Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Broadlands Park The Green Upton Norwich Norfolk NR13 6AZ The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maggie Prettyman
Date: 2 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home
Name of care home: Address: Broadlands Park The Green Upton Norwich Norfolk NR13 6AZ 01493751521 01493751521 www.broadlandspark.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Raymond Hollyman,Mrs Susan Hollyman care home 22 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care home only To service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection 3 0 Over 65 0 21 Care Homes for Older People Page 4 of 26 Brief description of the care home Broadlands Park is a care home providing personal care and accommodation for up to 22 older people some of whom may also have dementia care needs. During the building works in 2009, the home plans only to accomodate up to 19 people. Broadlands Park is a privately owned and run residential care home. The home is located in the rural Norfolk village of Upton. The service is long established and is based in a period house with accommodation currently on the ground floor and in a purpose built new wing. The upper floors, kitchen and laundry of the home are currently being renovated and rebuilt, and a shaft lift is being installed. This work will be continuing during 2009. The home has gardens to the front and rear, but these are not in use during the building works. The home currently charges in the region of £400 per week according to residents individual need. Residents are expected to pay for their own toiletries and hairdressing. Care Homes for Older People Page 5 of 26 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the provider and a recent unannounced visit to the home. This report gives a brief overview of the service and current judgments for each outcome group. The unannounced inspection took place over the course of 7 hours. Prior to the inspection records and previous reports held by the Commission were read. During the inspection a tour of the premises was undertaken, staff practice was observed, records and files were read and checked and residents, their visitors and the NVQ assessor currently working with staff were consulted. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? The biggest changes since the last inspection have been the move into the attractive and spacious new wing and a significant improvement to the medication system at the home. The new wing has been sensitively designed and has an excellent build quality. Residents are very pleased with their new facilities. A new senior worker has taken Care Homes for Older People
Page 7 of 26 responsibility for the medication system, and is to be commended for the work and professionalism that she has brought to this process. In addition to these improvements, the home has invested in new technology and has an informative website that lets people know about its service and also keeps relatives who do not live nearby, up to date with the homes news. The home has also put great effort into making enjoyable daily activities and entertainment that reflect the wishes and interests of people who live there. There has also been a recent consultation about the menus, and these will soon incorporate residents suggestions and choices. The home has improved its recruitment process, and makes better checks on the background and work history of staff before they come to work there. The training system at the home and investment in NVQ qualification has also improved. The visiting NVQ Assessor, who is currently helping a large number of staff to achieve NVQ3 in care said I have no problems at this home, people here are well motivated and want to do well. The home really supports them and helps them to achieve high standards What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking about coming to live at the Home and their families have excellent information about its facilities and the services it provides. They have their needs assessed and a contract that clearly tells them about the service they will receive. Evidence: The Service User Guide has been recently updated and is informative and helpful. The home has put a lot of effort into establishing and keeping up to date a really detailed and interesting website that not only tells people about the home. but also updates people about news and events. One persons advocate confirmed that the description of the home was an accurate reflection of the services it provides Inspection of files demonstrated that detailed contracts are in place for everyone who lives at the home. these are clear and tell people about their rights of tenancy and what room they will have. These contracts were found to be signed by the resident themselves or a relative if appropriate.
