Inspection on 08/01/08 for Broadoak Manor Nursing Home

This inspection was carried out on 8th January 2008.

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

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

Other inspections for this house

Broadoak Manor Nursing Home 11/12/06

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 09:30 8 January 2008 th 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.V347835.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.V347835.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.V347835.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 11th December 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. It is split across the site into four separate units, three of which admit elderly people with general care needs and one [Havanagh] cares for elderly people with dementia. 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 £482 - £664 weekly. Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The last key inspection was carried out in December 2006. The home was also visited more recently in October 2007 when a ‘random’ inspection was carried out looking at some concerns raised around the management of pressure sores in the home. The findings of the inspection were positive and there is further reference to this under the ‘complaints’ section of the report. Prior to the inspection the manager was sent and completed a comprehensive form containing pre inspection information about the home which assisted in directing the site visit. The inspection took place over a period of 3 days. The inspector visited three of the four units [Ravenhead unit was not visited as this unit was the subject of the random inspection in October 2007]. The units visited were Havanagh, Stapley and Ashton. Havanagh is a specialist dementia care unit. The inspector met with residents on each of the units and spoke with relatives who were visiting the home. The inspector also spoke with members of care staff and unit managers on a one to one basis and the registered manager, deputy manager and administration staff. 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 resident’s care plans, staff files, staff training records, financial records and health and safety records. Some survey forms were sent to the home prior to the inspection so further comments could be made by residents, relatives and staff. At the time of this report 12 had been returned and comments are included. What the service does well: Broadoak Manor Nursing Home DS0000005452.V347835.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. Those assessments seen were very comprehensive and easy the follow so that all care needs were assessed. 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. Some care needs are detailed extremely well. Residents with pressure sores had detailed instructions and recording of wounds so that progress could be assessed. 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. Health care is well monitored on all units. Residents and relatives reported that any issues are always dealt with and hospital appointments are maintained. There are clear records of health professionals visiting. Medication was reviewed on Ashton unit. Those administration records reviewed were clear and easy to follow evidencing those medicines had been given as prescribed. There are regular audits carried out by senior management. There were generally good standards of personal care on all units. Residents were observed to be clean and appropriately dressed. There is regular hair dressing appointments. Residents and relatives commented: ‘The staff look after residents with care, kindness and dedication’. ‘He always seems very happy and content with the care he receives. ‘ I’m very happy with the care on the unit’. ‘The staff a very kind and work very hard. They look after me well’. Out of the comments received there were no negative comments about the general care in the home. It is particularly difficult to monitor residents with confusion as their behaviour can lead to them compromising their dignity. On Havanagh 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. The inspector spent some time directly observing the care and Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 7 staff were seen to be skilled at interacting and supporting residents so that their dignity and sense of person were maintained. Residents and relatives were aware of the complaints process and felt that concerns were listened to and staff were approachable. The complaints procedure was seen in the information guides in residents bedrooms. There were no complaints recieved. The mamagers have a good history of investigating and reporting complaints and this was evidnced from complaint records available. Staff training is good. The home has over 60 care staff trained to NVQ level. Staff reported that both induction and ongoing foundation training was good and showed progression around current clinical themes and was based on regular staff supervision in terms of supporting staff generally. Staff generally felt supported by the managers and felt that they were approachable. The managers have a very good history of learning and developing the home along good practice principals and also of meeting statutory requirements and recommendations. The home have very good external and internal quality assurance systems. For example there has been more recent work completed around blood bourne viruses and how this may effect proceedures in the home. Policy has been updated on the basis of good practice guidance. The home is able to show a progressive improvement in many areas and this is also evidenced by the satisfaction surveys completed by both staff and residents. What has improved since the last inspection? The relative involvement in the care planning process has improved so that relative reported that they felt more included but it is further recommended that this process is more evident and formalised around more regular reviews. The managers have worked well to ensure that all staff are now receiving regular and ongoing formal supervision sessions so that they feel supported in their role and communicate any issues in a structured way. Although there is still some work to do the provision of activities on the units has generally improved and the feedback from residents and relatives was more positive on this visit. The consistency of standards around cleanliness on the units has improved. All areas seen were clean and comfortable and residents and visitors felt that this was consistently maintained. There were some requirements and recommendations made on the last inspections regarding medication administration which have been attended to. Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 8 The medication standards on Ashton were inspected and standards were good and administration safe. The monitoring of the incidents of pressure sores in the home is very good and staff continue to receive training updates as needed. What they could do better: Currently any skin applications [creams] are kept in resident’s rooms and administered by care staff as part of the routine personal care when residents are, for example, getting up in the morning. The administration recording is made by the nurse however on the medication administration record [MAR]. It is recommended that the person actually administering the cream signs for this as this is a more accurate record as it identifies the care staff responsible. The provision of activities and social care has improved since the previous inspection and the daily life on the units is relaxed and residents feel at home. There is a commitment to provide better standards in this area of care. More could be done however with respect to organising social care and activity and providing more social structure to the day. 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 further ideas were discussed with the manager in charge of the unit and reference material was recommended. The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. One staff file contained ‘character’ references rather that a reference from a past employer in care. It is important that new staff have references from previous employers if they have worked in care settings. Accident records are generally comprehensive although it was noted that there was nowhere to record whether relatives had been informed and this was a recommendation from the previos inspection. Please contact the provider for advice of actions taken in response to this Broadoak Manor Nursing Home DS0000005452.V347835.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. The summary of this inspection report can be made available in other formats on request. Broadoak Manor Nursing Home DS0000005452.V347835.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.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have a thorough assessment prior to being admitted to the home so that all care needs can be better addressed. 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. The written service user guide had been made available and these were also observed to be present in each room in the information folder. The homes statement of purpose and ‘service user guide’ has also been updated recently to include some changes made when the homes Certificate of registration was reviewed. This shows that he information available is always current. All residents are assessed prior to admission to the home and the assessments process continues following admission. There has been a change Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 12 to the documentation since the last inspection. Those assessments seen were very comprehensive and easy the follow so that all care needs were assessed. Assessments are reviewed every six months. They covers all areas of daily living activities such as communication, lifestyle, sexuality, safe environment, mobility, mental state [very comprehensive], dependency score, breathing, eating and drinking, eliminating, personal care, sleeping, pain, medication and end of life arrangements. A ‘map of life’ plan covers the residents social history. 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 and there is a section on the documentation for relatives / residents to sign. Broadoak Manor Nursing Home DS0000005452.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manages the health and personal care needs of resident’s well 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 had a very detailed plan around communication and the importance of ensuring that glassess and hearing aid are worn. A care assistant spoken with was able to disuss the importance of this so that the resident could be better orientated to the environmnt. Some care needs are detailed extremely well. Residents with pressure sores had detailed instructions and recording of wounds so that progress could be assessed [this reinforced findings from the random inspection carried out Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 14 previously]. The standard was not always consistent however and in one case the recordings contained photographs of wounds that had conflicting dates on them and a wound chart that had stopped being used in favour of entries in the care notes. The resident in question had various wounds which were therefore difficult to track. The same resident had very recently been reviewed by the doctor and family had been seen regarding arrangments for terminal care. This aspect of care was not covered in the care plan however [relevent section was blank]. An appropiate pressure relieving matress was not in place which showed a lack of planning [ this was attended to]. It is important that care plans are updated routinely as needs develop so that contemporaneous information can be relayed to all staff and care planned thoroughly. This was an exeption however and overall [7 care plans were reviewed] 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 recommendations made on previous inspections residents and relatives are now more involved in the care planning process certainly in the early stages. This includes the assessment stage and then the initial care plan. Staff explained that the assessments and plans are formally reviewed on a six monthly basis and there are entries on records to show that relatives and residents are involved in this. One relative said ‘I’ve seen the care plan – this was when my wife first came in but not since. The staff keep me informed about any changes and they recently phoned me to say she was off colour.’ In each of the care files there is a section for recording relative input and although there are some recordings made it remains inconsistent. Still some relatives and residents reported that they were unaware of ‘care plans’. One said ‘we can always ask but it would be nice if staff told us about the general care on a more regular basis’. It is recommended that managers on all units continue to develop communication here. Health care is well monitored on all units. Residents and relatives reported that any issues are always dealt with and hospital appointments are maintained. There are clear records of health professionals visiting. Medication was reviewed on Aston unit. Those administration records reviewed were clear and easy to follow evidencing those medicines had been given as prescribed. There are regular audits carried out by senior management. There are no residents on the unit inspected who are self medicating. This was discussed with reference to the homes policies and procedures and good practice. There is an appropriate risk assessment tool if staff need to consider a resident self medicating. This is good practice in terms of encouraging selfcare and autonomy with residents. Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 15 Currently on Ashton unit any skin applications [creams] are kept in residents rooms and administered by care staff as part of the routine personal care when residents are, for example, getting up in the morning. The administration recording is made by the nurse however on the medication administration record [MAR]. It is recommended that the person actually administering the cream signs for this however as this is a more accurate record as it identifies the care staff responsible. There were generally good standards of personal care on all units. Residents were observed to be clean and appropriately dressed. There is regular hair dressing appointments. Residents and relatives commented: ‘The staff look after residents with care, kindness and dedication’. ‘He always seems very happy and content with the care he receives. ‘ I’m very happy with the care on the unit’. ‘The staff a very kind and work very hard. They look after me well’. Out of the comments received there were no negative comments about the general care in the home. It is particularly difficult to monitor residents with confusion as their behaviour can lead to them compromising their dignity. On Havanagh 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. The inspector spent some time directly observing the care and staff were seen to be skilled at interacting and supporting residents so that their dignity and sense of person were maintained. Broadoak Manor Nursing Home DS0000005452.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily life social care for residents continues to be developed so that residents generally are supported to feel relaxed and ‘at home’. EVIDENCE: The new care documentation has a section, which outlines the resident’s social history, and the staff complete this with input from the resident or relatives. This forms a useful outline and gives background so that social interaction and activity can be better planned. Each unit has the input of a member of staff - hobby therapist who provides and co-ordinates this. the pre-inspection information reported that two more staff have been employed to try and get more input onto the units for residents. Residents and relatives on the general units reported general satisfaction with the staffs efforts and many commented that activities are enjoyable. On the day of the inspection staff were involved on one of the units with organising some chair exercises for residents who seemed to be enjoying Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 17 this. Other residents and relatives reported birthdays being celebrated [observed on one of the units] and karaoke sessions. One resident said she had been out on trips on occasions. Although improved more could be organised for residents. There were reports that activities are still sporadic and not consistent. Staff reported that some activities are organised but more could always be done. One resident summed up the general picture: ‘Activities are generally a couple of days a week. I sometimes go out and have been to the theatre. Not much happens on a daily basis on the unit. Meals are very good. We tend to have soup and sandwiches for dinner and a main meal at night. I don’t know the menu. We can ask for cooked breakfast. Had one this morning. it is very flexible and I can get up when I want. There is access to the garden and I often go out and do a bit of gardening’. 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 was a relaxed feel to the unit and staff were present in good numbers in the day area. There was regular interaction observed and the quality of staff interactions was good and supported residents as individuals. Residents enjoyed a good level of engagement with their surroundings. In terms of more formal activities and time spent one to one with residents socialising their remains little time for this, however, due to staff spending a lot of time on physical care needs and the hobby therapist attending on average for three sessions a week. Staff reported that more could be done with more staff and that the input of the hobby therapist had actually been reduced. The board advertising activities was empty. Following the inspection a letter from the managers of the home was recived and pointed out that Havanagh unit had experienced an outbreak of an infection which meant that activities had been curtailed for the week of the inspection. There was some discussion with the manager of the unit who also listed further development of activities as a priority and discussed with the inspector the value of more hobby therapy input and perhaps using this time for more one to one work given the poor level of most residents comminication skills. 