Inspection on 12/06/07 for Broadlands Nursing Home

This inspection was carried out on 12th June 2007.

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

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

Other inspections for this house

Broadlands Nursing Home 16/06/06

Broadlands Nursing Home 15/12/05

Broadlands Nursing Home 01/08/05

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 Janet Pitt Key Unannounced Inspection 12th and 25th June 2007 11:30 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 Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 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. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadlands Nursing Home Address 51 Burdon Lane Cheam Surrey SM2 7PP 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) 020 8661 1120 020 8661 1768 Mr N Baloo Mrs Anita-Marie Porter vacant Care Home 25 Category(ies) of Dementia (25), Mental disorder, excluding registration, with number learning disability or dementia (25), Old age, of places not falling within any other category (25) Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2006 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 nine double bedrooms and seven single rooms. 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. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £550 £650. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. One survey was received from residents. Six surveys were received from relatives and one survey was received form a professional. Two site visits were carried out which lasted a total of three hours and forty minutes. During the inspection care documentation, staff files and medications were examined. A tour of the premises was undertaken. The inspector was invited to lunch with residents and spoke with five people in total. What the service does well: What has improved since the last inspection? Medication recording and stock control has shown significant improvement since the previous inspection. Awareness of Adult Protection procedures has increased and staff have recently received training in this area. Staff supervision is undertaken regularly. Health and safety issues have been addressed as required at the last inspection. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 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 Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have sufficient information to make a choice about where to live. Admissions are not made until a needs assessment has been undertaken. Residents and their representatives are consulted about needs. Assessments undertaken on admission need to contain sufficient detail to enable needs to be identified. EVIDENCE: The home manager assesses residents prior to admission. Once a person has been admitted they are assessed again. It was noted that there is a standardized assessment form, which covers the requirements of Standard 3 and is based on activities of daily living. More detail is needed to make sure that all needs are identified. There was some information on hobbies, e.g. knitting and radio, but particular Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 9 programme preferences were not noted. Dietary likes and dislikes were not specific, e.g. ‘eats most things’. All survey respondents indicated that they had sufficient information on the home prior to moving in. The pre inspection questionnaire detailed that have been no changes to the Statement of Purpose and Service User Guide since the previous inspection. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Outcomes for residents indicate that they consider their needs to be met. Care plans and daily records must fully evidence how needs are met. Minor medication issues must be addressed to make sure there is a clear audit trail. EVIDENCE: One comment on a survey was: ‘Unfortunately [the resident’s] condition means [they] are unable to live life [they] would choose. However, Broadlands provides [them] with a safe. Clean environment which is all I can ask.’ Residents care plans were noted to lead from assessments. Generally care plans evidenced how needs were to be met. There were detailed fluid charts and food records in place. The fluid records evidence that sufficient amounts of fluid were offered regularly. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 11 Residents preferred hours of sleep were recorded. Continence plans needed more detail on how often toileting should occur and types of products to be used. Some plans had good instructions on how to communicate effectively with residents. Moving and handling assessments and Waterlow scores, were reviewed regularly with changes noted. Each resident had a general risk assessment covering issues like mobility, sight, behaviour, orientation, falls and wandering. Wound records are maintained separately. Each dressing changed is detailed. It is recommend that monthly photos are taken, in line with Royal College of Nursing guidance. Residents’ body weight charts indicated that weights are stable. Residents daily records must contain details of how needs are met. Daily records were bland, but there were some good entries. e.g. ‘fed herself with breakfast and lunch. Slept on and off whilst sitting out in the lounge.’ Phrases such as: ‘All care given’, ‘slept well;’ and eating and drinking well’ do not provide sufficient evidence of what has occurred. Residents’ wishes for end of life care and death and dying were consistently noted. Policies and procedures relating to last offices and care of the dying resident give clear guidance for staff and make sure that residents wishes will be respected. There is a need to develop information on sexuality, in order that residents are able to maintain or develop significant relationships. Details of residents’ social history and life events were available within plans. The medication policy was reviewed April 2007 and noted to be satisfactory. Medications were observed to be stored appropriately. Sharps bin are available for use. Discussion was held around types of lancets use for blood glucose monitoring. It was recommended that disposable lancets were used. The manager organised supplies prior to the end of the second site visit. A recommendation was also made regarding correct procedures when taking blood samples for glucose monitoring. There needs to be a clear audit trail of medications into and out of the home, to protect residents from harm. No gaps in administration were seen on medication administration records and allergies were noted. One prescription for antibiotics had not been given properly, only half the dose had been given. This was addressed immediately. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 12 The Manager stated that stock check would be done and a clear audit trail would be in place. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in meaningful activities of their choice. Care must be taken to make sure that residents’ dignity is promoted at all times. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance as needed. The staff are aware of the importance of unhurried mealtimes. EVIDENCE: Activities provided are suitable for residents needs. Staff were observed to interact on a one to one basis, e.g. discussing a resident’s family with them. There was good evidence of training being put into practice, specifically when assisting persons with dementia. Pre inspection information states that there is a choice of menu and dietary needs are catered for. Cooked breakfast available. Lunch is the main meal; alternatives tend to be salad or omelette. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 14 Two meal times were observed. The inspector was invited to sit with some residents. Staff were seated to assist residents with their meal. Portion sizes were good and the meal had three types of vegetables. Meals were presented attractively and there was a choice of cold drinks. Tea or coffee were offered after the meal. The dining room has been made to look attractive; there were fresh flowers on the tables and co-ordinating napkins and tablecloths. Residents were enjoying looking at the flowers and staff were discussion the flowers with them. Use of disposable bibs, does not respect residents as adult, an alternative needs to be sought. Residents were gently encouraged by staff, to sit down and finish their meal if they got up to wander. One resident did not want lunch and told staff to take the meal away three times, which they did and reoffered a meal when it was requested. Residents were asked consistently whether they had finished their meal, before plates were taken away. Comments heard during mealtimes were: ‘I am going to help you with your juice.’ ‘Would you like me to help you.’ ‘Take [your] time, [it’s] hot’ Residents were consistently informed about what the member of staff was going to do. There was encouragement to maintain independent skills. Overall the meal on both occasions was relaxed and unhurried providing a good social opportunity for residents. All survey respondents indicated that they are able to maintain contact and were made welcome in the home. (See summary section). One person commented that private telephone lines or a separate telephone line for residents would be useful. It is recommended that consideration be given to this. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives are confident that complaints will be investigated and appropriate action taken. Staff have received training in Protection of Vulnerable Adults. EVIDENCE: All survey respondents indicated that they were aware of how to make a complaint. The pre inspection questionnaire stated that there had been no complaints or POVA’s since the last inspection. Protection of Vulnerable Adults (POVA) training was recorded as given in May 2007. There is one ongoing POVA investigation, which commenced prior to the previous inspection. This was discussed with the manager. The manager said she had complied with all that was asked of her. There is a possibility that the investigation was handled poorly at commencement by other agencies. The manager stated she has not been informed of what the allegations were and was concerned about the fact she was on holiday at the time and other staff had yet to be interviewed at the time of inspection. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 16 The issue was around apparent restraint of a resident. The manager stated this was a last resort and appropriate consultation had taken place prior to a lap belt being used. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to personalise their rooms and have access to comfortable communal areas. The home is well lit and clean and tidy. EVIDENCE: The manager said that a small grant for decoration and refurbishment of the home had been obtained. This will progress planned work. She has already identified areas for priority work. A plan of redecoration and refurbishment must be supplied to CSCI. Screening was available in shared rooms. Residents are able to bring in personal items, their clothing was neatly organised. The home was clean and tidy at the site visits and provides a suitable environment for the people living there. The main lounge has a selection of chairs and a sofa. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of residents. Staff receive training that is relevant to the work they are to perform. The recruitment procedure protects residents from harm, by making sure appropriate checks are carried out. EVIDENCE: Comments from surveys regarding staff included: ‘All staff are kind and dedicated.’ Staffing rotas indicate that there are sufficient numbers of people available to assist residents. One carer spoken with was able to state what training they had recently undertaken, which consisted of POVA, dementia awareness and rights and responsibilities. The carer was pleased they were able to put their learning into practice. There is a keyworker system in place. Staff receive appropriate supervision to perform their role. Mandatory checks are carried out prior to a new employee commencing work. The application Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 19 form requires minor amendments requesting details of cautions as well as convictions. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the necessary qualifications and experience. Procedures must be implemented to make sure there are clear lines of accountability when the manager takes annual leave. Residents and their representatives are consulted about how the home is run. EVIDENCE: The manager stated that she always aims to promote resident centred care and that Broadlands is their home. She has eight years experience managing Broadlands and her staff team has not altered during that time. She is able to act in a professional manner when dealing with other agencies and health professionals. For example she discussed one residents treatment with the general practitioner (GP). The GP survey indicated that they considered the Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 21 manager to be professional. ‘Good home. Reflects the matron’s good practice and leadership.’ The manager queried whether she required a deputy and what happens when she is on holiday. It was explained that although she has twenty-four hour responsibility, procedures should be in place to make sure that home continues to run effectively whilst she is on leave. It is her choice whether to have a designated deputy or share the responsibility amongst trained members of staff. She also discussed the need to have RMN’s. She was informed that CSCI required a first level registered nurse and the expectation that staff will have the necessary skills and qualification to meet residents’ needs. The kitchen has recently introduced hazard analysis principles in food management and is awaiting the Environmental Health Officer to return to check compliance. Records were noted to be kept in accordance with the guidelines. Residents’ personal allowances are handled appropriately and records maintained. One comment from a relatives survey was: ‘it is commendable that the door is always open and there are no restrictions on visiting. What you see is what you get and really feel that it is a home. Matron runs a very tight ship and that is to her credit. She commands respect and earns it from all. [We] are very happy with the home and the care provided for [the resident]. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 22 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 3 X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement The registered person must ensure that assessment undertaken in the home fully detail needs, including sexuality. This will make sure that residents are confident that all needs will be identified. The registered person must ensure that care plans detail fully how care is to be given. This will make sure that residents needs can be met consistently. The registered person must ensure that daily records detail fully how needs have been met. This will evidence that residents are appropriately cared for. The registered person must ensure that there is a clear auditable trail of medications. This will make sure that residents receive medications in a safe manner. The registered person must ensure that residents do not wear ‘bibs’. This will make sure that residents’ dignity is maintained. DS0000019080.V338080.R01.S.doc Timescale for action 30/10/07 2 OP7 12 (1) (a) 30/10/07 3 OP7 17 (1) & Sch 3 30/10/07 4 OP9 13 (2) 30/10/07 5 OP15 12 (4) (a) 30/10/07 Broadlands Nursing Home Version 5.2 Page 24 6 OP19 23 (2) (b) 7 OP29 Sch 2 (2) The registered person must provide a copy of the redecoration and refurbishment programme for the home. This will evidence that residents live in a well maintained environment. The registered person must ensure that appropriate information is asked for on application forms. This will make sure that residents are protected from harm. 30/10/07 30/10/07 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 OP8 OP13 Good Practice Recommendations It is recommended that photographs of wounds are taken at regular intervals to evidence progress. It is recommended that a resident’s telephone line be provided. Broadlands Nursing Home DS0000019080.V338080.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000019080.V338080.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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