Care Homes for Older People Page 10 of 26 Evidence: Residents files demonstrated that a good needs assessment is undertaken before anyone comes to stay at the Home. there is enough detail for the home to say whether or not they can meet prospective residents needs. Care Homes for Older People Page 11 of 26 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. People are treated at all times with respect and dignity and their privacy is respected. Evidence: There were care plans in place for all the residents whose files we checked. These were mostly fairly detailed and told staff how and why they should meet peoples individual needs. Some people did not have much information recorded about their personal history, and some had not been recently reviewed. We noticed that bed rails were in place for one resident, but that these had not been risk assessed Evidence from peoples personal files showed that they see the Doctor when they need to and that they access other health care services such as District Nurses, Chiropody and continence advisors if they need to. when asked, people living at the home said they felt their health is well cared for and they are given help and pain relief if they need it. Some health care notes are being recorded in a separate handover book, and this carries a risk that not all information will be transferred to peoples files. Care Homes for Older People Page 12 of 26 Evidence: Observation of the medication round and inspection of the medicine trolley demonstrated that the home has worked hard to make its system safe and secure. All the requirements and recommendations from the last inspection have been met. The medicine trolley was extremely well organised and clearly laid out. Audits are in place and people are consulted if they regularly refuse medication to see why this is and referred to the Doctor to have it stopped if necessary. We found a problem with the fridge temperature and storage of drugs there, but this was rectified during the inspection. We noticed that sometimes the person giving out drugs is disturbed by other staff and residents, and suggested the home does something about this. We also discussed the fact that the home does not have a procedure for considering the administration of covert drugs, and suggested that it would be good practice to develop this in case there was a time when it needed to be considered for a resident who lacked capacity. People living at the home confirmed that they are treated with respect by the staff who work there. They always receive their personal care in private, and likewise see the doctor or nurse in their room or in the treatment room. they said they can talk on the mobile telephone in private and that their letters are handed to them unopened. Peoples name of choice was recorded in their file, and staff used these at all times. Care Homes for Older People Page 13 of 26 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to make choices about how to live their daily lives, There are suitable activities for people, and their family and friends are welcomed to the home. The food at the home is good and well presented. Evidence: People living at the home said that they enjoy the range of activities that are offered to them. They recently had the opportunity to Make three wishes and staff at the Home have done their best to try and make these come true. People have done a variety of things as a result and it has created discussion and interest at the home. Residents said that their routines are flexible, they get up and go to bed when they want. they spend their days where they wish and do what they want during the day. People living at the home confirmed that their relatives are welcomed when they visit and can come at any time they wish. Visitors said that they are offered refreshment and a warm welcome. People also said that the home regularly emails or posts newsletters to them and that they find th website helpful as it is well maintained and regularly updated. There is a family notice board where updates and information are posted. Relatives are also being involved in regular meetings at the home to discuss its services and how it can improve. The home is also rated as 5* by an independent
Care Homes for Older People Page 14 of 26 Evidence: company that looks at how pet friendly homes are. Residents confirmed that they have autonomy and choice in their daily lives. Most of the residents files were signed by them personally, or by a relative or advocate if not. Residents meetings are now being held, and people who live at the home have made decisions about the decor and facilities in the newly built wing. A tour of the kitchen showed that it was clean and tidy. A kindly and professional worker was seen carefully preparing a nutritious and appealing lunch. The home had no requirements from a recent environmental health officer inspection. A new kitchen is in the process of being built. Menu records showed that people are making daily choices about their food. A sweet trolley is taken round to enable people to choose their dessert at the table. People living at the home said they enjoyed the food, that it is good quality and well presented. Care Homes for Older People Page 15 of 26 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust and effective complaints procedure. Staff are trained to protect the people who live at the home. Evidence: The home has dealt with two formal complaints since the last inspection. They have taken suitable action to address any issues raised, and reported this to the Commission. Residents confirmed that their occasional day to day grumbles are listened to and acted upon. the home keeps a grumble log to record minor complaints to see if there are any underlying patterns and trends. Staff training records demonstrated that people are trained in safeguarding at induction and that this training is updated. Care Homes for Older People Page 16 of 26 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people to live in a well maintained and comfortable environment. Some aspects of infection control and fire safety need to be addressed by the home. Evidence: A tour of the premises was undertaken and the home was found to be clean and hygienic throughout. A Housekeeper was hard at work