CARE HOMES FOR OLDER PEOPLE
Broadoak Manor Nursing Home Mulcrow Close Parr St Helens Merseyside WA9 1HB Lead Inspector
Mr Mike Perry Unannounced Inspection 16th May 2006 09:30 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.V296696.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.V296696.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.V296696.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 30.8.2005 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. Broadoak Manor Nursing Home DS0000005452.V296696.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. The inspection took place over a period of 22 hours over 3 days. The inspector met with residents on each of the 4 units and spoke with residents and 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 interviewed. 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 6 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 8 had been returned and comments are included. What the service does well:
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 choice about coming into the home. 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. Assessments during the first stages of admission were found to be very thorough on all the units. 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 are always kept fully informed. Two residents had poor eyesight and were registered blind. Care plans were inclusive of needs in this area and staff worked with relatives to ensure appropriate communication aids were in place.
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 6 There were generally high standards of personal care on all units. Residents were observed to be clean and appropriately dressed. Residents commented: Care is very good. All your needs are looked after Staff are champion. I feel that I have my privacy. One relative reported that for the first time they had felt able to go away on holiday with the knowledge that their loved one was receiving good care. Policies are available regarding the of residents monies in the home and reference is made in the service user guide. Those interviewed understood the arrangments. Bedrooms seen on all units were very personalised and the memory boxes on the doors on Havannah evidenced good practice in terms of personalisation and orientation for residents. 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. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. All units visited were clean, bright and well maintained. 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. A maintainance team is employed and records seen indicate complience with health and saftey issues such as fire requirments. The extenal grounds are maintained well and can be accessd by residents. Each unit has its own garden area. 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. The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults so that residents are protected from staff that may be unsuitable. 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 Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 7 many years. All staff and residents / relatives were supportive of Nicolas approach. Health and Saftey records were seen [electrical saftey, gas saftey, fire records] and this area is managed satifactorily. What has improved since the last inspection? What they could do better:
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 8 Some relatives and residents said that they had not had a contract for the care in the home. It was agreed that all new admissions to the home would receive Terms and conditions of residency. Residents, visitors and staff were unaware of how to access inspection reports on the units. It was agreed that inspection reports should be available at the information areas at the entrance to units. Although care planning is generally very good, on Staply unit a resident with mental health needs was reviewed. The care plan documentation addressed these issues but could be more specific and this was discussed with staff. Residents and relatives varied in their involvement with the care planning process. Some had seen the care plan and some had not. 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 in the care planning. 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. This was discussed with reference to one resident who exposes herself and requires specific clothing [trousers] to promote her dignity. Specific reference in the care plan was needed. Although residents comments were much more positve around social activities [ see above] there was still a feeling that more can be developed in this area. Some comments from relatives were that although they appreciated staffs efforts more could be done to stimulate residents - even for short periods. On some days there is limited input [ for example on the previos week the hobby therapist only had input for 2 days]. There has also been limited training reported in this area. The generall maintainance of the home is good. Some mrovments could be made in certain areas and these are recommended in the report. Nurses can spend upto 3 hours on a shift completinge care records. Quality assurance needs to consider ways of stramlining and reducing the paper work to some degree. A recommendation is made regarding the accident recording documents to ensure that relatives are always informed in the event of any accident although relative feedback in this area was good. Please contact the provider for advice of actions taken in response to this Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 9 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.V296696.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.V296696.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 but all resiidents need to 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 choice about coming into the home. Comments received were that staff spent a lot of time explaining things. The written service user guide had been made
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 12 available and these were also observed to be present in each room in the information folder. Some relatives and residents said that they had not had a contract for the care in the home. Following discussion with the manager and administration staff it became apparent that whilst privately paying residents receive a contract and terms and conditions of residency those funded by social services only receive the initial contract from social services. It was agreed that all new admissions to the home would receive Terms and conditions of residency. Residents, visitors and staff were unaware of how to access inspection reports from CSCI [although some reference is made in the information folder]. It was agreed that inspection reports should be available at the information areas at the entrance to units. 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. Assessments during the first stages of admission were found to be very thorough on all the units. These included assessments under all of the activities of daily living as well as risk assessments for falls, mobility and other care issues. Care records are now audited on a regular basis by the managers to help ensure some consistency. Broadoak Manor Nursing Home DS0000005452.V296696.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): 7,8,9,10 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 very well although some care needs can be more fully addressed so that the qualty of care interventions can be improved. Personal care needs are met consistently overall so that residents are treated with respect and their dignity maintained. EVIDENCE: The way tha the care is plannned was reviewed on all of the units. Following requirments made on the previos inspection there would, on the evidence of this inspection, appear to be more consistency of care standards. 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 such as offer closed questions to enable [resident] to make easy decisions and likes to sit at table with knife and fork. Both of these recorded for residents who are confused.
