Inspection on 12/08/08 for Broadoaks

This inspection was carried out on 12th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broadoaks 17/09/07

Broadoaks 31/10/06

Broadoaks 16/01/06

Broadoaks 03/08/05

Broadoaks 20/01/05

Broadoaks 20/09/04

Broadoaks 24/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

CARE HOMES FOR OLDER PEOPLE Broadoaks 2 Southend Road Rochford Essex SS4 1HA Lead Inspector Bernadette Little Unannounced Inspection 12th August 2008 09:45 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 Broadoaks DS0000018064.V370077.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. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadoaks Address 2 Southend Road Rochford Essex SS4 1HA 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) 01702 545888 01702 546442 www.crollgroup.co.uk Eastwood Hall Limited Mrs Agnes Stubbings Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th September 2007 Brief Description of the Service: Broadoaks is a large detached 19th century Manor House situated close to Rochford town centre. Care and accommodation is provided for twenty residents. The home is not registered to admit service users who are diagnosed as suffering from dementia. Accommodation is provided on two floors with a shaft lift to enable access. Bedrooms are all single rooms with en suite facilities. The Home has two lounges, a pleasant dining room and a visitors room. There is parking to the front of the building and a secure garden with seating available to the side of the building. The Home shares a minibus with three sister homes, and this is available to provide transport and outings for service users. The registered providers have a website that can be accessed on www.crollgroup.co.uk The home has a statement of purpose and service users guide available. Information about the home and most recent inspection report are available to residents/visitors in the lobby area of the home and copies. An information pack including a copy of the most recent inspection report is provided to each new resident. It was confirmed at the site visit that the current fees at the home are £550.00 to £655.00. There are additional charges for chiropody, hairdressing, personal items, newspapers/magazines, some transport costs and any privately arranged therapies. Broadoaks DS0000018064.V370077.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 one star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken over an eight period hour period on one day as part of the routine key inspection of Broadoaks. There were nineteen people living at Broadoaks. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is required to detail their assessment of what they do well, what could be done better and what needs improving. This information was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. Completed surveys were received from four residents, five relatives, three staff and a health professional. The information they contained as well as comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection was greatly appreciated. What the service does well: Residents felt satisfied with the standard of care they received at Broadoaks and all those who completed surveys felt that staff listened to them and acted on what they said. Many relatives also commented positively about the home for example “are very glad (relative) is in such a lovely caring home, we can go home knowing they are safe and kept well”. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 6 Discussion with residents and staff, and looking at everyday life in the home, showed that residents’ right to make choices are respected and routines are flexible to suit resident needs. All comments received from residents, either from surveys or through direct conversation, were very complimentary about the quality, the choices and quantities of food served. Broadoaks provides a clean and homely environment for the people who live there. Residents spoken with found their rooms comfortable and they had been able to bring keepsakes and other items to make them homely. A relative said “Broadoaks is a lovely home, very clean and comfortable” Residents also spoke positively about the staff and said things such as “ the staff are nice”. A staff survey contained the comment “I think the service provided here at Broadoaks is very good and all their needs are met. The residents all seem very happy and a jolly crowd. The staff and management care and to me that means a great deal.” What has improved since the last inspection? What they could do better: The registered provider needs to tell the Commission about important changes at the home such as that the registered manager resigned and who is now managing the home. The Commission has serious concerns regarding aspects of care planning, staff recruitment and staff induction/training at Broadoaks that do not best safeguard residents well being. These were identified as requirements following the inspection of Broadoaks in September 2007 and have not been met in full. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 7 Every resident needs to have an individual plan of care in place on admission that includes all their care needs and preferences and clearly shows staff how these are to meet on a day to day basis. These care plan needs to have up to date risk assessments to help staff keep residents’ safe and well. Records must be available to show that all the right references and checks have been taken up on staff before they start working at the home so that residents are safeguarded. Staff must be given induction training to help them to get to know the residents and understand the work they need to do. Staff also need to be provided with basic training such as moving and handling. This will promote quality care outcomes and the safety and well-being of residents and staff. The manager needs to ensure that residents medications are safely recorded and managed, so that residents get their medication as prescribed, with clear guidance for staff, and risk assessments to ensure that residents’ safety is promoted. We wrote separately to the registered provider about these and subsequently received a full and positive response confirming that they will be actioned without delay and closely monitored. 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. The summary of this inspection report can be made available in other formats on request. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 5. Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to visit the home and receive information on which to base a decision to live at Broadoaks but can not be reassured that the home has fully considered their needs. EVIDENCE: The manager states in the Annual Quality Assurance Assessment (AQAA) that people who enquire about Broadoaks are provided with an information pack and encouraged to come and visit the home to inspect the quality of care and accommodation provided. At the site visit, the manager advised that people are provided with a copy of the statement of purpose and service user guide after they move into the home and so do not have this information available when making a decision about the home. However, the registered provider demonstrated that information about the content and availability of the service user guide is sent to people in response to all initial enquiries. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 10 Surveys received confirmed that people felt they had had enough information about the home prior to admission on which to base a decision. Residents and visitors spoken with confirmed that they or their relatives were able to visit the home as part of their selection process. In discussion, the manager said they now encourage people to come to the home so that they can undertake the pre-admission assessment at that time and they have included more questions on the assessment form in order to understand peoples needs better. They also said in the AQAA that each application is given careful consideration by the homes management to ensure that Broadoaks is able to meet the needs of that person. Admission assessments were available on files sampled. They contained basic information on peoples needs, for example relating to mobility, diet, vision, hearing, sleeping patterns etc. One of these was dated as completed on the day the person was admitted. There was no recorded reason to explain why the home had admitted a resident in this way or how management were able to give the application appropriate consideration. A resident profile is completed by residents and their relatives on/soon after admission and provides more detailed information on the individuals religious/cultural needs, hobbies and occupations, physical needs, skin condition, mobility, diet, continence, hygiene and personal care preferences, psychological needs, behaviours and abilities such as going out independently and self-medication. They were signed by the resident where possible and also by the family and manager, which is good practice. Following an issue raised at the last inspection, the manager states in the AQAA that residents will be informed in writing following initial assessment as to whether Broadoaks can meet their needs. Evidence of this however was again not available at the site visit. The manager confirms in the AQAA that that intermediate care is not offered at Broadoaks. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be treated with dignity and respect. Shortfalls in care planning, risk assessing and some aspects of medication management means that residents cannot be assured that their needs will always be met. EVIDENCE: Residents spoken with said that they were satisfied with the care or am totally satisfied. In resident surveys, three of the four received indicated that people felt they always received the care and support they needed. In surveys, relatives felt that the care home always or usually meets the needs of the resident and provided the care and support that they expected or agreed. Comment included the care provided is of the highest quality and Broadoaks has a very comfortable family atmosphere and a high standard of care. The manager states in the AQAA that what they could do better is to redesign the residents’ care plan. Care plans were requested for sampling for three residents. The care management plan for each person continued to be written on part of one page. In discussion, the manager stated that this is not enough Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 12 to include all the information necessary and as the print is so small it also makes it hard to find the information. The manager confirmed that care plans need to provide more space to include information on all the persons needs and opportunity to provide clear instructions for staff on how these are to be achieved in practice. It was also discussed with the manager that for all admissions, at least an interim care plan, based on detailed pre-admission assessments, should be in place on admission. Two of the care plans sampled contained basic information relating to some of the persons identified needs and preferences but did not follow up the information in the assessment form that they did not sleep well or had a poor diet. This assessment in one case did not identify accurate information regarding the person’s particular sensory impairment. A risk assessment form was in place that included falls, challenging behaviour, mobility, sensory needs, self-medication, medical needs and night risks as well as a body chart. It was positive that where a high risk was identified relating to mobility, a moving and handling assessment was in place. However where a medium risk of falls was identified, there was no care plan in place, even though the resident had a particular sensory impairment. It was of concern that no care plan was in place for the third resident to instruct staff on how to meet this persons needs. The manager confirmed that the person was admitted on the day they came for a pre-admission assessment, that there was a lack of clarity as to whether the person was admitted for respite care, and the time period this might have entailed and how and when they were provided with their own personal items such as clothing. The resident was able to advise that they needed to put on weight. There was no nutritional assessment or any other risk assessments to ensure this persons well-being during their time at Broadoaks. There were also no daily care records provided relating to this resident’s care to support monitoring of their care and well-being. The manager was advised at the time of the site visit of the concerns relating to the absence of a care plan, risk assessments and daily care notes. As there is no registered manager in post at Broadoaks, a letter was subsequently sent to the registered