CARE HOMES FOR OLDER PEOPLE
Broadfield House Broadfield Drive Leyland Preston Lancashire PR25 1NB Lead Inspector
Della Lovell Unannounced Inspection 28th March 2006 09:30 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 Broadfield House DS0000035758.V286556.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. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Broadfield House Address Broadfield Drive Leyland Preston Lancashire PR25 1NB 01772 422111 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) Lancashire County Care Services Mrs Wendy Cooper Care Home 45 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (14) of places Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 45 service users to include: Up to 14 service users in the category of OP (Old age, not falling within any other category). Up to 31 service users in the category of DE (Dementia). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines that may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 29th November 2005 2. 3. Date of last inspection Brief Description of the Service: Broadfield is a well-established care home located in Leyland, which is operated by Lancashire County Care Services. There are shops and many other local facilities available nearby. The home has gone through an extensive period of refurbishment and building work and provides accommodation in four separate units within the home. The standard of the furnishings and fittings provided are of a high standard. The home is registered to accommodate 14 older people and 31 people who have care needs associated with a diagnosis of Dementia. One of the units in the home is designated to provide short-term rehabilitation services for people with dementia care needs. It is anticipated that the length of stay for people admitted to this unit will be for a period of up to twelve weeks. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in March 2006. The inspection involved discussion with the people who lived and worked at the home, examination of records and a tour of the home. What the service does well: What has improved since the last inspection? What they could do better:
The registered person must ensure that all service users, which include those service users staying on the rehabilitation unit, have a care plan, showing how the needs are to be met. All risk assessments must provide instructions for care staff on actions required to minimise the identified risk and all staff undertaking risk assessments must be trained to do so.
Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 6 Although training is provided by the home, the registered person must ensure that all staff are kept up to date with moving and handling and food hygiene. It is recommendation from this report that the activity programme should be developed further to take into consideration the service users history and choices. 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. Broadfield House DS0000035758.V286556.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 Broadfield House DS0000035758.V286556.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): 3 and 6 All service users needs are assessed before admission to the home. However there was not sufficient information for service users admitted to the rehabilitation unit to ensure their needs will be met. EVIDENCE: All service users at Broadfield are referred through the Local Authority and an assessment was in place for all service users. A number of files were checked as a part of the inspection process and assessments were seen to be kept on the service users individual files. The home had undertaken a full history, likes and dislikes and all medical conditions were also recorded and assessed. Staff have access to service users files and keep information up to date. Service users spoken to felt that their needs were being met. Broadfield provides a rehabilitation unit for service users suffering from dementia. A new format had recently been developed for recording service users goals and outcomes on the unit. However this had not been fully implemented at the time of the inspection. It was unclear from one service users file what the outcome and goals were and although some needs had been highlighted there was no evidence of what action the unit was taking to meet the assessed needs.
Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 9 Since the last inspection a conservatory had been built on the rehabilitation unit, which provided additional lounge space. Additional space was also available on the unit for therapy and treatments. The unit was staffed by, care staff from the home and external professional such as a social worker, occupational therapist and a physiotherapist. The registered manager told the inspector that the external professionals arrange the admissions and discharges and the team leader manages the staff on the unit. The registered manager attends weekly meeting to over see the management of the unit with regards to the admissions and discharges. The team leader provides staff supervisions and risk assessment and is still awaiting training in these areas. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 10 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 and 9 Resident’s health and personal care is met by the home’s care planning process. However the home must ensure that a consistent care planning approach is developed which includes service users staying on the rehabilitation unit. The homes medication procedure ensures the safety of service users. EVIDENCE: The files of three service users were looked at. Two from the residential units and one from the rehabilitation unit. Pre admission assessment for all service users had been undertaken and comprehensive care plans had been provided for the two service users living on the residential units. These care plans provided clear instructions for staff on how the assessed needs were to be met. There was evidence from one file that a health care need had been diagnosed and regular hospital appointments had been arranged by the home to ensure the service user received the appropriate treatment. Information had also been recorded on NHS services received such as chiropodist and optician. The registered manager was advised to develop a format to record these visits, which would provide a clear overview of when services and treatment had taken place. Since the last inspection the registered manager had archived all the old care plan and all care plans had been reviewed and updated. There was a risk
Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 11 assessment in place, which identified each risk, and the action required to minimise the risk. Services users said the care was very good and felt there needs were being met. One service users file on the rehabilitation unit was also looked at. There was an assessment in place but no care plan. The registered manager told the inspector that a new format had been developed which looked at goals and outcomes. The inspector noted that the assessment highlighted a number of needs including health care needs. There was no information on how the home was meeting the needs and the risk assessment did not cover all the risks identified from the assessment. Although the rehabilitation unit has a multidisplinary team involved, all service users must have a care plan showing, how the needs are to be met while staying at the home. All staff administering medication had received training. Since the last inspection the registered manager had developed a monthly audit to ensure that the correct procedures are being followed. This was seen recorded additionally all staff are monitored by the registered manager with regards to their competence. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 The homes procedures enable service users to exercise choice and control over their lives and service users maintain contact with their families and friends as they wish. EVIDENCE: Both service users and staff were able to confirm that there were no restrictions with regards to visiting. Service users told the inspector that they were able to see their visitors in their own room or the communal areas if they so choose Service users or their families manage the finances. The home provides a lockable storage area in all the bedrooms and payments are generally made via a relative. The home holds a small amount of money for some service users. All written records were seen to be appropriately maintained and up to date. Observations made confirmed service users had control over their own lives. Service users were seen making choices with regards to their meals and the daily routine. A tour of the premises confirmed service users had brought their own personal possessions with them on admission to the home. All service users spoken to said that the staff at the home were very good and always offered choices. The registered manager informed the inspector that since the last inspection designated staff members had been given the responsibility of organising
Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 13 activities each day. The inspector noted that there was a programme of activities on the board. There was no evidence that service users had been consulted in this process. It is recommended that the home develops a programme from the individual service users history and current choices. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 14 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): These standards were not assessed. EVIDENCE: Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 15 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): These standards were not assessed. EVIDENCE: Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,and 30 The policies and procedure for recruitment of staff are robust and provide safeguards for the protection of service users. Staff are provided with training to ensure they are competent to meet the needs of the service users living at the home. EVIDENCE: The staffing levels were sufficient for the number of service users living in the home at the time of the visit; a duty rota was kept which identified which staff were on duty and in what capacity. The home had a robust recruit policy and procedure in place, which ensured the Protection of Vulnerable Adults. The file of one newly appointed staff member was looked at. All the appropriate checks had been undertaken by the home prior to the staff member starting work at the home. An induction programme was in place to ensure the staff member was competent and confident to do the job of a carer. Staff on duty told the inspector that they felt well supported by the training provided and one staff member said that she had enjoyed the current training being provided by the home on dementia care. The home had a training programme in place that covered mandatory training such as moving and handling and food hygiene. The manager had developed a good training matrix, which identifies which staff members are in need of updates. At the time of the inspection a number of staff still required training with regards moving and handling and food hygiene. The registered manager told the inspector that this training had been arranged. This is an outstanding
Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 17 requirement from the last inspection and must be addressed by the registered person. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 36 The home is well managed by a person who is fit to be in charge, which ensures the service users interests are safeguarded. EVIDENCE: Service users or their families manage their finances. The home provides a lockable storage area in all the bedrooms and fee payments are generally made via a relative. The home holds a small amount of money for some service users. All written records were seen maintained and up to date. The home had a set of policies and procedures in place for financial arrangements, which are up dated accordingly. A record is kept of all items brought into the home and this is kept on service users file. The manager was advised to ensure a signature is obtained once a service user leaves the home. A register is kept for valuables and this was seen appropriately maintained. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 19 The registered manager is qualified and competent and keeps her knowledge up to date by attending management meeting and relevant training. The manager told the inspector that she was currently working towards a Masters Degree in Dementia Care. All service users spoken to were very satisfied with the care and support they receive. The staff are provided with regular supervision and training and meetings are held on a regular basis. Staff told the inspector that they felt supported by the management team and that training is available to them. Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 20 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 X X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X X Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3OP6 Regulation Requirement 14(1)14(2 ) Timescale for action The registered person must 31/04/06 ensure that the service users assessments and care plans for service users receiving rehabilitation care clearly documents the intended outcomes and goals to be achieved including any home visits. (Time scale of 31/01/06) not met.) The registered person must 31/04/06 ensure that all risk assessments provide instruction for care staff on actions required to minimise any identified risks. (Time scale of 31/01/06) not met.) The registered person must 31/04/06 ensure that staff undertaking risk assessments are provided with appropriate training in this area. (Time scale of 31/01/06) not met.) The registered person must 31/04/06 ensure that all staff are provided with mandatory training including moving and handling. (Time scale of 31/01/06) not met.)
DS0000035758.V286556.R01.S.doc Version 5.1 Page 22 2. OP7 13(4)(c) 3. OP7OP30 18(1)(c) (i) 4. OP30 13(5) 18(1)(c) (i) Broadfield House RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP7 OP12 Good Practice Recommendations The registered person should consider using one format for recording all NHS services. Following consultation with the service users the registered person should develop a programme of activities, which takes into consideration service users history and choice. The registered person should ensure that a signature is obtained for service users property leaving the home. 3. OP35 Broadfield House DS0000035758.V286556.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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