Inspection on 11/12/06 for Broadoak Manor Nursing Home

This inspection was carried out on 11th December 2006.

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

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

Other inspections for this house

Broadoak Manor Nursing Home 08/01/08

Broadoak Manor Nursing Home 16/05/06

Broadoak Manor Nursing Home 02/09/05

Broadoak Manor Nursing Home 01/09/04

Broadoak Manor Nursing Home 21/04/04

Broadoak Manor Nursing Home 12/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Broadoak Manor Nursing Home Mulcrow Close Parr St Helens Merseyside WA9 1HB Lead Inspector Mr Mike Perry Unannounced Inspection 11th December 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadoak Manor Nursing Home Address Mulcrow Close Parr St Helens Merseyside WA9 1HB 01744 615626 01744 615301 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Nicola Jayne Garner Care Home 120 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (84), of places Terminally ill over 65 years of age (6) Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 84 OP and up to 30 DE(E) and up to 6 TI(E). The service should employ a suitably qualified and experienced manager who is registered with the CSCI. To have 1 temporary registered bed for a named service user who is under 65 years of age To admit a named Service user Mrs LG who is currently 52 years of age 16th May 2006 Date of last inspection Brief Description of the Service: Broad oak Manor Nursing Home is owned and run by BUPA. The Registered Manager for the home is Mrs Nicola Garner, who is a trained nurse. The home is situated in the St. Helens area, and is close to local shops and road links. The home is a modern, purpose built facility and is registered for 120 beds. The home can accommodate 84 physically disabled/older persons, 30 EMI and 6 palliative care Service users. The home is all located on one level and broken down into four smaller units of 30 beds. These units are named Stapley, Ashton, Ravenhead and Havanagh. Each unit has a designated Senior Nurse who has day-to-day responsibility for the provision of care. The fees for the service are currently £367 - £596 Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the entire core Standards the home is expected to achieve. This is the second key inspection of the home, the previous one having been carried out in May 2006. The inspection took place over a period of 16 hours over 2 days. The inspector visited 2two of the four units. These were Havanagh and Stapley units. Havanagh was chosen as it is a specialist dementia care unit. Stapley unit is a general care unit and is the focus of a recent complaint, which had been referred through the adult protection procedures and was being reviewed on this inspection. As a result of this a social worker also visited on the first day of the inspection as part of the review of the complaint. The broad details of this complaint are described under ‘Complaints and Protection’ in this report. The inspector met with residents on each of the 2 units and spoke with a number of relatives who were visiting the home. The inspector also spoke with members of care staff on a one to one basis and the registered manager, deputy manager and administration staff. Visiting professionals were also contacted for their comments. A tour of the units was carried out and this covered all day areas of the home and some of the resident’s bedrooms [not all bedrooms were seen]. Records were examined and these included 5 of the resident’s care plans, staff files, staff training records, financial records and health and safety records. Some survey forms were given out as part of the inspection to residents and relatives. At the time of this report 2 had been returned and comments are included. What the service does well: All residents and relatives felt that they had been given enough information so that they were able to make an informed choice about coming into the home. The written service user guide had been made available and these were also observed to be present in each room in the information folder. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 6 All residents are assessed prior to admission to the home and the assessments process continues following admission. On all care files seen there were also assessments completed by health care professional such as district nurses and social care professionals [social workers]. Relatives felt that they had been consulted as part of the assessment process. All residents have care plans and these were found to be very detailed and covered relevant aspects of the care. There was good personalisation with usfull comments recorded to assist staff in their interactions with residents. Health care is particularly well monitored on all units. Residents and relatives reported that any issues are always dealt with and hospital appointments are maintained. Medication was reviewed on Stapley unit. Those administration records reviewed were clear and easy to follow evidencing those medicines had been given as prescribed. There were generally good standards of personal care on both units. Residents were observed to be clean and appropriately dressed. Residents commented: ‘Staff are very good’ ‘They look after us well’ ‘We have a good time. The staff are always helpful’. Residents and relatives on the general unit reported general satisfaction with the staffs efforts to provide socilal activities for resients. On the day of the inspection there was a quiz organised and the activities co ordinator exercised some skill in getting residents involved. Policies are available regarding the managment of residents monies in the home and reference is made in the service user guide. Those interviewed understood the arrangments. Both staff and relatives reported a relaxed and freindy atmosphere on all the units. From general observations it was very evident that staff interact well with residents and hold them in positive regard. Some staff were observed to be particularly skilled, for example in reasuring and orientating confused residents during the dinner time meal on Havanagh unit. All resident surveys returned and all comments recieved were very positive about the choice and food provided in the home. The main midday meal was observed on the two units. On Stapley this was sociable and relaxed with staff taking time to assist those that needed help with feeding. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 7 Those interviewed felt that they were able to approach staff and that their concerns would be listened to. There is a complaints procedue and this is in all of the service user guides which are in bedrooms. A tour was conducted of the general environment on two of the units. Stapley unit was clean, bright and well maintained. There has been recent refurbishment and residents commented on this and how homley the unit is. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Units are all on one level so there is easy access for wheelchairs and residents with mobility difficulties. There were reported, and also observed, to be good provision of disability aids and nursing equipment. Bedrooms seen were very well personalised and homley. All were decorated appropiatly. This was the case on both units. Staff training is good. The home has over 50 care staff trained to NVQ level. Staff reported that there is always some training every week. Staff generally felt supported by the managers and felt that they were approachable. The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. 3 staff files were seen and all contained full references and Criminal Record checks [CRB]. Nicola Garner is the manager of Broad Oak Manor. She has very good experience in the clinical field working as a registered Mental Nurse [RMN] for many years. The home have very good external and internal qualty assurance systems. This was evidenced on this inspection through the monitoring of pressure sores in the home and how this has fed into an action plan resuting in measurable outcomes for resifdents in terms of reduced incidents of pressure sores in the home. What has improved since the last inspection? What they could do better: Some areas of the care plans were less detailed. One resident who had been breifly on a one–to–one observation plan for reasons of aggressive behavior had not had this recorded in the care plan as it had been between the monthly Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 8 reviews. It is important that care plans are updated routinley as needs develop so that contemporaneous information can be relayed to all staff. Information received from residents and relatives was that they had not been involved and they did not know what a care plan was and how this linked into the care. Generally the managers need to develop this aspect of care planning so that there is consistency across all units and residents and relatives are aware of and feel involved. Although all of the care plans seen stipulated that relatives are to be updated regularly there was hardly any reference to discussions with relatives in the care notes. The inspector suggested ways of improving communication with relatives by developing evaluations to include relatives and also developing the role of key workers so that conversations and information is recorded in key worker diaries. Residents who may wish to self medicate were discussed. Although the general level of dependency of residents in the home is very high it is important that residents are assessed pre admission and again on admission for compliance with medicines and whether they are able to manage their own medicines. This is good practice in terms of encouraging self-care and autonomy with residents. Residents on PRN medication [medication given when necessary] were reviewed. Although the medication records indicate when the medicine had been given there was no information as to why the medication is to be given. PRN medication should be monitored through the care plan. Although important for all residents, the provision of activities on Havannah unit are a particular measure of the quality of life for residents. On the day of the inspection there were no activities organised. More needs to be developed in this area. The comments recieved were similar to the last inspection. Relatives and care staff felt that there were long periods when there was little in the way of theraputic activity for residents. On Havanagh the use of the ‘memory boxes’ outside residents rooms could be further develpped. There could also be better thought given to orientation aids such as signs and information boards. The environment has not been develped any further since the last inspection. On Havanagh the meal times are more difficult to manage due to the nature of the challanging behaviors of residents who are confused. From the observations made by the inspector it was apparent that staff were having to observe wandering residents as well as feed other residents and sometimes had to leave residents being fed to intervene elsehwere. Quite a few residents are not taken to the table and have meals in their armchairs but those who were trying to feed themselves found this difficult. The mealtime was therefore rather chaotic and not relaxed. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 9 The manager needs to look at meal times as a quality issue and devise ways of managing more sociable meals. Havanagh unit admits elderly people with dementia and as such there needs to be attention paid to the environment with respect to residents needs for clear orientation and providing areas of interest and stimulation. This needs to be developed with some consistency. There was some discussion around the extra demands placed on staff by residents who have dementia. The observations made by the inspector and supported by relative interviews is that the quality of staff is not in question it is more around the numbers of staff to provide quality outcomes for residents on Havanagh unit. The inspector would recommend a review of the adequecy of staff numbers with an emphasis on social and activities hours on the unit. As with the last inspection staff interviews revealed that much time is spent on completing paper work and records and this was cited as a reason why care is pressured on a daily basis. Quality assurance needs to consider ways of streamlining and reducing the paper work to some degree. The management have started a process of staff supervision sessions and it is targeted that this will be extended to all staff on a regular basis. The management should now move to develop supervision fully as it is a key method of providing support to staff and will reinforce planned developments around the key worker role. Accident records are stored in care files. It was noted that there was nowhere to record whether relatives had been informed The manager informed the inspector that this had been approved and new forms would be made available soon. 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 Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 1,2,3 The quality in this outcome area is good; this judgement has been made on available evidence. The home provides good information for prospective residents and their relatives so that an effective choice can be made to move into the home. Contracts are issued to all privatly funded residents and all resiidents recieve terms and conditions of residency at the point of moving into the home. Appropriate assessments are carried out by the home, which include social service and / or health assessments so that the home is better able to ensure care needs will be met. EVIDENCE: All residents and relatives felt that they had been given enough information, both in writing and verbally, so that they were able to make an informed Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 12 choice about coming into the home. The written service user guide had been made available and these were also observed to be present in each room in the information folder. All residents are assessed prior to admission to the home and the assessments process continues following admission. A recent admission on one of the general care units of a resident with mental health needs unit included a preadmission assessment by 2 trained nurses, one of whom is a mental trained nurse [RMN]. On all care files seen there were also assessments completed by health care professional such as district nurses and social care professionals [social workers]. Relatives felt that they had been consulted as part of the assessment process. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 13 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 the following standard(s): All key standards. The quality in this outcome area is good; this judgement has been made on available evidence. The home manages the health care needs of resident’s well although some care needs can be more fully addressed with reference to relatives and residents input into care plans so that the qualty of care interventions can be communicated more effectivly. Personal care needs are met consistently overall so that residents are treated with respect and their dignity maintained. EVIDENCE: All residents have care plans and these were found to be very detailed and covered relevant aspects of the care. There was good personalisation with usfull comments recorded to assist staff in their interactions with residents. For example one resident who gets agitated and aggresive had care interventions recorded suggesting a move to a less stimulating environment at these times. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 14 Some care needs are detailed axtremely well. Residents with pressure sores had detailed instructions and recording of wounds so that progress could be assessed [in one case it was a little confusing following the care as old care plans for preexisting wounds had not been removed for archiving]. Other areas of the care plans were less detailed – for example there was no record of the type of pressure relief mattreess being used at the time and it is recommended that this is recorded as it is an important part of the care. Another resident who had been breifly on a one–to–one observation plan for reasons of aggressive behavior had not had this recorded in the care plan as it had been between the monthly reviews. It is important that care plans are updated routinley as needs develop so that contemporaneous information can be relayed to all staff. Overall however the care plans are detailed and reflect the care given. The Care plans are evaluated on a regular basis with all care needs commented on in terms of any progress made. All the care plans are subject to regular auditing by the managers. Following a recommendation on the last inspection for the residents and relatives to be involved in the care planning process there has been no progress on this front. Information received from residents and relatives was that they had not been involved and they did not know what a care plan was and how this linked into the care. Generally the managers need to develop this aspect of care planning so that there is consistency across all units and residents and relatives are aware of and feel involved. This is particularly so with relatives of residents who are confused and therefore on Havanagh unit in particular. Health care is particularly well monitored on all units. Residents and relatives reported that any issues are always dealt with and hospital appointments are maintained. Relatives varied in their opinion as to how