CARE HOMES FOR OLDER PEOPLE
Broadlands 28 Shelford Road Ratcliff On Trent Nottingham NG12 1AF Lead Inspector
Caroline Brailsford Lee West Unannounced 12 July 2005 - 9:30
th 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. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Broadlands Address 28 Shelford Road Ratcliffe on Trent Nottingham NG12 1AF 0115 933 2727 0115 911 5027 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) Miss Soowantee Doma Miss Soowantee Doma Care Home - Private 19 Category(ies) of OP Old - 19 registration, with number of places Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 One named Service User mybe within category DE 2 Serive User shall be within category OP. Date of last inspection 5/3/05 Brief Description of the Service: Broadlands is a care home providing personal care and accommodation for 19 older people. It does not provide nursing care.It is owned by Miss Doma and Mrs Auchraje, with Miss Doma being the registered manager. The home is located in the village of Radcliffe on Trent and it is approximately a quarter of a mile from the village centre, which has shops, pubs, a library and all the amenities one would normally expect from a large village.The home was opened in 1970 and is an extended, detached property. Service users are accommodated on the ground and first floor, access to which is by 2 stair lifts. There is some seating outside and a small garden area. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took 4 hours and there were 2 inspectors. Inspectors looked at three service user’s files, particularly at the care plans and risk assessment. Other paperwork was also inspected, for example health and safety records. There were several staff on duty who the inspector observed and the deputy, who had a private interview. The inspectors spoke to three service users to find out their views on the home. The inspectors had a tour around the building led by the deputy. What the service does well:
The care plans were well organised and presented. They had been regularly reviewed since the last inspection. The medication trolley and administration records were checked and practice was found to be safe and well organised. The home have a new medicine trolley which the deputy said has been beneficial. The deputy stated that all staff have now received their medicines training from the local pharmacist, also that there is a first aider on every shift The service users have a well balanced diet, served in a pleasant dining area. The home’s environment was pleasant and mainly in a good state of repair. The deputy reported that since the last inspection there is now a routine maintenance book, which is working well for the handyman. There has been a fire drill since the last inspection, which was recorded, and the fire tests on equipment were mostly up to date. The grounds appeared to be pleasant and safe with the garden accessible to the service users. There were accessible toilets, which were suitable for the service users needs and adequate baths and showers. The staffing on the day of the inspection appeared to meet the needs of the service users who were resident. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Broadlands C53 C03 S50869 Broadlands V237938 120705 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 Broadlands C53 C03 S50869 Broadlands V237938 120705 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) 1 The statement of purpose was unavailable in the home and therefore not accessible to service users or their relatives. EVIDENCE: The inspectors were not able to check the statement of purpose as the deputy was not able to provide the document for inspection. There was a requirement at the last inspection to bring the document up to date. This requirement will be carried over and checked at the next inspection. Broadlands C53 C03 S50869 Broadlands V237938 120705 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 The care plans did not contain the level of detail required to ensure that staff know what to do and ensure that needs can be met. The health needs of service users was not clear from the plans and care plans did not contain some key information putting the service user’s at risk. Medication in the home was well organised but a policy and procedure was not in place to ensure safe practise at all times. EVIDENCE: The inspectors selected three files for inspection. All files were well organised and contained care plans. The care plans had been recently reviewed with regular reviews since the last inspection. The care plans provided information with regard to service users needs but now need to be expanded to provide more detail. For example The detail did not include how plans would be implemented or specific steps which staff should take to ensure needs will be met. Personal history information was given little attention and on one file there was no documentation regarding this. Risk assessments were present but some lacked clear detail and actions, which should be taken to minimise risk. Some key information regarding the health
Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 10 needs of one service user was omitted from the care plan and the risk assessment had not been amended further to an incident. Although some medical information was found in the files it was difficult to see what the medial history was for one service user as there was little information. The deputy explained that she and the manager are in the process of updating all the care plans and the inspectors viewed on which had been completed. This was easy to read and contained more detail. The medication trolley and administration records were checked and practice was found to be safe and well organised. The home have a new medicine trolley that the deputy said has been beneficial. The deputy stated that all staff have now received their medicines training from the local pharmacist, also that there is a first aider on every shift There was no procedure or policy on the administration of medicines within the home Broadlands C53 C03 S50869 Broadlands V237938 120705 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) 15 The service users have a well balanced diet, which is served in a pleasant dining area. EVIDENCE: The inspectors observed dinner being served by a cook and a care staff. Both staff had completed their food hygiene training. The meal was Cornish pasty, chips and peas. The portions appeared small but the deputy explained that many of the service users have small appetites. The menu was not inspected but two service users said that the food was good and that fresh vegetables, salad and fruit were regularly served. Three service users said that they had enough to eat and there were regular drinks served throughout the day. One service user said that there was no choice of food but the deputy said that a choice was always offered. Another service user said that she did have a choice and was happy with the arrangements. