Inspection on 19/12/08 for Broadmeadow

This inspection was carried out on 19th December 2008.

CSCI found this care home to be providing an Good service.

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

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broadmeadow Park Farm Road Folkestone Kent CT19 5DN     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: Mark Hemmings     Date: 1 9 1 2 2 0 0 8 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 34 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Broadmeadow Park Farm Road Folkestone Kent CT19 5DN 01303854900 01303221092 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kent County Council care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Additional conditions: 0 40 The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP) Physical disability (PD) - maximum number 5. Date of last inspection Brief description of the care home Up to 35 older people and five people with a physical disability can make their home in Broadmeadow (the Service). The property is purpose built and it opened on 4 August this year. Its a detached building on two floors. The living space is divided into wings or units. Each unit has a similar layout. There is a lounge/dining room. Attached to the dining area is a small kitchenette. There is then a number of bedrooms in the area. People who occupy these bedrooms will normally use the lounge nearest to them. On the ground floor, the units are called Warren and Romney. Each has ten bedrooms. These units are reserved mainly for people who stay for short periods of time and who are taking part in something called the Intermediate Care programme. We say more Care Homes for Older People Page 4 of 34 Brief description of the care home about what this means in the next section of this Report. At the moment, there are three older people who have made their longer term home in Romney. They have chosen to live there. Its not planned to increase the number of people who live long term in the Service. The units on the first floor are called Round and Castle. Round has 15 bedrooms and its intended to be used by people who are staying in the Service for a short time. Castle is five self contained flats. They are intended to be used by younger adults who have a physical disability. Again, it is not anticipated that people will make these their longer term home. Rather, they will be used as a stepping stone to living in the community. All of the bedrooms are for single occupancy. Each has a private bathroom with a shower, toilet and wash hand basin. There is a passenger lift between the floors. There is also a call bell system. This has call points in each of the bathrooms and toilets as well as in all of the bedrooms and their private bathrooms. This means that people can ring for assistance. Care Homes for Older People Page 5 of 34 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: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about 8 oclock and were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with six of the people who live in the Service and with one of their visitors. We also spoke with the Manager, Care Homes for Older People Page 6 of 34 the senior administrative officer, two team leaders (care workers who are in charge of each shift), four care workers, two care managers (social workers), the cook and a housekeeper. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked some of the people who live there and some members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Broadmeadow. We sent out 20 questionnaires and we got 12 of them back. What the care home does well: What has improved since the last inspection? 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 34 Care Homes for Older People Page 9 of 34 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 10 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The way the Service is set up means that most people will only be staying for a few weeks or so. The Manager says that for people who stay for short term care, there is a definite plan from the start about them going home on a set date. Most of these people stay in the Service on a planned basis. This is usually so that their family members who support them at home, can have some time to themselves. For the people who are part of the Intermediate Care arrangement the date is not fixed. This is because of the nature of this arrangement. The people who use this service have Care Homes for Older People Page 11 of 34 Evidence: often been in hospital and they need time to recover their strength. Also, they may need to re-gain some of the skills that we all need in order to manage at home. To do all of this, arrangements are made for them to work in a focused way with a whole number of people who can assist them. These include people like occupational therapists, physiotherapists, nurses and care managers. Their length of stay depends on how they do, but usually it is hoped that it wont need to be longer than about six weeks. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. We looked at what is done in the Intermediate Care arrangement to prevent this. There are weekly meetings between all of the intermediate care staff. At these meetings all sorts of relevant things are talked about. For example, what needs to be done to help the person become more independent in the kitchen and in the bathroom. Or, it might be that enquiries need to be made early on to make sure that home care support is ready for when the person goes back to their own home. We looked at the records of the meetings that have been held so far for one person. They show that all of these things are being actively thought about. The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into Broadmeadow is the right thing for them. She also talks with family members and with people like care managers. For people who move into the Service under the Intermediate Care arrangement, the Manager will also often speak with people such as occupational therapists, physiotherapists and nurses. All of this is done so that she can build up a really good picture of how the person can best be supported. After she has got all of this information, she can then decide if Broadmeadow can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person needs to have time to themselves so that they dont feel crowded. The Manager says that when she gets the information she shares it with care workers. This is done so that they know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days while they get to Care Homes for Older People Page 12 of 34 Evidence: know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the assessment process people are invited to visit Broadmeadow and they can also stay for a short trial period if they want to. This is so that they can see what the place is like first hand. She says that during these visits people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. We asked one person about their experience of moving in. They say that the care workers did know about the support they need from the start. They also say that they were made welcome and that this made a big difference for them. They say that they are glad to be in Broadmeadow and not in hospital anymore. Care Homes for Older People Page 13 of 34 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. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some of the paperwork is complicated and not user friendly. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at four of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs special help to make sure that Care Homes for Older People Page 14 of 34 Evidence: they dont fall and hurt themselves. Another person needs support to get to the toilet when they need to. Another person can drink a bit too much and needs support to manage this better. We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, they are patient with someone who finds it hard to make sentences. They wait for them to finish what theyve got to say. Then they check out that they have understood them right. The plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the team leaders check out with the care workers and with the people concerned how things are going and what might need to be changed. All in all, theres a lot of written information. Staff are spending large amounts of time writing things down. This then results in there being lots of complicated looking paperwork to wade through. Were used to it. But it even took us some time to get to grips with it all. Its very unlikely that the people who its written about will find it easy to use. Or, interesting enough to spend time on. Were not surprised to hear that people dont really bother about it that much. The Registered Provider has asked people to fill out a questionnaire saying what they think about Broadmeadow. Twenty four people completed one. One of the questions is about have people been involved in deciding whats in their plan of support. Its disappointing to note that only five people say always, while seven people say usually, three people say sometimes and six people say never. This is a pity because its all about them. The Manager recognises this. She is going to look into what can be done to make the whole process more straight-forward and more user friendly. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. The Manager is active about this and she makes sure that people get the medical attention they need. Care Homes for Older People Page 15 of 34 Evidence: Some people manage their own medication. Most of these are people who are part of the Intermediate Care arrangement. When people first come to Broadmeadow, members of staff ask about this so that they know what help might be needed. For example, what medicines might need to be re-ordered so they dont run out. Or, whether someone wants a hand in being reminded about taking medicines on time. For the other people, members of staff handle their medicines for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at four medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. We asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. In the questionnaire we talked about earlier, people are asked about whether or not care workers are respectful in how they go about things. Twenty two people say that they always are and two say that they usually are. Two people summarise the general mood in their comments to us when they say, I like the staff, because theyre so kind and helpful, really theyre very good and the staff are okay really they help and theyre around when I need help. No you cant fault them at all. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 16 of 34 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. Standards 12, 13, 14 and 15. There are some interesting things for people to do, but some of them might want to be involved in deciding whats going on. People are free to receive visitors and to spend the day as they wish. Good quality meals are served, but some people want to change parts of the catering arrangements. Evidence: The plan is that each weekday there is a social thing that people can go along to if they want. We looked at the calendar that is used to plan these events and it says that they include things like bingo, skittles and sing-alongs. There is a record that shows roughly what each person has chosen to do. We wanted to see what people are choosing to do in practice. So we looked at the records for one person. Over a period of three weeks or so they had lots of visitors but they only did two social activities as such. These involved doing board games. We asked two people about what activities they do and we got different accounts. One person says, I dont want to be jollied along thank you, Ive had enough of that in hospital, I want some quiet time. The Care Homes for Older People Page 17 of 34 Evidence: other person says, it can be a bit boring sitting here all day in the lounge without much to do. Its not like being at home where you pass the time by fiddling with things. The Registered Providers questionnaires ask people about social activities. We looked at some of the answers. People were asked if they have a choice of things to do. Eight people say always, six people say usually, four people say sometimes and two people say never. They were also asked if they have been involved in planning what things to do. Five people say always, two people say usually, five people say sometimes and eight people say never. At the moment, there is no programme of trips out of the Service to local places of interest. Also, there are no outside entertainers coming into the Service now and then. There is a balance to be struck between people being able to do interesting things and not being pushed into doing what they dont really want to do. Were not sure that the balance in Broadmeadow is quite right at the moment. We made a point of noting what people were doing when we were there. Most people for most of the time werent doing that much really. There was quite a lot of sitting around and not being engaged in things. The Assessment says that the activity calendar will be reviewed and changed according to (peoples) requirements. We think that it would be a good idea for the Manager to take a look at this whole thing. As part of this review, it would be helpful to ask people if there is anything new and different they would like to do. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Manager says that the Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One person summarises the general view when they say, the food is really good and theres plenty of it. Oh I like my meals here and look forward to them. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a Care Homes for Older People Page 18 of 34 Evidence: reasonable balance, the main lunchtime dishes including things like chicken and mushroom pie, vegetable pasties, smoked haddock and cottage pie. Care workers say that people can have drinks and snacks throughout the night. This is because they have access to kitchenettes on each of the units. This is a good idea. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. The questionnaires we have already mentioned ask people a number of things about the catering arrangements in the Service. The answers give a mixed picture. When asked about liking their meals, 17 people say that they always do, four people usually do, three people sometimes do and no one never does. When asked about having a choice of meals 13 people say always, nine people say usually, one person says sometimes and one person says never. When people were asked about if they choose where they can dine 12 people say always, five people say usually, one person says sometimes and four people say never. We think it would be a good idea for the Manager to look into what people are saying. This is so that she can see if some of the present catering arrangements need to be changed. Care Homes for Older People Page 19 of 34 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. Standards 16 and 18. There is a complaints procedure. Complaints are dealt with properly. People are safeguarded from being bullied or taken advantage of. Evidence: We asked people about making complaints. No one has felt the need to do this so far. They indicate by their relaxed manner that they will feel quite okay about doing so should there be a need in the future. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Since the Service opened there has been one formal complaint. We looked into what this was about and how it was sorted out. The person making the complaint was a relative who was concerned about their mother having some falls. The records show that a senior manager who isnt based in Broadmeadow, dealt with the complaint. They did this by speaking with all of the people concerned to find out exactly what had happened. They then wrote quite a long letter to the person who made the complaint. They explained how the falls had happened and what is being done to help prevent them happening again. The Registered Provider has a procedure for how complaints have to be handled. This includes clear timescales for doing things such as responding to people who make complaints. This complaint was dealt with within the required timescale. We understand that the relative is quite happy with the steps that have Care Homes for Older People Page 20 of 34 Evidence: been taken. Were pleased to note that the person concerned hasnt had any falls since then. Its very important that people are confident that they are safe from being taken advantage of. For example, that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. Things that might show that somethings not right. None of them have any concerns about how things are going. The people who live in the Service say and indicate that they feel safe in Broadmeadow. Care Homes for Older People Page 21 of 34 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. Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a large and well equipped laundry. Evidence: As we have said earlier, Broadmeadow is a brand new building. Its made from modern materials and its fitted out with all sorts of up to date things. For example it has automatic opening front doors and air conditioning. It looks new. On the outside the gardens are only just getting going and so things look a bit stark. On the inside, its plain that careful thought has gone into designing things. The corridors are nice and wide. The bedrooms are spacious and even the private bathrooms are a very good size. Doorways are wide so its easier for things like wheelchairs to be used. Theres also plenty of storage space for wheelchairs and other bits of equipment. In the units the lounges are well sized. All of the decoration and carpets are new. The place has that new smell to it. The building is fitted with an automatic sprinkler system. This provides a very high Care Homes for Older People Page 22 of 34 Evidence: level of fire safety protection. Sprinkler systems are now recognised to be the best system possible. This is because theyre so safe. The Kent Fire and Rescue Service inspected the building before it opened. It said that everything is okay with the sprinklers and with other fire safety things. The Registered Provider has a system of doing regular fire safety risk assessments. This is where someone goes around the place to check out that everything is still working in the right way. The local Department of Environmental Health also called to look at the kitchen. They say that its finished to a high standard. We looked in the kitchen too. Its well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things are not allowed to hang around too long. She regularly checks the fridges and the freezers to make sure that they are cold enough. She also checks the temperatures of certain cooked foods. This is done to make sure that they are properly cooked through. She knows about good food hygiene. For example, about the need to use different chopping boards for different foods. Also, about the importance of washing your hands before touching food. People who need it are helped to get about. Weve already mentioned the wide corridors and such like. This extends to the shared use bathrooms that are on each unit. These are a good size and they are well laid out so that things are easy to get to. Each has a hoist. This means that people can sit in a chair that swivels and lifts into and out of the bath. There is also a mobile hoist that can be used in the bedrooms. This might be needed if someone cant manage at all to get out of bed. In two of the flats, there are things called tracker hoists. These are hoists that run on a track that is securely fixed to the ceiling. These tracks run from above the bed right into the private bathroom. They mean that someone who cant stand up, can be helped out of bed and then can move straight into the bathroom. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There is a passenger lift that gives step-free access around the accommodation. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. It was warm inside when we were there. Care Homes for Older People Page 23 of 34 Evidence: The building is fitted with modern under-floor heating. This means that there are no radiators at all. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There are also two large dryers. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. One of the checks that is done when someone first moves in, is whether or not their clothes need marking with their name. We looked at how this is working in practice. We did this by checking some of the items in the laundry. They are all marked. We also asked people about this and they say that they do nearly always get their own clothes back from the laundry. New rules have been brought out to make sure that used water from the washing machines and from the dishwasher doesnt leak back into the main pipe-work. It looks like the Registered Provider already complies with the rules. However, to double check this the Manager is going to contact the local water supply company. Shes going to do this by 1 February 2009. Care Homes for Older People Page 24 of 34 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. Standards 27, 28, 29 and 30. There are enough staff around. They know what theyre doing. Security checks are completed on new members of staff. Evidence: The number of care workers on duty varies a bit depending on the number of people who are living in the Service at any particular time. The Manager says that when the Service is heading towards being full, she plans to have about six care workers on duty. This is so that there can be one person in each of the units. This will then leave two care workers who can go between the units. They can help out for example, if things are particularly busy or if someone needs two people to support them. Until very recently, the number of people living in the Service has been quite low. But its building up now. We looked at the records of which care workers have been on duty in the Service during the course of a recent week. We think that enough people have been around, given the number of people living in Broadmeadow at that time. We asked three care workers if they think that the Service is staffed okay and they say that it is. The questionnaires ask people if they get enough support. Twelve people reply that the always do, six people say usually, one person says sometimes and no one says never. At night time, there are three people on waking duty. Care Homes for Older People Page 25 of 34 Evidence: During the day there are other members of staff around. For example, there is the cook and there are housekeepers. There is a team leader on duty for each shift. They are in charge whenever the Manager is not around. They can make decisions about important things. Such as whether or not to call a doctor. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. We looked at the records for two care workers who have recently been appointed since our last inspection. All of the checks that we need to see have been done. New care workers receive introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each persons needs for support. Also, they were told about important things. For example, the individual plans of support and how to go about things such as helping people get about safely. This initial training is just to get them started. Theres a lot to learn after that. They begin this by completing a workbook. This takes them about 12 weeks to finish. It involves them having training on the job from other care workers. It also involves them reading things like guidance notes and the Registered Providers own policies and procedures. We looked at one of these workbooks. Its based upon a national model that we think is very well done. We looked to see how well the care worker concerned has completed their workbook. Its quite detailed. It shows that the person filling it out has been thinking about important things. For example, about how to help people in the bathroom while respecting their need for dignity. Or, about how to help people keep their skin healthy so it doesnt become sore and red. The Manager says that after their introduction, care workers are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. The Registered Provider intends care workers to do most of this training on a rolling basis, so that they have regular refreshers. We looked at some of the records of this extended training. We wanted to see how well this system is working. In general, most of the care workers have done quite a lot of useful training. However, there are some gaps. For example, the records show that three care workers are overdue to attend a course in basic first aid. The records also show that nine care workers are overdue for doing training in how to keep people safe from being abused in some way. Or again, three care workers have not yet had training Care Homes for Older People Page 26 of 34 Evidence: about how the reduce the chances of infection through sensible things such as wearing gloves and aprons when this is necessary. Given some of these gaps, we are pleased to note that all of the existing care workers and not just the new ones, have now completed the workbooks that we spoke about earlier. This has been done as a one-off exercise to make sure that everyone has the knowledge and skills they need to support the people living in Broadmeadow. This exercise work is almost complete. The Manager now needs to examine all of the workbooks. This is so that she can satisfy herself that they have been filled out okay. The information in the workbooks will give her a useful guide about what if any further training a particular care worker might need to do. She hopes to have all the workbooks signed off by 1 March 2009. There is a total of 34 care workers. Of this number, 22 have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. Eight more are on with doing it. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. They know a lot about how each of the people who use the Service like to be supported. For example, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 27 of 34 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. Standards 31, 33, 35 and 38. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are sensible health and safety arrangements but there is one thing that now needs to be sorted. Evidence: The Manager runs things on a day to day basis. She has a detailed knowledge of how things are going. When we ask her questions about points of detail she pretty much knows the answers. She doesnt have to fiddle about looking for things and she doesnt have to ask other people. This is a good sign because someone senior needs to be in charge and on top of things. The nature of the Service means that there are quite a few comings and goings. The Manager cant be there all of the time to oversee every aspect of this. She has to rely Care Homes for Older People Page 28 of 34 Evidence: upon people like the team leaders to take decisions on her behalf. She has set up some good systems to help staff be clear about what they should be doing. Also, the Manager keeps an eye on how these are working out in practice. We think that all of these things are really important. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every month or so. Some of these are for everyone to go to. Others are held later in the day because its easier for night staff to go then. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, they have talked about how important it is to double check that the front door is closed securely at night. Also, they have discussed how important the workbooks are that we have already spoken about. Another thing, is the need to check that peoples clothes are marked with their names. Its really important that the people who live in the Service have their say on how things are going. After all, theyre the experts because they live there. There also needs to be a system for getting what members of staff think. This is because they know in detail how things work in practice rather than in theory. We have already spoken quite a lot about the questionnaires that the Registered Provider has asked people to fill out. Members of staff and peoples relatives have also filled out their own version of the questionnaires. The answers in the questionnnaires that were filled out by the people who live in the Service, have been added up by the Manager. This is how we were able to see the results. The other ones have been returned direct to the Registered Provider so we dont know what has been said. The whole exercise hasnt been finished yet. However, there is already plenty for the Manager to go on. She is going to look into some of the less positive things that have been said about the Service. This is so that she can get to the bottom of anything that might need to be sorted out. There are monthly house meetings that all of the people who live in the Service can go along to. They can talk about anything they want to do with their home. We looked at the records of the last such meeting. These showed that people in general are quite happy with Broadmeadow. Most of their suggested improvements were little things about the catering arrangements. For example, one person asked to have a particular spread. The manager has since provided this. A more major thing was people being unhappy about last minute changes to the menu. They were sometimes getting meals that they hadnt ordered. The Manager says that she has looked into this and that she has sorted out what was most often the cause of the problem. Care Homes for Older People Page 29 of 34 Evidence: A senior person from the Registered Provider calls to the Service about once a month. They have a look around, talk to people and check out that things are going okay. We looked at the records of the most recent of these visits. They are checking important things, such as how the Intermediate Care arrangements are working out. Also, they double check to make sure that there are no complaints waiting to be dealt with. Earlier in this Report, we spoke about the Assessment that the Registered Provider sent to us. This is supposed to be a detailed account of how things are going. Were disappointed in the way this has been done. Some of the sections are not completed at all. Those that are, dont have much information in them. We will expect to see a much more thorough account when the Registered Provider sends us its next Assessment in 2009. The Manager and the team leaders help some of the people who have made their home in the Service to manage their personal spending monies. They have been asked to do this so that money doesnt get lost and so that each person has enough to buy the things that they want. The system involves the Service holding small amounts of money for people and then using it to buy things for them. For example, paying for toiletries or paying for someone to see the visiting hairstylist. The system needs to be clear and well recorded to show that everything is above board. We spoke with the senior administrative officer. She oversees all of this and she keeps a track of all the money that is received and all of it as its spent. She has an organised system to do this. We looked at the records in detail for one person. The amounts spent add up in a logical way and the things bought are reasonable. For example, one of things bought is a tube of toothpaste. The paper balance matches the cash balance. Everything seems to be okay. The Manager says that people who move into the Service only for short stays are asked to manage their own personal spending monies. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. In addition to this, the Registered Provider intends all members of staff to do fire safety training at least once every six months. This is so that they know things such as how to use fire restraining doors in the right way. Also, so that they know how to prevent the occurrence of a fire safety emergency in the first place. This means doing sensible things such as unplugging electrical appliances when they are not being used and in particular at night. We looked at the records of who has done this training. In general, things are quite overdue. The Manager recognises that this really does now need to be sorted out. She says that this will be done by 1 March 2009 at the latest. There are up to date reports from engineers about the gas appliances, the electrical Care Homes for Older People Page 30 of 34 Evidence: wiring, the hoists and the lift. These were completed as part of the process of opening the Service. They say that everything is new and is in good working order. We looked at the record of accidents that have occurred in the Service since the last inspection. There have been quite alot. But most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what happened. This is done so that they can do something if there is a particular problem that causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Each month the Manager does a review of the building to see if there are any hazards that might cause someone to have an accident. We looked at the records of the most recent of these reviews. She is looking at sensible things such as are all areas well lit and are fire escape routes clear. She says that she has not found any obvious hazards around the place. We kept our eyes open when we were walking around. We didnt notice any particular hazards. Things such as bleach are stored safely when they are not being used. The housekeeper we spoke with knows all about the need to do this. She realises that some people might mistake this for something you can drink. Care Homes for Older People Page 31 of 34 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 32 of 34 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 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 Care Homes for Older People Page 33 of 34 Helpline: 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 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. 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