making sure that the home had been properly cleaned, and attending to potential trip hazards. Resident lounges are homely and comfortable. Extensive building work is being undertaken to radically improve the accessibility and facilities of the home and residents have recently moved in to the new wing. This area has been carefully and sensitively designed, and this bodes well for an extremely high standard of accommodation when the full refurbishment has been completed. The home is to be commended for the high standard of finish and the size, layout and decor of each persons new room. Unfortunately during the inspection we found two fire doors propped open, one of them by a fire extinguisher. This is an extremely dangerous practice and the home must ensure that this practice does not continue. We also noted that a fire drill has not taken place recently because of building works. The new laundry has yet to be built, so temporary facilities are upstairs. These are limited, but the home has recognised this and records demonstrated that any soiled
Care Homes for Older People Page 17 of 26 Evidence: articles of linen or clothing are sent to an external laundry firm rather than being washed at the home. Unfortunately during the inspection we found unmarked soaps, sponges and a nailbrush in communal bathing areas. This is a problem that we have found before, and the home must take this risk to infection control more seriously in the future. Care Homes for Older People Page 18 of 26 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained and in sufficient numbers to make sure that people living at the home has their needs met Evidence: Observation of the home during the inspection showed that there were enough staff on duty to look after residents in a kindly and caring way. A rota of staff is kept and people cover each others shifts when they are on holiday or off sick. A visiting NVQ assessor said that the staff she has contact with are enthusiastic and well motivated to complete their qualification. The home has exceeded the minimum standards recommended for levels of NVQ qualification, and now many staff are progressing to NVQ 3. A selection of staff files were examined. The home is now achieving good standards and in some cases is exceeding the standards set. Gaps in employment are checked and full work histories were in place for some people recently recruited. The homes training coordinator discussed the training programme available to staff, and described it as comprehensive and regularly updated. Full training records were not available at the home during the inspection as they were elsewhere. However a few files were available containing staff induction records. These were of a high
Care Homes for Older People Page 19 of 26 Evidence: standard, and indicate that other training is good, although we could not see the direct evidence that it is so. Care Homes for Older People Page 20 of 26 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well run by an acting manager and the homes owners and safe working practices are being adhered to, Evidence: The homes manager has left since the last inspection and the deputy manager is acting into this role with the support of the homes owners. She is not yet registered with the Commission and is in the process of studying for her NVQ4. She is a warm, friendly and professional person who is working hard to develop her management skills and to provide a good service to the homes residents. The home has not conducted a full quality assurance survey this year, but has spent its time doing surveys and checks to ensure that people living at the home are being well looked after and not having their care disrupted by the significant building works that are taking place. Personal monies held on behalf of residents were checked and found to be securely
Care Homes for Older People Page 21 of 26 Evidence: kept and in order. The safe working practises of the home were checked. There were maintenance records in place for the boiler, hoists, fire alarms, water temperatures and COSHH products. Accident records are kept and accidents and falls are audited. One resident had had their medication changed as a result of the home noticing an increase of falls, and this change prevented further incidents. It has been a difficult time for the home as the building work has inevitably caused extra health and safety concerns, but these have been well managed and staff and residents have been protected during this time. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 The home must make sure that a written risk assessment is undertaken before bed rails are used. This is to make sure that people do not come to harm if cot sides are used 10/04/2009 2 19 23 The home must make sure that fire doors are not propped open and that extinguishers are carefully looked after. This is so that residents are not put at risk by potential fire being able to spread and fire equipment possibly damaged by misuse. 10/04/2009 3 26 13 The home must make sure that soaps, sponges and nailbrushes are not left in communal bathrooms This is so that good infection control systems operate in all parts of the home 10/04/2009 Care Homes for Older People Page 24 of 26 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 3 7 7 8 It would be good practice for care plans to be more regularly reviewed. It would be good practice for the home to have more detailed life histories for some people. It would be good practice for the home to make sure that peoples health and personal care records are only recorded in their personal files and not elsewhere in handover books. It would be good practice for the home to make sure that the person giving out medication is not disturbed. It would be good practice for the home to have a policy and procedure for covert administration of drugs in case this should be needed at some time in the future. It would be good practice for the home to conduct a virtual fire evacuation so that staff are properly prepared should a fire break out. It would be good practice for an up to date overview of individual staff training to be kept in the home so that the manager can check peoples current training achievements. 4 5 9 9 6 19 7 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!