they were kept informed. On the inspection those interviewed were pleased with the way staff kept them up to date. A feature of the complaint reviewed as part of the inspection was that communication with staff had been less clear. Although all of the care plans seen stipulated that relatives are to be updated regularly there was hardly any reference to discussions with relatives in the care notes. The inspector suggested ways of improving communication with relatives by developing evaluations to include relatives and also developing the role of key workers so that conversations and information is recorded in key worker diaries. Medication was reviewed on Stapley unit. Those administration records reviewed were clear and easy to follow evidencing those medicines had been given as prescribed. As well as the existing auditing process it is recommended that the supplying pharmacist complete regular audits of stock. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 15 There are no residents on the units inspected who are self medicating. This was discussed with reference to the homes policies and procedures and good practice. Although the general level of dependency of residents in the home is very high it is important that residents are assessed pre admission and again on admission for compliance with medicines and whether they are able to manage their own medicines. This is good practice in terms of encouraging self-care and autonomy with residents. Residents on PRN medication [medication given when necessary] were reviewed. Although the medication records indicate when the medicine had been given there was no information as to why the medication is to be given. This is particularly important with any antipsychotic medication as staff interpretation of the reasons for administration may vary. PRN medication should be monitored through the care plan. There were generally good standards of personal care on both units. Residents were observed to be clean and appropriately dressed. There is regular hair dressing appointments. Residents commented: ‘Staff are very good’ ‘They look after us well’ ‘We have a good time. The staff are always helpful’. It is particularly difficult to monitor residents with confusion as their behaviour can lead to them compromising their dignity. On Havannah unit particular vigilance is required. Residents here were observed to be suitably dressed and relatives reported that they were pleased with the way staff monitored this aspect of care. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 16 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 the following standard(s): Key standards The quality in this outcome area is adequate. This judgement is made on the available evidence including the site visit. Residents are supported to be involved in activities although there is a realisation that more can be developed in this area to ensure a better quality of life for residents on Havanagh unit. Residents are encouraged to maintain their independence and exercise choice. A choice of good quality home cooked food is provided to the residents. The management of mealtimes on Havanagh unit needs reviewing. EVIDENCE: Each unit has the input of a member of staff - hobby therapist who provides and coordnates this for 13 hours per week. The hobby therapist has to raise money independantly through various events and raffles to provide social activities but following on from the last inspection there is now some funding available from the company towards activities for residents. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 17 Residents and relatives on the general unit reported general satisfaction with the staffs efforts and many commented that activiies are enjoyable. On the day of the inspection there was a quiz organised and the activities co ordinator exercised some skill in getting residents involved. Although important for all residents, the provision of activities on Havannah unit are a particular measure of the quality of life for residents. On the day of the inspection there were no activities organised. The coordinator has been busy organising a christmas raffle and some decorations had also been put up. The manager of the unit talked about some work involving pictures of old St Helens which were in the corridoor area by the day room and also the possible development of a snozylyn room although this was on a very limited budjet. More needs to be developed in this area however. The comments recieved were similar to the last inspection. Relatives and care staff felt that there were long periods when there was little in the way of theraputic activity for residents. The 13 hours of hobby theraphy means that on some days there is limited input. There remains limited training reported in this area. A dementia care journal recommended on the last inspection has been acuired and the manager of the unit expressed interest in dementia care mapping which would be a usfull tool to use both theraputically and as an audit tool to assist in developing staff skills. The development of the keyworker role could also be used to enhance socilal input for residents and this was discussed. Policies are available regarding the managment of residents monies in the home and reference is made in the service user guide. Those interviewed understood the arrangments. Records are available and were seen of those residents who have accounts with the home. One resident was discussed in detail and much work had been done by staff to ensure tha the resident accessed funds and that opportunities had been made to assist in puchasing anything the resient needed. Bedrooms seen on the two units were personalised. On Havanagh the use of the ‘memory boxes’ outside residents rooms coukld be further develpped. There could also be better thought given to orientation aids such as signs and information boards. The environment has not been develped any further since the last inspection. Both staff and relatives reported a relaxed and freindy atmosphere on all the units. From general observations it was very evident that staff interact well with residents and hold them in positive regard. Some staff were observed to be particularly skilled, for example in reasuring and orientating confused residents during the dinner time meal on Havanagh unit. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 18 Realtives are free to visit at any time. They repoted that staff ar always welcoming. All resident surveys returned and all comments recieved were very positive about the choice and food provided in the home. The main midday meal was observed on the two units. On Stapley this was sociable and relaxed with staff taking time to assist those that needed help with feeding. On Havanagh the meal times are more difficult to manage due to the nature of the challanging behaviors of residents who are confused. There is also alot of residents who require to be fed which takes up alot of staff time. From the observations made by the inspector it was apparent that staff were having to observe wandering residents as well as feed other residents and sometimes had to leave residents being fed to intervene elsehwere. Quite a few residents are not taken to the table and have meals in their armchairs but those who were trying to feed themselves found this difficult. The mealtime was therefore rather chaotic and not relaxed. It is to the staffs credit that they possessed the patience and skills to ensure that all residents did have something to eat. It was noted in the discussion with the manager that the staffing was actually higher that usual because of the presence of some student nurses. The manager needs to look at meal times as a quilatilty issue and devise ways of managing more sociable meals. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 19 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 the following standard(s): Key standards. The quality in this outcome area is good; this judgement was made on available evidence including a site visit. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. Management ar experienced and staff have had training in the use of adult protection policy and proceedures. EVIDENCE: Those interviewed felt that they were able to approach staff and that their concerns would be listened to. There is a complaints procedue and this is in all of the service user guides which are in bedrooms. The procedure is also displayed on the units. The managers on each unit had knowledge and copies of the local adult protection procedures. Staff interviewed were able to identify and describe what would be termed abusive care or mistreatment. Staff reported that training in abuse awareness is part of the induction process but that many staff had attended further training and that these are repeated periodically. Staff files evidenced some of these courses. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 20 A recent adult protection issue was reviewed on the inspection with a visiting social worker. The management where responsive to the issues raised. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 21 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 the following standard(s): Key standards The quality in this outcome area is adequate, this judgement was made on available evidence. Residents are provided with a safe, comfortable and homely environment in which to live. EVIDENCE: A tour was conducted of both units visited. Stapley unit was clean, bright and well maintained. There has been recent refurbishment and residents commented on this and how homley the unit is. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 22 Units are all on one level so there is easy access for wheelchairs and residents with mobility difficulties. There were reported, and also observed, to be good proviosion of disability aids and nursing equipment such as bath hiosts, walk in showers, raised toilets and handrails in corridors. Bedrooms seen were very well personalised and homley. All were decorated appropiatly. This was the case on both units. Havanagh unit admits elderly people with dementia and as such there needs to be attention paid to the environment with respect to residents needs for clear orientation and providing areas of interest and stimulation. Some of these ideas have been discussed in other parts of the report. The staff and managment have some ideas in this area but they need to be developed with more consistency and quality. The unit was not as clean as could be expected. Coridoor areas wee observed to have debis collected until late afternoon. The manager explained that one of the house keepers was of sick currently. Cleaning practice was discussed and again there needs to be more consistency. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome area is good; this judgement was made on available evidence. Staff numbers are appropriate to meet service user’s basic care alhtough there needs to be some review of staffing with resopect to providing quality outcomes for residents on Havanagh unit. Staff training is well co ordinated enabling them to understand and meet the needs of the residents more effectively. Staff are recruited appropriately so that residents are protected. EVIDENCE: The duty rotas confirm that all units have 2 trained staff on in the mornings and 1 in the afternoon. There are a minimum of 4 care staff on days. This provides the daily direct care and is supported by 13 hours a week input from the hobby therapist. This is for upto 30 residents on each unit. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 24 There was some discussion around the extra demands placed on staff by residents who have dementia. There are observations made in other parts of this report around provision of care for residents on Havanagh unit that need some attention by management [ see ‘health and personal care’ and ‘ daily life and social activities’]. The observations made by the inspector and supported by relative interviews is that the quality of staff is not in question it is more around the numbers of staff to provide quality outcomes for residents in areas such as personal care and provision of theraputic social intervention. The inspector would recommend a review of the adequecy of staff numbers with an emphasis on social and activities hours on the unit. As with the last inspection staff interviews revealed that much time is spent on completing paper work and records and this was cited as a reason why care is pressured on a daily basis. Nurses can spend upto 3 hours on a usual shift completinge care records. Quality assurance needs to consider ways of streamlining and reducing the paper work to some degree. This remains a strong recommendation. Staff training is good. The home has over 50 care staff trained to NVQ level. Staff reported that there is always some training every week. Following previous recommendations there has been a lot of training activity around the prevention and treatment of pressure sores. The planned training and staff files were seen. Training at all levels from induction through to foundation and statutory is consistently managed through the training coordinator [deputy manager]. Staff reported that statutory training such as manual handling and fire safety is regularly provided. Staff generally felt supported by the managers and felt that they were approachable. Regular supervision sessions have yet to become part of he culture of the home although a start has been made. As with the previous inspection some staff were concerned that they do not receive a handover if they come on duty in the afternoon and that this could affect the continuity of care. . The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. 3 staff files were seen and all contained full references and Criminal Record checks [CRB]. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome area is good; this judgement was made on available evidence including a site visit. The manager of the home displays the skills and knowledge to manage the home so residents and staff needs are supported There are systems in place so that the quality of the service can continue to be improved with reference to service users needs and comments. EVIDENCE: Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 26 Nicola Garner is the manager of Broad Oak Manor. She has very good experience in the clinical field working as a registered Mental Nurse [RMN] for many years. She has a qualification in at degree level and is able to provide evidence of continual self-development. The management have started a process of staff supervision sessions and it is targeted that this will be extended to all staff on a regular basis. This was discussed on the previous inspection and the management should now move to develop supervision fully as it is a key method of providing support to staff and will reinforce planned developments around the key worker role. The home have very good external and internal qualty assurance systems. This was evidenced on this inspection through the monitoring of pressure sores in the home and how this has fed into an action plan resuting in measurable outcomes for resifdents in terms of reduced incidents of pressure sores in the home. Health and Saftey records were seen [electrical saftey, gas saftey, fire records] and this area is managed satifactorily. Accident records are stored in care files. these are generally comprehensive although it was noted that there was nowhere to record whether relatives had been informed and this was a recomedaionfrom the previos inspection. The manager informed the inspector that this had been approved and new forms would be made available soon. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Residents and/or representatives must be involved in the care planning process. This needs to be standardised across all units. On this visit there was little evidence from care notes that relatives are routinely involved and kept up to date with care. 2 OP12 12 The provision of therapeutic activities for residents with dementia must be developed with greater consistency. All areas of the home must be maintained in a clean and hygienic state with some consistency 4 OP36 18 All staff must receive regular supervision at least 6 times yearly. [Last requirement date 15/06/06 not met - new date set] 01/03/07 01/03/07 Requirement Timescale for action 01/03/07 3 OP26 23 01/03/07 Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations All care interventions need to be recorded. Also care needs should be addressed as they arise to have a more Contemporaneous care plan. 2 OP9 All residents should be assessed for ability to self medicate on routine admission assessments. PRN medication should be monitored through the care plan and evaluated routinely. The supplying pharmacist should complete routine audits. 3 OP19 The environment on Havanagh needs to be further developed with reference to good practice around orientation of residents and providing areas of stimulation and interest. 4 OP27 The staffing on Havanagh should be reviewed with respect to the comments made around the quality of provision of care for people with dementia. 5 OP33 As a quality assurance issue the management should continue to review and adapt the care documentation to try and reduce the amount of paper work that has to be completed by staff. 6 OP38 The current accident reporting form needs to record whether relatives have been informed. Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broadoak Manor Nursing Home DS0000005452.V311838.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!