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not inspected on this occasion. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,25,26 The areas used by service users are pleasant and welcoming but there are some issues with regard to cross infection and cleanliness which could pose a significant risk to service users. EVIDENCE: The home was pleasant and mainly in a good state of repair. The deputy reported that since the last inspection there is now a routine maintenance book which is working well for the handyman. There has been a fire drill since the last inspection, which was recorded, and the fire tests on equipment were mostly up to date although there had not been a test on the emergency lighting since April 2005. All fire tests and maintenance is kept together in a file. At the last inspection there was a requirement for the manager to have a fire risk assessment in place, this was not in the file and the deputy did not know whether this had been completed. The grounds appeared to be pleasant and safe with the garden accessible to the service users. There were accessible toilets, which were suitable for the service users needs and adequate baths and showers. One service user said that she was happy with the facilities. There are two toilets near the lounge
Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 14 and dining room one of these had a grab rail with a hand towel draped over it. The deputy removed this when it was pointed out by the inspectors. The other toilet floor appeared dirty at the back of the toilet and in particular near to the door where a towel was placed on the floor to soak up excess water from a leak. There was no liquid soap or paper towels in several of the hand sinks around the home. The commodes were found to be soaking in bleach in the service users baths; the deputy explained that there was no sluicing facility in the home. The laundry contained a washing machine with appropriate temperature settings to control the risk of infection. There was a tumble drier and space to hang the clothes on a line. The line however was sited above the freezers where the food is stored. The flooring and some areas of the walls were difficult to keep clean and there were cracks where dirt was building up. Generally the room was found to be dirty, the sinks were stained, the windowsill was covered in dead insects and there were no hand washing facilities. The pump for the central heating system was sited in the laundry and the casing was hanging down. There were requirements for liogionella testing set at the last inspection and also the water temperatures to ensure that water is distributed and stored appropriately. The temperatures had been taken but the thermometer only reaches 50 degrees, which does not allow for checking the higher temperatures for legionella. The top stair on the main staircase has an area of carpet, which is frayed and stuck down with tape. This could pose a risk to the service users. The step from the hall to the corridor towards the laundry had no apparent risk assessment. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27 The staffing on the day of the inspection appeared to meet the needs of the service users who were resident. EVIDENCE: The staff on duty appeared to be respectctful towards the service users and were welcoming to the inspectors. Service users spoken with said that there were enough staff on duty to meet their needs. One service user said that “some staff were better that others” this person raised no concerns about any staff members. There appeared to be the correct numbers of staff on duty and the deputy reported that staffing is based on the needs of the service users. Also that there are three staff on duty during the day and at night there is one awake and one asleep. She felt that there was enough staff to ensure that all service users’ needs are met. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) EVIDENCE: These standards were not inspected on this occasion. Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 x x x 2 1 STAFFING Standard No Score 27 3 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 x x x x x x x x Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 18 yes 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. Standard 1 Regulation 4(1) Timescale for action The registered person must bring 14/8/05 up to date the Statement of purpose and subsequently the service users guide in the home.This is outstanding from the last inspection. The registered person must 14/8/05 make available the Environmental Health Officer report for the next inspection.This is outstanding from the last inspection. The registered person must 14/8/05 make sure that the fire risk assessment is in place and up to date.This is outstanding from the last inspection. The registered person must 30/7/05 make sure that there is appropriate testing for legionella in the home.This is outstanding from the last inspection. Care plans need to be developed 31/8/05 to contain the required detail regarding exactly how the service users needs will be met. Risk assessments must contain 31/8/05 all key information and steps which must be taken in order to minimise the risks. The registered person must 31/8/05
Version 1.40 Page 19 Requirement 2. 19 23(2) 3. 19 13(4) 4. 25 13(4) 5. 7,8 15 6. 7,8 13(4) 7. 9 13 Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc 8. 19,21 9. 10. 19,21 19,26 11. 19,26 12. 13. 19,26 19 14. 19 develop a medication policy for use within the home. 13(4) The registered person must ensure that staff do not drape towels over handrails in the bathrooms. 13(4),16(j Adequate and safe arrangements ),23(k) must be made for the sluicing/washing of commodes. 16(j) The clothes line above the freezers or the freezers themselves must be moved to ensure that contamination of food does not take place. 16(J)13(4 The flooring in the laundry and ) toilet must be impermeable in nature and easily cleaned and the leak in the toilet must be fixed. 16(J) Dedicated handwashing facilities 13(4) need to be provided in the laundry. 13(4) The carpet on the top step should be either removed or repaired to make safe with regard to the risk of trips. 13(4) The step from the hall to the coridoor leading to the laundry must be risk assessed by the registered manager. 17/7/05 14/8/05 14/8/05 31/8/05 31/8/05 31/8/05 31/8/05 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 21,26 26 Good Practice Recommendations Paper towels and liquid soap should be present in all toilets bathrooms ans the laundry. The laundry should be cleaned to prevent dirt building up and the spread of infection Broadlands C53 C03 S50869 Broadlands V237938 120705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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