home 38 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of services users who can be accomodated is: 38 The registered person may provide the following category/ies of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Dementia - Code DE Date of last inspection Brief description of the care home Broad Oaks is a care service for people with learning disabilities. The service consists of four bungalows, two blocks of four flats, and a resource centre. The home has accepted groups of people with a wide range of needs, and covering a great age range: two of the bungalows have groups of much older residents, several of whom are over 65 years of age and one bungalow offers a home to young adults who are between 19 and 25 years of age. Built around a central courtyard, and backing onto a small estate of new houses in a residential area of March, the bungalows and flats blend in well with Care Homes for Adults (18-65 years) Page 4 of 34 1 38 Over 65 0 15 Brief description of the care home neighbouring properties. Each bungalow consists of single bedrooms all with ensuite toilet and washbasin, a kitchen/dining room, lounge, laundry, bathroom, shower room and cloakroom. The flats are in blocks of four, each for two people, with two bedrooms, bathroom, living room and kitchen. An additional building on the site, the leisure and education centre, contains offices and rooms where a range of activities can take place, both during the day, during the evening and at weekends. There is an art room, a sensory room and a large room which houses a piano and an organ. This room can be divided into two. There is also a kitchen, and toilet facilities. Adjacent to a public recreation park, Broadoaks is situated about five minutes walk from the centre of the busy market town of March, which offers a range of shops and leisure facilities. The home is within easy driving distance of Peterborough which has additional leisure facilities such as bowling and ice-skating. All of the people who live at Broadoaks are funded by local authorities/care trusts. Fees range from 619.00 to 1991.32 per week, based on the amount of care and support needed by each person. A copy of the inspection report is available in each bungalow and each block of flats, and in the reception area of the resource centre. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission carried out a key, unannounced inspection on the 16 November 2009. There were two inspectors. One inspector looked at records in the office, the other case tracked a number of residents records and visited one of the houses talking to staff and residents there and observing care practices. On the day of inspection the deputy manager was the most senior person on duty and the Operations manager was on site, completing a monthly audit of the service, as required by regulation 26. During our feedback we stated that we would like to continue the inspection over a second day, because of some concerns identified on the first visit and also because we wished to be proportionate and case track more residents and speak to staff working in the other homes. They all fall under one registration. We agreed to go back on the 24 November 2009. Following the first visit we raised a safeguarding concern with the appropriate authorities and a meeting was convened under safeguarding protocols. At this meeting Care Homes for Adults (18-65 years) Page 6 of 34 we were able to share our concerns but also to recognize the efforts taken by the deputy manager to address some of these concerns and to agree further actions. On the second day of inspection we were met by the deputy manager and a manager from another registered scheme within the same organization. She was providing some support to the deputy manager in the absence of the manager who is on leave. At the second inspection we case tracked a further three people and spoke to staff on two separate units. We have an Annual Quality Assurance Review, (AQAA) from last year but had not received one for this year. The home said it had not been received. This will be sent out again along with staff and resident surveys, which will be used to inform the next inspection which will be within the next year. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 34 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual pre-admission assessments must be sufficiently robust to enable the home to decide if they are able to meet a persons needs. The home must be able to demonstrate how they meet specialist needs. Services provided must be clearly identified in the statement of purpose. Evidence: The home has a main reception area situated in the day centre. The statement of purpose, service user guide and the Care Quality Commission (CQC) inspection reports can be found at reception. There is also a separate leaflet describing the individual dwellings. The statement of purpose and service user guide have been reviewed in the last year and are produced in print and widget format. Different formats would be helpful. The statement of purpose must give a full range of fees. The deputy manager stated these were under review with the local authority. The home accommodate people 18-65 with a learning disability but also have people over 65, people with dementia and people with secondary mental health issues. The statement of purpose must give information about the range of needs the home can accommodate and any specialist support and services they are able to provide. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: We asked to case track three people and asked to see their initial assessments before moving into the home. There was no pre-admission assessment for the first person case tracked who had transferred from another home. We were concerned about this because it was an emergency admission and the reasons for the breakdown of the first placement were not clearly documented. The second pre-admission assessment was comprehensive and clearly described the persons needs. The assessment was not signed and did not state who was involved in the assessment process and how information was collated. The third pre-admission assessment was detailed and described clearly what needs were to be met but some information about the reasons for admission, which were discussed under safeguarding procedures were not on the file. We carried out the inspection over two days and spoke to eleven staff. This included three team leaders. We also spoke to the operations manager, the deputy manager and the manager from another registered service who was supporting the deputy manager. We asked about meeting specialist needs and some staff said they had received lots of training and were well supported by other health and social agencies. Training records for staff indicated some significant gaps. We identified gaps in statutory reviews and lengthy waits for specialist services, following referrals. Some residents needs remained unmet and caused us concern. This is discussed later in the report. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans must help staff meet residents needs and identify where their needs have changed or remain unmet. A clear audit trail should identify what actions have been taken to meet identified needs Evidence: We asked to case track three people on the first day of the inspection but only managed to look at two files. One reason for this was the amount of information held on each resident. There is a general file and a file with current information. There are records around daily recordings such as what personal care was given and activities. The information on the file is so considerable it is hard to see how to meet residents needs as it is unrealistic to go through so much information, some relevant and up to date other information is historical. We went back on a second day and looked at a further three residents files and meet with the residents and staff to discuss their care needs. Our findings are as follows. One person had specialist needs and these were not being met. There was a lack of Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: clarity between the home and the purchasing authority about whether the fees being paid included costs for day care. There was poor evidence of what activities were being provided. There was an activity plan in place, but daily notes did not evidence that this was being followed. There was poor information about their social history and what interests they may have had or could develop. There was a lack of clarity about the use of prescribed when necessary (PRN) medication. There was no clear instruction about when certain medications should be administered. We looked on the medication recording sheet for the previous two weeks, and one PRN medication had been administered every day. The person had some mental health issues and their was no care plan in place for this. We saw some evidence that the person was receiving support from the psychiatric services and a referral had been made to the learning disability team for some behavioral support. There were no clear guidelines in place around the positive management of behaviour. Through observation we saw staff reacting to behaviour rather than pre-empting it and using techniques to encourage more positive behaviours. The resident had limited verbal communication and there was no communication assessment in place to help identify what would improve methods of communication, through the use of symbols and, or pictures. There was no evidence that an assessment had been carried out in respect of a deterioration of the residents skills level and likely support they required around the reduction of mobility, poor skin integrity, incontinence and self help skills like eating and drinking. The home had made a number of referrals but the home were unable to evidence that these had been followed up. Risk assessments were in place and reviewed but we did not see up to date assessments for lap belts and cot sides and their justification for use. The person did not have access to specialist equipment needed, although a request had been made. No evidence was provided that this had been followed up. We had significant concerns about this person and felt that there may be a deprivation of their liberty particularly as they were rarely being supported to go and were being restrained without the justification for it being made clear. We saw no evidence that their mental capacity had been assessed and felt that a skills level assessment should be completed. We referred this person under the safeguarding of vulnerable adults , Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: (SOVA) and had a meeting last week which was helpful and we were encouraged by the providers response. We looked at a further file on the first day of inspection. This person did not have a pre- admission assessment. We were unable to meet this person. Risk assessments were in place for challenging behaviours and the home were being supported by the mental health services. Medication was being prescribed to manage some difficult behaviour but there was no clear pattern or description of the behaviour. The staff were being asked to record this retrospectively so it would be difficult to see how effective the use of medication was. There was also a history of challenging behaviour but without pre assessment information it was difficult to follow this through. We saw a detailed strategy intervention programme which talked about the different behaviours and strategies to manage them. We were unclear who drew this up and whether there was a multi-disciplinary approach. It had not been reviewed for a year, although there was a change in the persons behaviour. The home had referred the person to the psychiatrist and a review was being held with the learning disability partnership on the second day of our visit. The monthly review summary showed little recording of behaviour positive or otherwise and used non descriptive words like agitated which does not tell you about the behaviour. There was little evidence of social activity and the social plan in place described how to manage difficult behaviours in public places but did not say that this person is able to tell you when they feel able to access the community. We were told this by the deputy manager. There were a-ot of risk assessments in place, some based on individual risk and others were generic, driven by the organization. This seemed completely unnecessary particularly where no risk had been identified. One female resident had risk assessments for shaving and falls. Their personal care record did not indicate the need for shaving and there was no identified risk of falls for this person. The number of records being completed was clearly time consuming for staff and largely unnecessary. We looked at one care plan which started with a personal profile of a resident with complex needs. This was very well written and was written from the resident perspective about how they wished to be supported, what their preferred routines were and what they were able to do for themselves and what they needed support with. It make constant reference to privacy and dignity and focused on strengths. This document would enable staff to know how to meet the persons needs without having to refer to all the other records. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: In another house there was a quick summary guide which would help staff unfamiliar with residents know how to meet their needs. The care plans seen on this unit were well written and showed evidence of regular review in consultation with residents. They also showed what activities residents had participated in. We were impressed by the staffs knowledge of residents needs and the houses benefit from a low turn over of staff which meant consistency for residents. We felt from the evidence gathered that some homes function better than others. The deputy manager in response to our feedback started her own internal review of one of the houses and was looking to restructure the unit. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must be able to provide sufficient evidence that they are enabling residents to access a range of fulfilling and meaningful range of activities in and outside the home. Evidence: We case tracked six people and spoke to staff about the social opportunities offered to residents. The feedback was mixed. In the first dwelling, three residents had one to one staffing for a specified period of time and there was good evidence of activities being provided, which were appropriate to the persons needs. This involved regular trips to the community. One resident had a bike, others had bus passes and season train tickets. On site there is a multi sensory room and a day centre, but this is used more for offices and staff training. The home has its own transport, but this needs to be booked in advance. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Three people did not have any planned day care. One person did not have the agreed funding in place for day care, and two other people stopped going to the day centre, one because of problems there. It was not evident if this problem had tried to be resolved. The home have people of retirement age and must demonstrate that they have opportunities to participate in activities which are appropriate and of their choosing. We saw some evidence of daily routines, which appeared to be flexible and recorded in care plans about what residents preferred routines were and what support they required. We observed lunch time, in one house. A choice of food was offered to residents but eating guidelines were not followed. Another resident appeared to be struggling with eating their meal and would have benefited from a slip mat. Staff offered tomato ketchup but because they did not respond they assumed they did not want ketchup. Staff need to think about how they offer choices to residents. Only one resident sat at the table. The other residents had lap trays. Menu records are kept. People case track had eating and drinking assessments and risk assessments for meal times. The home have notified us of a number of incidents of people chocking and had taken appropriate actions. Risks must be assessed in all areas of self help and daily living skills before an incident/accident occurs given the vulnerability and severity of physical/learning of some of the residents. Appropriate supervision was given throughout meal time. one person did not have appropriate utensils as suggested in the review notes. A referral had been made for an occupational therapy assessment but this was outstanding. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home access a range of health care services to meet the needs of residents, but gaps in statutory provision mean that some identified needs remain unmet. The home must provide a clear evidence trail to demonstrate that they have followed up referrals. Evidence: We saw health care records for people and generally these were comprehensive. The home access the Learning Disability Partnership for advice around managing difficult behaviour and there was evidence of regular psychiatry involvement. The experience of staff about support from other health and social services was mixed. Some staff said they were well supported by the district nurses and felt residents health care needs were met. Health care action plans showed the home accessing a range of services, optical, dental and chiropody services. In other instances referrals had been made to specialist services but the referrals had not been actioned. There was no clear audit trail showing these had been followed up. We looked at medication on two units. Staff receive two types of training and ongoing support from the district nurses, who train and delegate procedures in respect of the Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: management of blood sugars and diabetic control and medication administered for epilepsy. Training records showed us that a lot of staffs medication training had lapsed and we were unable to evidence if only staff with update training were administering medication. On our second visit the deputy manager had looked at which staffs training was up to date and they were the only staff permitted to administer medication. We audited medication and found a number of errors. The Senior on duty in charge of medication said she had received up to date medication training but had not received her certificate. We audited one persons medication and there was a shortfall in the number of tablets for that week, so staff had been taking tablets from another week. There was no explanation on the medication recording sheet for this. We checked the controlled drugs register and the number of tablets for one person checked was correct. We looked at another record and the number of controlled drugs was incorrect with one tablet unaccounted for. We had a discussion with the deputy manager and manager from another home, about an issue where a staff member had re -written part of instructions on a MAR sheet. An investigation was conducted and it was concluded that the staff member had been carrying out instruction from the pharmacist at a local chemist and was acting according to what she had been instructed to do. The deputy manager has agreed to meet with the chemist to ensure that accurate and appropriate instructions are recorded. The home have been conducting their own investigations into shortfalls we have identified and we saw evidence of medication audits and action plans to deal with shortfalls. We were concerned that as required medicines (PRN) protocols were not sufficiently robust. On another dwelling medication was checked and the findings were as follows, medication recording sheets were accurately recorded. PRN Lorazepam prescribed for one resident was treated as a controlled medication and was double signed in a separate record book and the medication is stored in a Controlled Medication cabinet. There were clear guidelines regarding PRN medication. The evidence for this was clearly recorded and two doses have been given in October and November. Clear recording on medication boxes showing the amount contained. Prescribed medication is safely stored along with homely remedies medication Staff signatures were recorded. Only staff who have received appropriate training can administer medication. One resident has been refusing medication but there was evidence of clear liaison with a psychiatrist regarding this issue. We have received a number of notifications from the home about medication errors. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have robust procedures for dealing with safeguarding issues and complaints. Evidence: The home has a robust complaints procedure and the home act upon complaints received. We discussed two ongoing complaints with the deputy manager. One is being investigated and a full review is ongoing. A second issue has been resolved. The home are proactive in reporting safeguarding of vulnerable adults (SOVA) concerns and do liaise regularly with the learning disability partnership (LDP.) We were concerned about the high level of accidents and incidents recorded monthly, many of which are reported to us under regulation 37. There does not appear to be any clear correlation between accidents and incidents and the operations manager stated these are monitored. Incidents of aggression between residents are recorded. We followed up an incident of alleged psychological abuse and a second incident of a resident who had bite marks. We are concerned about the number of incidents. Over a period of three months accidents/incidents averaged 23 per month. Incidents/accidents had been referred to the appropriate agencies. We were concerned about the percentage of staff who did not have up to date training in non-violent crisis intervention (NVCI.) We were also concerned that behavioural management guidelines were either not in place, or where they were in place these had not been drawn up using a a multi-disciplinary framework. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The AQAA from last year stated that the home has clear policies and procedures on the prevention of abuse and safeguarding of vulnerable adults which can be provided upon request and which we adhere to. These policies and procedures are well advertised within the home and adhere to the guidance in no secrets. The deputy manager stated she is the POVA lead and 70 staff have completed the training since January 2009. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes inspected were fit for purpose and the environment appeared appropriate to need. Evidence: Broad Oaks provides accommodation on a site which consists of a day centre and a number of individual dwellings, houses and flats, which accommodate up to thirty eight people. The houses are divided up according to need, such as high dependency. We walked around a number of houses and they were appropriate to need. We looked at the cleanliness and infection control practices, (not procedures.) and were satisfied these were robust. Some staff handling food did not have an up to date food hygiene certificate. Bedrooms were personalized and many had multi-sensory equipment, such as lights and shiny tiles. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must be able to evidence that it has a quality workforce. They can demonstrate this through its recruitment processes, training, development, supervision and skills mix of staff. Evidence: We talked to ten staff and the deputy manager and operations manager. The feedback from care staff was mixed. Staff showed a good understanding of meeting residents needs. Most staff had worked in the home for at least two years. We asked staff about their training needs, induction, supervision and appraisal. Staff stated they had received all their mandatory training and also did more specialized training like equality and diversity, epilepsy, NVCI s (Non Violent Crisis Intervention.) Staff receive training in medication from the Primary community team, (PCT) and from a leading pharmacist. Staff are responsible for monitoring blood sugars and administering medication for epilepsy, in the mouth or rectally. Staff are trained and supervised by district nurses to do this. Some staff stated they had not had an annual appraisal and staff supervision varied from staff member to staff member. One person said 6/8 weeks. Another person said they have had two this year. We looked at three staff records and found the following training was out of date: medication,(for 2) infection control, (for 2) non violent crisis Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: intervention, (for 3) and manual handling (2.) There was no evidence of supervision on the second file and two recorded supervisions on the third file. We looked at an induction record and this was satisfactory. Mandatory training for that person had been planned. We spoke to some staff about induction and they confirmed they were shadowed by more Senior staff as part of their induction and some of their initial training was completed through videos and questionnaires. One staff member said as part of the interview they were invited to attend a two hour trial to meet residents and familiarize themselves with the home. Staff stated that team meetings were held regularly and senior team leaders also had their own meetings. We looked at the training matrix which showed us the training records of 92 staff and this showed a high percentage of training was out of date. Examples were medication training, through the pharmacist, 54 either had not received the training or it was out of date. Epilepsy/stesolid 26 staff had it in date, 60 staff either did not have it or it was out of date. Manual handling 36 in date, 55 do not have it or it is out of date. We saw no evidence that staff had received training in mental health. Some staff had received dementia awareness training, but we do not have a percentage of staff. The supervision matrix showed some significant gaps. The staff files inspected were satisfactory and showed that the organization have good recruitment procedures. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance systems are in place and the home consult people about the service they are providing and identify areas which require improvement to ensure people get a satisfactory service. Evidence: When we visited the home, the manager was on leave and the deputy manager was the most senior person on duty. The operations manager was completing an internal audit of the service and there were some similarities from her findings to ours. We looked back on past audits required under regulation 26. They were comprehensive. The manager is well qualified and the home employ 100 staff. The home did not have any staffing vacancies and cover leave with their own staff, who pick up overtime. We spoke to ten staff and they had all been employed for two years or more. There is a team leader in each house and there are staff who are known as floats and will cover other houses and provide back up should there be any challenging behaviour. One team leader told us there had been high sickness rates, but the organization had introduced back to work interviews which had been effective at monitoring and Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: reducing staff sickness rates. We looked at a number of records and took some information from the AQAA. The home are required to complete another AQAA for 2009 so some of the information may not be up to date. An example being policies were last updated in 2007, according to the AQAA received in October 2008. Staff recruitment files were satisfactory, but staff training records and supervision records were unsatisfactory. Residents records on the whole were good, but need to be simplified and include information only relevant to that persons care needs. Accident and incident reporting and recording is good, but when follow- action is required it does not say who should do this and by when. We looked at the records and followed them up to ensure actions had been taken and they had. We believe there is an unacceptably high level of incidents and accidents and these must be thoroughly reviewed. We looked at quality assurance. The home had circulated surveys to staff, relatives and residents in the last month. They had 11 surveys returned from residents and 14 from relatives. Their comments suggested relatives and residents were largely happy with the service provided. We saw an action plan following a staff survey. A high percentage of staff identified training, supervision and support as areas which need to be improved upon. The action plan gave clear targets and timescales. The deputy manager stated they have regular residents meetings in each dwelling. One home we visited stated they do not have meetings. Regular staff meetings are held, and relative meetings are held, a recent one was on the notice board and the meeting before no one attended. Care Homes for Adults (18-65 years) Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 42 13(4) Any risks to people who live 12/11/2007 at Broadoaks must be identified, assessed and so far as possible eliminated, so that people are safe from harm. Risk assessments must be carried out on the portable heaters in the Lodge. Care Homes for Adults (18-65 years) Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The home must only admit people after a full assessment has been undertaken and the home must ensure that the needs assessment covers all the areas described in standard 2 This is to ensure the home are certain that they are able to meet the persons needs and they fall within their registration criteria 30/01/2010 2 3 12 The registered person must 30/01/2010 demonstrate that they have the capacity to meet assessed needs including specialist needs. Staff must have the necessary skills and experience to deliver the services and care offered by the home. This is to ensure that needs are met and staff are given the appropriate training and Care Homes for Adults (18-65 years) Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action support to meet these needs. 3 6 12 The service user plan must set out how the current and anticipated specialist requirements will be met. It must clearly describe restrictions on choices and freedom and the rationale for this. It must focus on positive behaviour and have a clear plan for dealing with difficult behaviours. It must be reviewed regularly and clearly show what actions have been taken and by who. This will ensure that residents needs are met in a planned and proactive way. Reviews will highlight if the actions taken by staff are appropriate or if further or different intervention is necessary. 4 11 16 The home must ensure that residents are integrated into the community and are given the opportunities to develop their emotional and social skills. This is to ensure that residents have every opportunity to develop, promote and retain skills. 30/01/2010 30/01/2010 Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 19 13 The home must ensure that residents have appropriate access to health care and the home must provide a clear audit trail. This is to ensure that residents get the services that they need to meet their health care needs. 30/01/2010 6 20 13 The home must 30/01/2010 demonstrate that they comply with their own medication policies in respect of the receipt, recording, storage, handling, administration and disposal of medication. This is to ensure medication is administered safely. 7 23 13 Physical and verbal aggression must be fully understood and clear guidelines must be in place and in accordance with the Department of Health guidance. All staff must receive appropriate training in this area. This is to ensure that behaviour is responded to appropriately within an agreed plan to protect staff and residents. 30/01/2010 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 35 19 Staffs mandatory training must be kept up to date This is to ensure staff have the necessary skills and experience to meet residents needs. 30/01/2010 9 36 19 Staff must be appropriately supervised and the frequency of supervision must be reviewed. This is to ensure the staff are sufficiently supported and has the opportunity to explore areas of their practice. 30/01/2010 10 42 13 The home must promote the 30/01/2010 safety of residents using the service. The number of accidents and incidents must be closely monitored and where possible reduced or eliminated. This is to ensure people using the service are kept safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should be simplified to enable staff to know how to meet residents needs and so residents can easily access the information Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 9 Risk assessments should be in place for identified risks, and should be specific to the individual and not generic. Where there is no risk identified it is not necessary to have a risk assessment in place. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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