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 14 on Staply unit a resident with mental health needs was reviewed. The care plan documentation addressed these issues but could be more specific. For example some direct instruction for key workers and care staff to spend time with this resident on a 1:1 basis and record interactions [ this residents is very solitary and spends most of the time in the bedroom]. 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. Information received from residents and relatives varied in their involvement with the care planning process. Some had seen the care plan and some had not. Some had signed the documentation in the care notes to evidence this but most were not signed. On one unit the staff had sent out letters to invite relatives for care plan reviews but on other units this was not formalised. 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 in the care planning. This is particularly so with relatives of residents who are confused and therefore on Havannah 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 are always kept fully informed. This was evidenced on the inspection when one resident was taken acutely ill. Nursing staff were vigilant in monitoring the condition of the resident and then appropriate in making a referral to the casualty department. Relatives were promptly contacted. The local hospital [PCT] are involved in ongoing medication reviews of residents on Havannah unit and on Ashton’s House they are involved in developing palliative care initiatives [The Macmillan team]. On another unit a resident with a pressure sore was being well monitored with very good wound charts and records of dressings in evidence. Two residents had poor eyesight and were registered blind. Care plans were inclusive of needs in this area and staff worked with relatives to ensure appropriate communication aids were in place. A visiting optician reported that the home were particularly vigilant with respect to referring residents for assessments and commented that this was especially the case with residents who are confused [Havannah] as this area of care can be overlooked for this client group. Medication was reviewed on Havannah unit. Following recent requirements from the Commissions pharmacy inspector the managers have made regular audits and improvements have been made. Those administration records reviewed were clear and easy to follow evidencing that medicines had been
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 15 given as prescribed. As well as the existing auditing process it is recommended that the supplying pharmacist complete regular audits of stock. There were generally high standards of personal care on all units. Residents were observed to be clean and appropriately dressed. There is regular hair dressing appointments. Residents commented: Care is very good. All your needs are looked after Staff are champion. I feel that I have my privacy. Some residents reported that there are not enough staff to answer call bells quickly enough. This is particularly the case from 0800 - 1000 although residents appreciated that this is when staff are at their busiest. 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. This was discussed with reference to one resident who exposes herself and requires specific clothing [trousers] to promote her dignity. Specific reference in the care plan was needed. Relatives reported that they were reassured that there is always staff in the day room so that residents are safe. One relative reported that for the first time they had felt able to go away on holiday with the knowledge that their loved one was receiving good care. Broadoak Manor Nursing Home DS0000005452.V296696.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): 12,13,14,15 The quality in this outcome area is good; this judgement was made on the available evidence. 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. Residents are encouraged to maintain their independence and exercise choice. A choice of good quality home cooked food is provided to the residents EVIDENCE: There were requierments made on the previos inspection regarding the development of activities across all of the units. The genearal feedback on this visit would evidence that ovrall there is now more attention being paid to this. There were social activities on all of the units visited. 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 varios events and raffles to provide social activities but the manager reported that a sum of money will now also be provided by the company to develop things further. Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 17 Residents and relatives reported general satisfaction with the staffs efforts and many commented that activiies are enjoyable and theres always some thing going on. comments recieved were that residents particulay enjoyed outside entertainers coming in and trips out [ either planned larger trips or simply being escorted out in the grounds]. Many qualified their comments by saying that staff are very busy and cannot spend much time socialising. An example of the effect of this are that each unit has exelent enclosed garden [ relative involved in the upkeep of one of the gardens] areas but most residents cannot access these without staff support and therefore can only use the garden infrequently due to other staff commitments. Although generally important the provision of activities on Havannah unit are a particular measure of the quality of life for residents. Again there was evidence of activies being organised from recent trips to the safari park, walks in the grounds, entertainers