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. One resident on a general care unit said she kept money in her handbag but had nowhere safe to lock it away. The bedside cabinet had a lock but there was no key available. Similarly the door to the bedroom did not lock and ‘some confused residents sometimes wander in’.This was discussed with the manager and although some residents have locks and Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 18 keys for bedrooms and drawers this is not consistent. [see recommendations under ‘environment’]. Relatives are free to visit at any time. They reported that staff are always welcoming. All resident surveys returned and all comments received were very positive about the choice and food provided in the home. The main midday meal was observed on 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 challenging behaviors of residents who are confused. There is also alot of residents who require to be fed which takes up alot of staff time. The manager explained that the meal trolley is now delivered earlier so that staff can have an extended period as many residents have to be assisted to feed. Staff were observed to support residents and the mealtime was well paced. This is an improvement since the last inspection. On all units there is a menu displayed but these tended to be inappropriately situated so that residents were not aware of them. They were also in small print so that any body with less than good eyesite could not read them. Broadoak Manor Nursing Home DS0000005452.V347835.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. 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. EVIDENCE: The information from the manager in the pre inspection information reads: We have a clearly defined company complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. The policy includes a three tier framework including the home, the regional management team and the national Quality and Compliance department. BUPA Care Homes has robust policies for dealing with allegations of abuse or neglect. Staff can not only raise concern within the home they have access to senior staff outside the home. There are well documented procedures for reporting under PoVA should the need arise’. The ‘random’ inspection in October 2007 was carried out following some concerns raised by a relative of a resident around pressure sore management Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 20 and health care. Also the homes complaints procedure was called into question. An extract from the report reads: The process of dealing with complaints was reviewed with respect to a recent complaint received by the home. The complaint had also been reviewed under the safeguarding adults procedures by the local authority. A senior manager in the organisation had conducted the homes investigation and the reply to the complainant covered the issues raised. The inspector spoke with a senior manager in social services who was able to report that the home had assisted their investigation. On this visit residents and relatives were aware of the complaints process and felt that concerns were listened to and staff were approachable. The complaints procedure was seen in the information guides in residents bedrooms. There were no complaints recieved. Broadoak Manor Nursing Home DS0000005452.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. the home provides comfortable and safe living conditions for residents but there needs to be further development of good practice principals in dementia care on Havanagh. EVIDENCE: A tour was conducted of three units visited. Stapley and Ashton unit were clean, bright and well maintained. There has been ongoing refurbishment and residents spoken with commented on how homely both of these units are. 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 Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 22 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 homely. All were decorated appropriately. This was the case on both units. Similary havanah unit was clean and well presented. there has been a new cleaning schedule for the home since the last inspection: ‘We use a specialist microfibre cleaning system that combined with effective cleaning regimes keeps the home clean and odour free’ In the case of Havanagh the unit was managing an infection outbreak at the time of the visit and the cleaning systems helped ensure that there were no malodorous smells apparent. Both visitors and staff felt that the unit had improved in this area. 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. There were signage around the vacinity of the main toilet near the day area but nowhere else. The menu board was not accessible to residents as it was not prominent and the lettering is too small. There are ‘memory boxes’ to identify individual bedrooms. Some further ideas were discussed with the manager in charge of the unit and reference material was recommended. Broadoak Manor Nursing Home DS0000005452.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. staff are recruited and trained to a good standard so that residents can be assured that there is safe care delivery. 