Inspection on 01/08/05 for Broadlands Nursing Home

This inspection was carried out on 1st August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broadlands Nursing Home 12/06/07

Broadlands Nursing Home 16/06/06

Broadlands Nursing Home 15/12/05

Broadlands Nursing Home 25/11/04

Broadlands Nursing Home 13/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Broadlands Nursing Home 51 Burdon Lane Cheam Surrey SM2 7PP Lead Inspector Margaret Lynes Unannounced 01 August 2005, 10.00 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 Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Broadlands Nursing Home Address 51 Burdon Lane, Cheam, Surrey, SM2 7PP 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) 020 8661 1120 020 8661 1120 Mr N Baloo Mrs Anita-Marie Porter Care Home 25 Category(ies) of Old age registration, with number Mental disorder of places Dementia Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/11/04 Brief Description of the Service: Broadlands is a pleasant home situated in a quiet residential area close to Cheam village. It is situated close to public transport links, including rail services and motorways. The home provides nursing care for elderly, mentally frail, residents. There are some nine double bedrooms and seven single. The majority of the bedrooms are situated on the ground floor. There is a large, attractive and well-kept garden, overlooked by a spacious conservatory in which the residents take their meals. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over one day. During that time a number of records were examined, a tour was made of the premises and time was spent talking with service users, their relatives and staff. The last inspection had resulted in 13 requirements being made. Six of these have now been met, and steps taken to rectify another (this requirement related to the need to record the wishes of service users in the event of their death. Staff are now seeking an opportune moment to raise the issue. The requirement has not, therefore, been repeated). Six requirements still remain, and an Immediate Requirement Notice was issued with regard to one as it related to fire safety. This visit resulted in a further seven requirements being made. They should not be difficult to meet and in doing so the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: This visit resulted in an additional seven requirements being made. This clearly indicates that although the service has got better in a number of areas there is still room for improvement. The failure of staff to maintain accurate medication administration records is of concern, as are the occasional low staffing levels. A concerted effort must be made to ensure that all 12 of the requirements listed at the end of this report are dealt with promptly. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 6 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 Nursing Home G53 G53 S19080 broadlands V221957 010805 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 Nursing Home G53 G53 S19080 broadlands V221957 010805 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) 3 (6 is N/A) Each of the service user files selected for examination contained a satisfactory pre-admission assessment. This means that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of four new residents were examined. Each one contained a preadmission assessment from the placing authority, and these were supplemented by brief in-house assessments. While it is acceptable for the pre-admission assessment to be provided by the placing authority, it is usually beneficial for the home to also carry out its own assessment. There is a proforma in place for this at Broadlands, however it was not being used to its full extent. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 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 and 10 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. Staff ensure that each resident is able to access community based health facilities as and when required. It was noted, however, that staff were not fully completing wound care documentation. This means that it is feasible that not all staff will be aware of the specific treatment to be given, which in turn can have a detrimental effect on the service user. The medication administration records were examined. Unfortunately a number of errors were noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. EVIDENCE: Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 10 There was good documentation in each of the service user files inspected. Supplementing the care plans were a number of assessments, including those for risk, pressure areas and moving and handling. The previously made requirement re the involvement of relatives in the planning of care has been met. The manager wrote to all relatives/next of kin seeking their involvement. It has to be said, however, that the majority declined to become involved. The documentation re wound care was good, but it was evident that staff were not always recording follow up care, which means that it is difficult to determine if the planned care had been fully completed. A number of gaps were found in the medication administration records. This was brought to the attention of the manager and the need for the trained staff to take more responsibility for their professional practice was discussed. From observing the interaction between the staff and the service users, and having also talked to a number of service users and their relatives, it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The home does not have a designated activities co-ordinator, nevertheless the relatively small size of the establishment means that staff are able to provide a sufficient amount of stimulation to satisfy the service users social and recreational interests. Visitors are encouraged to call, and there is an established relatives forum. This means that service users are enabled to maintain contact with family and friends and the local community as they wish. A number of service users met with the Inspector and they all felt that they were enabled to exercise choice and control over their lives to the extent that it was possible. The lunchtime meal was observed and appeared to be well prepared and appetising. Service users confirmed that the food was more than satisfactory. EVIDENCE: Service users were asked if they felt that they had enough to stimulate them during the day, and all said that there were enough activities should they wish to partake in them. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 12 The opportunity was taken to speak to several relatives, all of whom were positive about the home and had no concerns. Four relatives kindly took the trouble to return the Commission’s questionnaires. Again, all were complimentary about Broadlands. Service users are able to take part, should they wish, in a number of activities, including musical afternoons. Garden fetes, arts and crafts, ball games, parties during the festive seasons and occasional outings in a minibus, which is hired for the occasion. It was pleasing to see home cooked food in ample supply being served hot, and with attention to presentation. Staff were available to assist residents where needed. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was also a satisfactory adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: No complaints have been made to the home since the last inspection. Neither have their been any adult protection issues. The previous inspection highlighted a need for the adult protection procedure to be revised, and for a whistleblowing procedure to be introduced. These issues have been rectified. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24 and 26 While in general the premises were well-maintained, there were a number of areas that needed relatively minor attention. Additionally there remain three outstanding requirements from the previous report. It was not felt, therefore, that the home was being kept as well as it could be, or that the home was as safe an environment as it should be. EVIDENCE: Still outstanding from the last visit were requirements re the need to remove wedges holding open bedroom doors, to carry out remedial work to the patio so that the surface did not cause a tripping hazard, and the need to fit suitable locks to bedroom doors. Following a walk around the home, three further areas of concern were noted. This has resulted in 3 new requirements being made. It should be said that these issues are quite minor and as such can be easily dealt with. It should be noted that due to the ongoing failure to remove the wedges and replace them with suitable door closures has resulted in an Immediate Requirement Notice being served on the home, as fire safety has been compromised. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 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, 29 and 30 From the rotas provided the Inspector was not fully satisfied that the number of staff on duty would result in the service users needs being consistently met. While both of the most recent additions to the staff team had been fully vetted, there was no evidence to confirm that this had been carried out before they started work in the home. Although there are no subsequent concerns, the failure to carry out adequate recruitment processes means that service users are placed at unnecessary risk. New staff are expected to work through an induction programme and a new inhouse training programme has been purchased which should provide staff with the opportunity to improve/enhance their skills. This will then have a beneficial effect on the care being provided to service users. EVIDENCE: Previously agreed staffing levels for this home mean that there should be two qualified staff with three carers on duty in the morning; one qualified nurse with three carers on in the afternoon/evening, and one nurse with two carers on duty overnight. The manager would be expected to be supernumerary however in this home she clearly works as part of the rota. The rota provided showed that the home was occasionally falling short of this, as on four occasions across one month there was only qualified nurse on duty in the morning. Care staff numbers were acceptable. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 16 The files of the two newest staff showed that they had undergone CRB/POVA checks after commencing work in the home. This is not an acceptable practice, and was discussed with the manager. It was previously required that staff be provided with induction and foundation training. Since that time, a new in-house training package has been purchased, which, when used, should prove beneficial. The home is fortunate to have a number of care staff who have completed an NVQ level II or III course, or who are in the process of completing it. There remains the need for staff to sign to say when they have read and understood the home’s policies and procedures. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 The Inspector was not fully satisfied that the home was being run in the best interests of the service users as the quality assurance system was not as comprehensive as it could be. The home maintains appropriate records regarding service users finances, thus ensuring that their interests are appropriately safeguarded. Due to the ongoing use of door wedges (see Standard 19), the Inspector was not satisfied that the home was not being maintained to an appropriate level of safety, thus putting service users at risk. EVIDENCE: The manager has in place a number of systems for checking the quality of the service provided, and some of these are documented. The views of relatives have been sought, as have the views of service users, although the latter has Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 18 just been verbally rather than more formally in writing. Part of the quality assurance should be the monthly visits by the Registered Person (or their nominee). Previous requirements have been made re the need to ensure that these visits are carried out as prescribed in the Regulations. Although the frequency of the visits has improved, written reports are still not being produced. Following on from a requirement in the previous inspection report, the manager has reviewed the system for recording service users’ monies, and has now introduced an individualised system. Although also required at the last inspection, a safe has yet to be purchased. The previous health and safety requirements, with the exception of the door wedges, have all been met. It was noted that the fire alarms were not being tested weekly, but that a fire drill was being held approximately every 9 days. The manager was advised to test a call point weekly (rotating the points used), and that the frequency of the drills could be reduced. Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x 2 x 3 STAFFING Standard No Score 27 1 28 x 29 3 30 2 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 2 x 2 x x 2 Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 20 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. 2. Standard 8 9 Regulation 13 13 Requirement The manager must ensure that wound care documentation is kept up to date at all times. The manager must ensure that medication administration records are accurately kept at all times. Bedroom doors must not be wedged open. Suitable door closures must be fitted. The previously set timescale has not been met. The manager must enure that the surface of the patio does not cause a tripping hazard. The previously set timescale has not been met. Staff must ensure that emergency pull cords are not tied up out of reach. Staff must be provided with suitable bath thermometers so that they can ensure bath hot water is at a satisfactory temperature before immersing residents. A suitable lock must be fitted to the first floor bathroom door. All bedroom doors must be fitted with an appropriate lock and service users provided with a key Timescale for action 1/8/05 1/8/05 3. 19 13/23 31/8/05 4. 19 13 30/9/05 5. 6. 19 19 13 13 1/8/05 8/8/05 7. 8. 21 24 12 12 31/8/05 30/9/05 Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 21 9. 27 18 10. 30 18 11. 33 26 12. 35 16 where appropriate. The previously set timescale has not been met. Staffing levels must be increased so that the minimum levels previously agreed are maintained at all times. Staff must read all relevant policies and procedures and sign to say that they have both read and understood them. The previously set timescale has not been met. The Registered Person must ensure that they (or their nominee) visit the home on a monthly basis and that a report of each visit is produced. The previously set timescale has not been met. The home must purchase a safe for the safe-keeping of service users valuables/monies. The previously set timescale has not been met. 1/8/05 30/9/05 1/8/05 30/9/05 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. Refer to Standard Good Practice Recommendations Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 22 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broadlands Nursing Home G53 G53 S19080 broadlands V221957 010805 stage 4 .doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!