and parties. Some residents had recieved more individual attention with nail care and cake decorating. Again more can be developed in this area however. Some comments from relatives were that although they appreciated staffs efforts more could be done to stimulate residents - even for short periods. The 13 hours of hobby theraphy means that on some days there is limited input [ for example on the previos week the hobby therapist only had input for 2 days]. There has also been limited training reported in this area. A dementia care journal was left for reference with respect to ideas for the provision of more activities and opportunities for social interaction. Policies are available regarding the 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 residnets who have accounts with the home. Bedrooms seen on all units were very personalised and the memory boxes on the doors on Havannah evidenced good practice in terms of personalisation and orientation for residents. 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. Realtives are free to visit at any time. All resident surveys returned and all comments recieved were very positive about the choice and food provided in the home. This is an improvment from the previos inspection.The main midday meal was observed on 2 of the units and was sociable and relaxed with staff taking time to assist those that needed
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 18 help with feeding. The meal consisted of a hot chioce and/or soup and sandwhiches. One resident commented tha there is always plenty of drinks and home made cakes in the afternoon. Another said the food is well presented not basic. there is good chioce e.g last week we had an indian day were we had a chioce of indian food There were soft diets for residents who had difficulty eating solid food and these were well presented on plates that seperated meat and vegtables to ensure a variety of tastes. Some relatives commented that menus used to be displayed but now weren’t [ comment on Havannah]. Broadoak Manor Nursing Home DS0000005452.V296696.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): 16,18 The quality in this outcome area is good; this judgement was made on available evidence. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed 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 his is in all of the service user guides which are in bedrroms. The procedure is also displayed on the units. One resident explained how he had made a complaint and this had been addressed by the manager of the unit as well as the homes manager. A recent complaint referred to the Commission but investigated by the home manager was discussed. The complaint had been investigated and reported on appropriately. The manager has also been keen to follow up the complaint report with the complainant and has entered into some constructive dialog. 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. This has improved since the previous inspection.
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 20 Broadoak Manor Nursing Home DS0000005452.V296696.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): 19,26 The quality in this outcome area is good, this judgement was made on available evidence. Residents are provided with a safe, comfortable and homely environment in which to live. EVIDENCE: All units visited were clean, bright and well maintained. 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 proviosion of disability aids and nursing equipment such as bath hiosts, walk in showers, raised toilets and handrails in corridors. Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 22 Bedrooms seen were very well personalised and homley. All were decorated appropiatly. One resident who was confused had damaged a chest of draws and the relative reported that this had been replaced in reasonable time. A maintainance team is employed and records seen indicate complience with health and saftey issues such as fire requirments. The extenal grounds are maintained well and can be accessd by residents. Each unit has its own garden area. Some issues that should be addressed: Havannah unit - some furnishings need replacing. specifically the Kirton chairs identified. This unit generaly needs more monitoring and shorter term maintainance plans given the client group although it is maintained satisfactorily. Curtains are needed on the entrance door to ensure privacy / dignity for residents who may wander and expose themselves in this area. Stapley unit - some oudour of urine in the day area. Managers report that some refurbishment is to take place which should resolve the problem. Broadoak Manor Nursing Home DS0000005452.V296696.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): 27,28,29,30 The quality in this outcome area is good; this judgement was made on available evidence. Staff numbers are appropriate and service user’s needs are being met effectively. 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 requirments from the last report around the consistency of staffing numbers has been addressed and there is now less use of agency cover. Residnets /relatives commented that there is always staff around - particularly in the day rooms. Comments were tempered by the fact that some felt call bells were not answered at busy times and staff are to busy to spend much time socialising. Staff interviews revealed that much time is spent on completing paper work and records and although they could see the importance of this it was cited as the main 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 stramlining and reducing the paper work to some degree.