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 input from the hobby therapist. This is for up to 30 residents on each unit. There were plenty of comments made by both staff and residents / relatives regarding the adequacy of staff numbers. Generally the main feedback could be summarised as; the quality of staff was very good but there needs to be more staff if the quality of care is to develop further: ‘There could always be more staff on to sit and spend time with residents’ [staff comment] ‘There’s never enough staff in that more staff means we can spend more time with residents and pay them more attention’ [staff] Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 24 ‘The staff work very hard and are very caring but I don’t think there’s enough’ [relative] The managers are very supportive. ‘There could always be more staff but we are never short staffed’ [staff] The consensus is that more staff would possibly equate with increased social activity an in terms of quality of care this would mean a better quality of life. This was discussed with the manager. The amount of paper work was still seen as an issue by trained staff but this has improved since the last visit with the introduction of the new care planning system which was seen as more ‘streamlined’. Staff training is good. The home has over 60 care staff trained to NVQ level. Staff reported that both induction and ongoing foundation training was good: ‘ I had a good induction and a mentor helped me work through the induction standards booklet’ ‘The training is good. Nearly everybody on this unit has been on training for dementia care’ The deputy manager is the training coordinator and was able to discuss records of staff training, which showed progression around current clinical themes and was based on regular staff supervision in terms of eliciting training needs. 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. 5 staff files were seen and all contained full references and Criminal Record checks [CRB]. One staff file contained ‘character’ references rather that a reference from a past employer in care [staff had worked in care previously]. It is important that new staff have references from previous employers if they have worked in care settings. Broadoak Manor Nursing Home DS0000005452.V347835.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes management display consistent and progressive monitoring and support of staff and have developed quality initiatives, which ensure that the home is managed in the best interests of the residents. EVIDENCE: 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. A deputy manager and 4 unit managers who run each of the care units support her. There are also ancillary support managers. Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 26 The managers have a very good history of learning and developing the home along good practice principals and also of meeting statutory requirements and recommendations. For example the management have started a process of staff supervision sessions and it is targeted at all staff on a regular basis as this has been a need over recent inspections and this has now been addressed. The home have very good external and internal quality assurance systems. This was evidenced on this and previous inspections through the monitoring of pressure sores in the home and how this has fed into an action plan resulting in measurable outcomes for residents in terms of reduced incidents of pressure sores in the home overall. There has also been more recent work completed around blood bourne viruses and how this may effect proceedures in the home. Policy has been updated on the basis of good practice guidance. The home is subject to external quality audits [RDB] and also company audits [Regulation 26 audits] and internal clinical audits by the deputy manager around, for example, care planining, training, medication. The home is able to show a progressive improvement in many areas and this is also evidenced by the satisfaction surveys completed by both staff and residents. Health and Saftey records were seen [electrical safety, gas safety, fire records, legionella] and this area is managed well. 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 recommedation from the previous inspection. The manager informed the inspector that this had been approved and new forms would be made available soon. The recommendation therefore remains. Broadoak Manor Nursing Home DS0000005452.V347835.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 X 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 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 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 X X 4 Broadoak Manor Nursing Home DS0000005452.V347835.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 OP12 Regulation 12 Requirement The provision of therapeutic activities for residents with dementia must be developed with greater consistency and input. [Last requirement date 01/03/07 not met] Timescale for action 01/05/08 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 needs should be addressed as they arise to have a more contemporaneous and updated care plan. The relative involvement in the care planning process has improved but it is further recommended that this process is more evident and formalised around more regular reviews. 2 OP9 The medication records for skin applications / creams DS0000005452.V347835.R01.S.doc Version 5.2 Page 29 Broadoak Manor Nursing Home 3 OP14 4 5 OP15 OP38 should be signed by the member of care staff carrying out the process / administration. All residents should be assessed regarding the need for locks to be provided to bedroom doors and also for a secure locked facility to keep valuables and money in their rooms. The menus on the units need to be displayed prominently and with regard to residents being able to see and read them. The current accident reporting form needs to record whether relatives have been informed. 6 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. 7 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. 8 OP29 It is important that new staff have references from previous employers if they have worked in care settings for at least for three months duration. [Refer to schedule 2 of the Care home regulations]. Broadoak Manor Nursing Home DS0000005452.V347835.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V347835.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. 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