CARE HOMES FOR OLDER PEOPLE
Broadoak Lodge Sandy Lane Melton Mowbray Leicestershire LE13 0AN Lead Inspector
Helen Abel Unannounced 4 August 2005, 10:00am
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 Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Broakoak Lodge Address Sandy Lane Melton Mowbray Leicestershire LE13 0AN 01644 481120 None 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) Mrs Christine Carne Care Home 27 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (5), Old age, not falling within any other category (27), Physical disability (4), Physical disability over 65 years of age (4) Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No one may be admitted into the home in categories PD or PD E when there are already 4 persons of that category accommodated in the home. No person to be admitted into the home in categories MD, MD(E) or DE(E) when 5 persons in total of these categories or combined categories are already accommodated in the home. No one under the age of 55 years can be admitted to the home. Date of last inspection 11th November 2004 Brief Description of the Service: Broadoak Lodge is one of fifteen 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 27 older people with a range of mental health, dementia, and physical disability. The home is set on Sandy Lane in Melton Mowbray. The home is set on one level around a courtyard. There is a paved area with seating and shrubbery within.The home is well maintained and furnished to a good standard. There are bar facilities within the home and two lounges. All rooms offer en-suite facilities. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced during a weekday morning over a four- hour period. We spoke with residents, staff and spent a short period with the Registered Manager. A full tour of the premises took place and some staff and care records were inspected as well as some records, policies and procedures relating to the management of home. The home was busy the morning of the inspection a visit from a clothes supplier meant that residents were in the lounge choosing clothes. A private hairdresser arrived to attend to an individual resident. A foot care professional was seeing residents in their bedrooms. What the service does well: What has improved since the last inspection? What they could do better:
Any concerns raised by residents must be dealt with promptly and to their satisfaction. Improvements could be made to residents rooms in order to provide a more pleasant environment. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 6 The outdoor courtyard could be made suitable for the residents with improvements and ongoing maintenance. This would then provide a pleasant and enjoyble outdoor area, for residents to spend time in during the warmer weather. The kitchen fire door must be kept closed to further safe guard residents. Training for new staff members must be reviewed to ensure staff have the necessary skills to meet the needs of the resident group. Resident’s risk assessements should be reviewed and update to ensure they reflect changing needs of those individals. Due to popular demand more bananas could be made available to residents. If the complaints procedure were better presented this would make it more accessible to residents and relatives. Development of the results of the residents satisfaction questionnaire with the inclusion of information about what improvements will be made would demonstrate a commitment to the process. 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 Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,5 Assessment processes are fully implemented, which ensures that the service meets prospective resident’s needs. EVIDENCE: All residents are assessed prior to entering the home. The Registered Manager will undertake this assessment often with the involvement of other health professionals involved in the residents care. Following on from these assessments residents are invited to visit and given written information about the home. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,11 Residents’ health, personal and social care needs are met. EVIDENCE: Care plans were examined and found to hold the appropriate and relevant information. Residents with significant health care needs were found to be given good support and care by staff. A residents risk assessment viewed was out of date and should be reviewed and updated. Resident’s medicine records were sampled and examined and were compliant. The administration of medicines systems were in good order Staff confirmed receiving good training around supporting residents with dying and death issues. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 10 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 residents. EVIDENCE: A range of activities is displayed on the lounge wall including bingo, classical films and coffee events. On the morning of the inspection a clothes supplier was present selling clothes to residents. Music from years gone by is regularly played. One new resident spoke of being very content in her room with a newspaper and magazines, watching television and crossword puzzles. Trips are organised during the warmer weather to local places of interest, including Burton on the Water and local garden centres. The Broadoak Group provides the transport for these trips. Meals appeared nutrious and varied with the menu displayed on the dining room wall. A resident commented on the general distribution of fruit. This aspect was discussed with the Registered Manager. It was agreed more bananas would be purchased as they are very popular in the home and arrange a fair distribution of fruit to all residents. Glasses are not routinely provided for all residents to use at meals and must use plastic cups. However when residents use the home’s licensed bar they are provided with the appropriate beverage glasses. Glasses should be provided for resident’s meals unless an individual’s risk assessment states other wise.
Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Resident’s complaints are not listened to and taken seriously, which may lead to issues of protection. EVIDENCE: There were various concerns from some residents to the inspector as follows: Residents had repeatedly requested butter but this had not been provided. The cook had been provided with a butter alternative but this was not what residents wanted. The toilet paper was reported to be very thin and of poor quality. Upon examining the toilet paper this did appear to be thin. The view that the handover period for staff sometimes missed important information about individual residents. This resulted in residents having to explain twice to staff when they were experiencing a problem. These aspects were discussed further with Registered Manager following on this inspection. See Requirements. The complaints procedure was displayed around the home in capital letters and should be reformatted for easy reading. Staff reported attending training around Protecting Adults and had found this training beneficial. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,26 The premises are generally well maintained, clean and hygienic with good processes in place to minimise any risk of cross infection. EVIDENCE: All areas of the home were very clean and tidy. One of the residents bedroom and en-suite was very drab and in need of urgent redecoration. The Registered Manager confirmed this room had already been identified for redecoration. The concrete courtyard is the only outdoor area available to residents. Garden furniture was available. However this area appeared unattractive and stark with no flowers and little greenery. This area must be improved upon in order to provide pleasure and enjoyment to residents. The kitchen fire door was propped open with a trolley and must be kept closed. This has been observed at previous inspections. The Registered Person shall take adequate precautions against the risk of fire. This was made an Immediate Requirement on the day of the inspection. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 13 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) 27,28,30 Resident’s needs are met by the numbers and skill mix of staff; new staff members have not received all the relevant training, which would enable them to be competent to do their jobs. EVIDENCE: There were good levels of staff observed during the unannounced inspection, with staff effectively deployed to support resident’s needs. Staff were seen to be sensitive when dealing with residents and were friendly and warm in their approach. Three staff spoken with talked about training undertaken and where anticipating further training with National Vocational Qualifications in Care. Two new staff have not received training around dementia care / dealing with aggressive behaviour; and for one staff member moving and handling. With the current needs of the resident group this must be addressed and relevant training provided. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, The home is generally run in the best interests of the home. EVIDENCE: Residents have regular residents meetings and in March 2005 completed a satisfaction questionnaire. The results are very positive and have been published. They do not include an action plan of how the shortfalls will be addressed. See Recommendations. A number of residents made complaints see Standard 16 Complaints. Other comments received were as follows: “ Meals are good” “ We are well looked after” “ Staff are very considerate” “Very nice staff “ The Commission’s comment cards were returned from residents, relatives and visitors and were positive about the home.
Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 3 x x x x x Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 16 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. Standard 16 Regulation 22 Requirement The Registered Person shall ensure the concerns identified upon inspection are promptly investigated and concluded. The identified bedroom and ensuite to be urgently redecorated. Other rooms also identified on the homes maintenance list and are still outstanding to be redecorated. The Registered Person shall ensure the garden area is made suitable for the residents with improvements and ongoing maintenance. The Registered Person shall take adequate precautions against the risk of fire. The kitchen fire door must be kept closed. Immediate Requirement The Registered Person must ensure staff at the home receive training appropiate to the work they are to perform. Timescale for action 5th September 2005 5th September 2005 2. 19 23 3. 19 23 5th September 2005 3rd August 2005 4. 19 23 5. 30 18 16th September 2005 Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 7 15 12 16 33 Good Practice Recommendations Review and update all residents risk assessments. Purchase more bananas as they are very popular in the home and arrange a fair distribution of fruit to all residents. Provide glasses, rather than plastic beakers to ensure dignity as per risk assessment The complaints procedure was displayed around the home in capital letters and should be reformatted for easy reading. The shortfalls from the residents satisfaction questionire should be addressed in an action plan. This should be made available to current and prospective residents, their representitives and other interested parties. Broadoak Lodge C51 C01 S1816 Broadoak Lodge V241492 040805 Stage 4.doc Version 1.40 Page 18 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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