CARE HOMES FOR OLDER PEOPLE
Broadoak Grange Sandy Lane Melton Mowbray Leicestershire LE13 0AN Lead Inspector
Helen Abel Unannounced 18 May 2005, 10:30am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Broadoak Grange Address Sandy Lane Melton Mowbray Leicestershire LE13 0AN 01664 562008 01664 562008 none Mr John Nunn & Mrs Barbara Nunn Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 33 Category(ies) of Dementia over 65 years (10), Old age (33), registration, with number Physical disability over 65 years (10) of places Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 3rd February 2005 Brief Description of the Service: Broadoak Grange Care Home is one of 15 homes owned by Mr and Mrs Nunn. The Registered Providers set up the Broadoak Group of Care Homes in 1986. Mr and Mrs Nunn have 17 years experience in providing nursing and residential care.The home provides care for 33 older people and is situated off Sandy Lane in Melton Mowbray. There is a large car park for visitors. The home is set on two floors. Some recreational facilities are provided and the home is able to provide transport for day trips. There is a well kept back garden with garden furniture and a greenhouse that service users tend plants in. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over a period of 5 hours. A second Regulatory Inspector assisted the lead Regulatory Inspector. The care of four service users was reviewed and this included looking at their care records, care plans, assessments and their medication. The service users in the communal areas of the home were observed to be relaxed, calm and sociable. The majority of the service users in the home are older people. Some service users have a physical disability, and a minority have dementia. All service users spoken to were able to comment about how they felt living in the home. Staff and relatives of service users were spoken with, and views were given about care provided in the home. Comment cards about the service were received from nineteen service users and one from relatives/visitors. The feedback was positive about the care at the home. What the service does well:
The management of medicines is effective, ensuring that service users receive the required medication at the expected times. Visitors are welcomed in the home during the day and evening, with good liaison demonstrated between staff and relatives. Meals provided to service users are of good quality and well presented. The home has good systems for cleaning, and all areas of the home are clean, pleasant and hygienic. Staff are deployed effectively in the home to support the needs of service users. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Maintenance systems could be more effective in ensuring that broken or damaged items are quickly fixed or replaced e.g. room buzzers. Water temperatures must be of an acceptable temperature in all water outlet areas specifically shower units. Ensure fire precautions are in place in all areas of the home. Ensure a new service user’s care plan is completed. To provide window restrictors to the small lounge and an identified service users top window. These were made immediate requirements on the day of inspection. Secure the rear and side parts of the garden area to ensure a safer outdoor environment for all service users.
Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 7 Individual risk assessments for service users, and the premises risk assessment must be kept up to date and acted upon accordingly. The recruitment procedures require further development to ensure two written references are obtained. Ensure care records more accurately reflect the individual needs of service users, are signed by the service user, and are more accessible to those involved in her/his care. Management should provide support to staff in managing and recording information in the daily care records. 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. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 Prospective service users have the information they need to make an informed choice about where to live. Generally assessments are satisfactory, however on occasion the assessment systems are not fully implemented. EVIDENCE: There is a comprehensive service user guide available in the home. Relatives spoken to confirmed they were given appropriate information about the home. During the inspection the service users care was examined from the point of entry to the home, to their current care needs. Two service user files were looked at in detail. One file did not have any information relating to her assessment prior to entering the home, and the second service user file showed no evidence of assessment or care plan. Other files examined did demonstrate written assessments and care plans. Information relating to personal care such as bathing and weighing is recorded, however the records are not always kept in the individual care notes of each service user Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10. The service user’s health, personal and social care needs are generally satisfactory and set out in an individual plan of care. Generally service user’ s health care needs are met, however not all are fully met. The home has good medication policies and procedures in place, which are implemented well. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: One service user’s care plan had insufficient detail regarding her assessment of health and care needs. One service user who had been living in the home for approximately two weeks had no written information detailed in her care records. Other care plans were examined and found to hold the appropriate and relevant information. During the inspection it was also found that one service user had not been given information from the GP regarding a serious illness, and the home’s managers had not followed this up. Other service users with significant health care needs were found to be given good support and care by staff. Staff are undertaking regular night time checks on service users, however there is no documentation to inform whether service users have given permission for their locked doors to be opened by staff.
Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 11 The medication records were examined and found to be of a good standard, demonstrating that the policies and procedures were being effectively enforced. Management and staff were observed to sensitively deal with, and respect the various care needs of service users; in particular, good practice was observed in supporting a service user with dementia. Staff demonstrate a good understanding of the rights of service users to have privacy. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 There are sufficient social, cultural, religious and recreational interests to meet the expectations and preferences of service users. Those service users who wish to maintain contact with family and friends have good opportunities to do so. Generally, services users are given sufficient help to exercise choice and control over their lives. Service users receive a wholesome and appealing diet in pleasant surroundings. EVIDENCE: Service users are supported in visiting local churches, and trips out with relatives. On the day of inspection staff were observed to provide residents with recreational activities such as skittles and dominoes, and were observed actively participating in these activities. One of the service users is a keen organ player, and an organ has been made available for his use. Many visitors were observed at the home during the inspection, and in discussion with two relatives, it was noted that the home welcomes visitors at any time during the day and evening. Lunchtime was observed, with residents appearing to enjoy a roast dinner, which was well presented, home cooked, with ample portions available. Service users spoken to, said that the dinners were ‘very enjoyable’, and there was ‘no complaints about the food at all’.
Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 13 Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 1618 to be inspected at the next inspection. EVIDENCE: Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25,26 Generally, service users live in a safe, well-maintained environment. There is good access to safe and comfortable indoor communal facilities, as well as sufficient and suitable lavatories and washing facilities. Bedrooms are comfortable and arranged to suit the needs of each service user. They have their personal possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: There is a maintenance programme in place, and the home had identified issues with some bedroom buzzers not working, and some showers being too hot, however on the day of inspection these items of work were still outstanding. The rear and side garden area of the home was viewed and was seen to have broken glass and unused window debris. The side of the home must also be made more secure. Following on the inspection the Registered Provider confirmed this would be carried out.
Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 16 All communal areas and some bedrooms were inspected and found to be decorated to a satisfactory standard, as well as being clean and hygienic. Sufficient and suitable furniture was also in evidence throughout the home. When asked, service users confirmed they were happy with the standards of cleanliness in the home. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Service users needs are met by the numbers and skill mix of staff. The home’s recruitment policy and practice is generally satisfactory, with adequate training in place to support staff’s competent practice. EVIDENCE: There were good levels of staff observed during the unannounced inspection, and staff were effectively deployed to support service users needs. Polish speaking service users are supported well by polish speaking staff. Staff gave information about their induction programme, however there was insufficient documentation to support this evidence. The acting manager confirmed that staff are undertaking training in Moving and Handling and Infection control, and some carers have undertaken training in the administration of medication. It was also confirmed that four members of care staff are about to commence National Vocational Qualifications in care. The acting manager is in the process of compiling staff training plans and records. The majority of required documents for new staff were in place, however although two references for a member of staff were requested, only one reference was obtained prior to acceptance in post. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38 The service users live in a home, which is run and managed by an acting manager who has not yet undertaken the Registered Manager process with the CSCI, she is however currently discharging her responsibilities in a satisfactory manner. The management approach of the home is not detrimental to the care of service users. The health, safety and welfare of services users are on the whole sufficiently promoted and protected. EVIDENCE: The current acting manager is in the process of being registered with the CSCI and has not yet undertaken her ‘fit person interview’. The acting manager was present for the majority of the inspection, and demonstrated a reasonable understanding of her role and responsibilities, as well as the needs of the service users at the home. Service users and relatives confirmed their satisfaction with her management and leadership qualities. One service user said ‘I’ve got no complaints about the staff and management of the home.’
Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 19 Not all service user risk assessments were observed to be sufficiently comprehensive, with one risk assessment for a service user not up-dated to incorporate high risk behaviour demonstrated in the home environment. The risk assessment for the home’s premises was not sufficiently completed; not having risk assessed any of the resident’s bedrooms or the dining rooms. The fire door to the kitchen was found to not close properly, thereby being a potential fire hazard. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x x x 2 Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 22 25 38 Regulation 16 13 13 Requirement To provide bedroom buzzers for the following rooms: 1,2,6,10, 12,14, 18,29,30,31,33 To repair service users showers 6,16,5. To maintain water temperatures to around 43.c To provide window restrictors to the small lounge and an identified service users top bedroom window. To ensure kitchen fire door is self closing . To complete the care plan for an identified service user. Ensure two written references are obtained for all staff. The rear and side garden area of the home must be made safe with debris removed and the side of the home made secure. Timescale for action 25th May 2005 25th May 2005 25th May 2005 Immediate Immediate On going 31st May 2005 4. 5. 6. 7. 38 7 29 19 23 15 19 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations Ensure the Broadoak homes assessment format is used
C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 22 Broadoak Grange 2. 3. 4. 5. 6. 7. 7 8 8 7 7 38 effectively for all new service user assessments. Guide and support staff to record in the daily care records, personal and health care given to service users. Consolidate all records relating to the personal care of service users e.g. bathing and weighing, into their individual care plans. Liaise with the identified service users G.P. and other health agencies to ensure the service user is given clarity about his medical condition. Ensure individual care plans are agreed and signed by the service user. Ensure permission is sought from service users regarding access to their locked bedrooms at night, and that this permission is recorded on their care plan. Re-visit the homes risk assessment to ensure all areas of the home are encompassed in the assessment. Broadoak Grange C51 S1648 Broadoak Grange V227394 180505.doc Version 1.30 Page 23 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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