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 24 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. 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. 1 or 2 staff reported some difficulty accessing NVQ training and also difficulty accessing assessors and this was fed back to the managers. 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 and should be developed over the next 6 months. 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. 5 staff files were seen and all contained full references and Criminal Record checks [CRB]. Broadoak Manor Nursing Home DS0000005452.V296696.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): 31,33,35,36,38. The quality in this outcome area is good; this judgement was made on available evidence. 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: Nicola Garner is the manager of Broad Oak Manor. She has only effectively been in post recently although has worked for the company in other care homes. 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 for example she is going on a Health and Safety course in the near future.
Broadoak Manor Nursing Home DS0000005452.V296696.R01.S.doc Version 5.2 Page 26 All staff and residents / relatives were supportive of Nicolas approach and although only recently in post was known to all of those spoken to. A deputy manager who has specific roles around QA and training supports her. Staff spoken to felt that the company had very fair procedures in terms of equality of opportunity and those overseas staff interviewed felt valued and supported. One staff member who had a particular learning difficulty stated that the deputy manager had offered extra support. 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. There has been progress in terms of the way The home is subject to some external Quality Assuranc processess such as Investors in People award. The company also send out satisfaction surveys to residents and relatives twice yearly with 50 surveyed over the year. Staff and managers are also surveyed. the most rcent of these were seen and indicate generall satisfacion with the service in the home particularly around dementia care [from relatives surveyed]. The QA processess should continue to improve with the introduction of another external quality audt [RDB] which is going to be introduced. There are meetings held with relatives on a 6 monthly basis although staff report that these are not well attended. There needs to be more of these organised at unit level, particularly on Havannah for example where residnets lack capacity to vioce opinions. Following recent requirments on inspection reports there are now quality audits on care planning and medications so that a more consistent standard is evident. It would be indicated that the auditing process looks at relative involvment in care planning [see health and social care]. 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. Broadoak Manor Nursing Home DS0000005452.V296696.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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 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 3 X 3 2 X 3 Broadoak Manor Nursing Home DS0000005452.V296696.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 OP2 Regulation 5 Requirement All residents admitted must receive a contract on admission or terms and conditions of residency. All residents must be protected in terms of dignity at all times. This is with particular reference to those residents who are confused and lack capacity. All staff must receive regular supervision at least 6 times yearly. Timescale for action 15/06/06 2 OP10 12 15/06/06 3 OP36 18 15/06/06 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 Refer to Standard OP1 OP7 OP7 Good Practice Recommendations Copy of CSCI inspection report to be available at entrance of each unit. Resident discussed on Stapley unit should have specific care planning instructions for staff around interventions for withdrawn behaviour. Residents and/or representatives should be involved in the
DS0000005452.V296696.R01.S.doc Version 5.2 Page 29 Broadoak Manor Nursing Home 4 5 6 7 8 9 10 11 OP9 OP12 OP15 OP19 OP19 OP19 OP27 OP33 12 OP38 care planning process. This needs to be standardised across all units. The supplying pharmacist should conduct a medicines audit on each unit on an agreed time basis. The provision and quality of activities on all units can continue to be developed with particular emphasis on those residents who are confused and lack capacity. Menus should be displayed on units. The Kirton chairs identified on Havannah should be replaced Curtains should be provided near the entrance to Havannah unit to protect resident’s dignity on occasions. The odour of urine on Stapley unit should be addressed. Units should consider a hand over period for staff coming on duty in the middle of the day. 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. The current accident reporting form needs to record whether relatives have been informed. Broadoak Manor Nursing Home DS0000005452.V296696.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
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