provider informing them of the serious concern regarding the lack of evidence of affective care management and how this could potentially put residents at risk. Healthcare needs were identified in the care plans sampled. Residents spoken with confirmed that staff listened to them and would call the GP etc. if requested or if the resident was feeling unwell. The five resident surveys received confirmed that people feel they always receive the medical support they need. A survey was received from a healthcare professional who routinely visits the home. This indicated that the individuals’ health-care needs are met by Broadoaks, that staff monitor residents, seek and take professional advice, Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 13 residents are supported to exercise choice and self-determination, are supported to self-medicate and that their privacy and dignity is respected. A sample of medication administration records (MAR) was reviewed and no omissions were noted, which is good practice. Photographs of residents were available with the MAR to support identification, which is a noted improvement from the last inspection, although no photograph was available for the resident for whom there was no care plan. The number of medications received was recorded and it was noted positively that the date of opening was recorded on packet and bottled medications. One of the resident’s MAR reviewed against the medications remaining showed inaccuracies, with fourteen tablets of one medication unaccounted for and another medication having one too many tablets remaining in the pack. Another of their medications could have had four tablets missing but it was not possible to be sure of this as no start date was recorded. The record of controlled drugs was contained in an appropriate register, signed by two staff, counted down appropriately and the liquid remaining appeared to be an accurate tally. Protocols were not available for ‘as required’ medications to ensure that these were administered to residents in a consistent and effective way. The MAR for one resident was clearly marked as ‘Self-Medicating’ and only records the amount received. When requested, staff confirmed that no risk assessment was available regarding this to ensure the well-being of this resident and other people in the home. This is outstanding from the last inspection. All residents spoken with were clear that their privacy and dignity were respected by the staff at Broadoaks. Residents confirmed that staff knock on doors before entering and that doors are closed when personal care is being offered. This was observed in practice during the site visit, as was staff talking to residents in a courteous manner and allowing them opportunity to respond and be listened to. Residents also confirmed that they could choose to spend time alone in their room and one person said I have meals with the others but dont bother going into the lounge otherwise, I sit here and I have a little privacy to myself, I like that best. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents of Broadoaks can expect to experience a generally fulfilling lifestyle led by their preferences and choices, and to enjoy a varied menu. EVIDENCE: The AQAA states that the activities co-ordinators provide a programme of activities. The manager confirmed at a site visit that there is currently no activity coordinator in post. However there is a plan for one of the housekeeping staff to try the role and if successful to take it over on a regular basis. Care staff participate in the provision of activities a programme of activities was available, and a quiz was ongoing at the time of the site visit. The profiles completed by residents or their relatives on admission give information on peoples interests and pastimes. This was noted in the care plans sampled, was known to staff, observed in practice and confirmed by the residents. A comment from a relative surveys included slightly disappointed at the amount of stimulation (resident) receives as we feel they would benefit from more encouragement to participate in activities and from resident surveys need an activity co-ordinator as one left and has not been replaced and perhaps some form of simple activity in the lounge to motivate guests. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 15 Residents spoken with were generally satisfied with the opportunities provided and a few explained that they preferred to spend time in their room, and that their choice was respected. One person said they dont force you to do anything. Some residents go out with their family and friends and all residents spoken with felt that their visitors were welcomed. Relatives spoken with confirmed that they always felt welcome at Broadoaks. Residents spoken with and records sampled confirmed that they do exercise choice and control in their everyday life at Broadoaks including issues such as what to eat, where to eat, what time to get up and go to bed, where and how to spend their time, who to have visit them or not, whether for example to drink tea or coffee or alcohol and what to wear. It was evidenced that residents’ independence is encouraged, an example of this was where a resident goes out each day to buy their own newspaper or to attend their own optician appointments. The manager states in the AQAA that they have introduced a new four-week menu and this was observed in practice. Residents were offered a choice at both lunch and tea and the food observed was well presented. Small circular tables provided a homely atmosphere with opportunity for social interaction and were nicely set with cloths, napkins and condiments. The chef confirmed appropriate qualifications in food hygiene and that residents views had been sought and respond to it in the changes to the menu. The chef was also aware of peoples specific dietary needs and preferences as identified in their assessments/care profiles and this diversity was respected. Ample food stocks were observed. All comments either from surveys or conversations with residents were very complimentary regarding the food at Broadoaks. These included the food is nice always and very wholesome, I need to put on weight and have come to the right place, the food is lovely and there is lots of it, the food is excellent and there is more than enough and plenty of choice, you can have your choice of food here and theres so much of it. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 16 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Broadoaks can expect to be listened to and to be generally safeguarded by staff knowledge that could be better supported by more up-todate information. EVIDENCE: A copy of the comments, complaints and suggestions procedure was available. Information on this and the opportunity to log complaints was available in the main entrance hall near to the visitors signing in book. The AQAA advised that it had recently been reviewed, however this was not found to be so. The document provided with dated February 2002, referred to the Commissions predecessor, gave the wrong contact information and erroneously indicated that the Commission for Social Care Inspection would investigate their complaints if the home could not resolve it. It had not been updated as recommended at the last inspection to inform people of their right to take complaints to social services. The manager stated that no formal complaints had been received since the last inspection. They advised that smaller issues are dealt with on a daily basis and recorded within the individual residents care notes. The commission had not received any formal complaints regarding Broadoaks. A number of thank you cards/complements were available. One recent one included the comment thank you for all the excellent care given over the years. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 17 Residents and relatives spoken were very clear that they would be able to raise any concerns or issue they were not happy with and one resident said I definitely could say if something wasnt right . This was also confirmed in the information received in surveys, however a relative added a comment we have found sometimes that we need to raise issues more than once. Following the recommendation in the last inspection report to review and update the homes policy and procedure on safeguarding vulnerable people, the AQAA advised that this had recently been undertaken. Again however the manager advised that an updated procedure was not available. The manager did not have access to the current guidance, protocols and contact details for safeguarding vulnerable people as identified in the last inspection report. The manager stated that no safeguarding referrals had been made since the last inspection. It is noted positively that a number of staff have attended updated training on basic safeguarding awareness. Staff spoken with were able to identify types of abuse and confirm that they would report it without hesitation, to their manager or more senior person within the organisation or to the commission if that was appropriate. The manager’s training on safeguarding was that organised for/directed at care staff some four years ago. It was recommended that she obtain updated training as well as information on current protocols and procedures. The manager was able to confirm that she would take appropriate steps to protect the resident in the event of an allegation and to report it both to the organisation and any other professional body that needed to be involved, for example the police. Recruitment procedures that are not as robust as they should be to safeguard people are discussed in the section on Staffing. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 18 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): 19, 22, 23, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents of Broadoaks live in a pleasant, comfortable and homely environment, where the addition of a ramp would better meet residents needs. EVIDENCE: Broadoaks has a pleasant large lounge and separate dining room overlooking the front garden. A new large screen television had been provided in the large lounge. The AAQA advises of a plan to upgrade the lounge furniture. All bedrooms are single occupancy and are fitted with a telephone point and television aerial point. There are two smaller lounges/visitors room available if people would like private visits without going to their room. Alternatively one of the rooms has a television set where people can watch something other than the programme showing in the main lounge. The AQAA advises that a number of bedrooms and hallways have been decorated and various carpets replaced and this was seen during the tour of Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 19 the premises. The carpets in the dining room and one of the smaller lounges were stained and in need of attention. Residents spoken with were very satisfied with their individual rooms all of which were personalised to varying degrees. Residents confirmed that they had been able to bring small pieces of furniture, photographs and ornaments to make their room more homely. One person said I have a lovely room. The service user guide clearly informs residents that should they wish to lock their room, they need to tell the manager and a lock will be fitted for them. Several residents have had their own telephone installed. A survey included the comment “Broadoaks is a lovely home, very clean and comfortable”. The AQAA advises of the plan to provide level access and enhancement to the back garden and this was already underway. The access, paved patio area, pergola and raised flowerbeds for resident use will provide an additional facility available to all residents and an opportunity for those who are interested in gardening. One resident said it will be lovely when its finished as they will be able to access it. The annual development plan for Broadoaks identified a plan to investigate the need for improved disabled access to the front of the building. Some residents and relatives spoken with the site visit, as well as comments in a survey received, indicated that the lack of ramped access to the front of the building causes them some difficulty. A resident said that they did “not like being bumped up and down to get in and out”. A survey contained the comment “there are no readily accessible ramps at Broadoaks. This makes it very difficult to use a wheelchair, as I need help. The staff are always willing to help but they need not be called upon if ramps were installed. The issue of lack of ramped access for those with mobility issues and wheelchair users has been raised previously in inspection reports. All areas of the home were clean and odour free. The laundry was suitably equipped and well-organised. All surveys received from residents and relatives and all those residents and visitors spoken with at a time of this inspection said that the home is always fresh and clean and that there are never any unpleasant odours. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Broadoaks can expect to be cared for by friendly, helpful staff, but can not be reassured that staff are safely recruited and trained. EVIDENCE: The manager advised that minimum staffing levels at Broadoaks are two carers and one senior throughout the day and one carer and one senior at night. The seniors provide a handover to the next shift so ensuring up-to-date information on residents is available. The rotas sampled showed there is no housekeeper support in the afternoon and at weekends, and no cook on some weekends, which means care staff have to manage these tasks as well. Information from resident and relative surveys showed some variance in their view of staffing levels and levels should be regularly reviewed. Comments included “sometimes carers are not available when I need help to use the toilet and I have to wait for help, sometimes feel hurried” and “I never have to wait more than five minutes for assistance”. A relative expressed the view that staff are not readily available to residents in the lounge at times. Residents spoken with privately at the site visit said that care staffing levels are satisfactory including response times to call bells. Observed and overheard interaction between staff and residents was positive and respectful. All comments received regarding staff were positive and Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 21 complimentary such as “the staff are very nice, I like them all” and “staff are approachable and willing to help.” Broadoaks has achieved its development plan of enrolling more staff for NVQ training, which is positive. The manager advised that six staff have achieved NVQ 3 and the remaining care staff have either achieved NVQ 2 or are enrolled/undertaking the training. Additionally two staff that have achieved NVQ 2 are planning to now progress to NVQ 3. Certificates to evidence this were seen on the staff training files sampled. In her AQAA, the manager states that some of the recruitment documentation is completed by head office to free up the managers time and that staff files contained all the necessary documents, including criminal record bureau checks. Recruitment files were reviewed for three staff employed since the last inspection to assess if appropriate information, references and checks had been undertaken to ensure that prospective staff are suitable people to care for the residents at Broadoaks. The files sampled did not contain all the required information. Povafirst checks were available, which is a noted improvement from the last inspection. Evidence of criminal record bureau checks were not available, and outstanding issue from the last inspection. Additionally concerns were identified including references being taken up and accepted from mobile phone numbers, a full employment history not being obtained, gaps in employment history/reasons for leaving not being explored and recorded and no photograph/evidence of identity. While some profiles and photocopies of criminal record bureau checks were seen to be available for agency staff there was no profile or evidence of identity, induction, training and appropriate references and checks available for an agency staff member confirmed as working at the home very recently, but there was a certificate of NVQ2 in Care. A relative survey said “when agency staff are required a system should be in place to make sure they are fully trained”. In the AQQA the manager states they carry out a robust induction programme for all new staff, and as identified in the last inspection report acknowledges that they could do better in ensuring the induction programme training booklets are completed within the recommended timescales. Induction workbooks based on the Common Induction Standards were available. There was no evidence of induction being completed for two of the staff and while the other workbook was completed by the staff member, there was no signature from any mentor or senior staff to confirm and evidence the accuracy of the information and to confirm competence. Surveys received from three staff indicated that they felt they had had a full and thorough induction. The manager does not maintain a training matrix and the benefit of this supporting her in ensuring that staff have training and updates in a timely manner was discussed. In her AQQA, that the manager identifies her plan for Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 22 improvement in the next 12 months as updating staff training requirements. Staff files sampled showed that two staff who have been in post between three and four months have still not completed moving and handling training yet the manager is qualified to train people in moving and handling. For one staff member, who has no previous experience in care, the only training evidenced on their file related to fire training. The three staff surveys received indicated that staff felt they received training appropriate to their role and that helped them to understand the needs of the service uses. The manager was advised at the time of the site visit of the concerns relating to staff recruitment and staff induction/training. As there is no registered manager at Broadoaks, a letter was subsequently sent to the registered provider informing them of the serious concern regarding the lack of evidence of robust recruitment, structured induction and basic mandatory training and how this could potentially put residents at risk. In Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect a home that is mainly run in their best interests, but some management systems, record-keeping and health and safety aspects may not best promote their well-being. EVIDENCE: The area manager confirmed the information noted in the AQAA that the registered manager had resigned that post and was now working as a deputy manager. The Commission had not been notified as required. The area manager advised that an application has been made to register the current manager. The Commission had no record of this application. The manager has experience of working as a deputy manager at Broadoaks. They have achieved the registered managers and also had evidence of training Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 24 for example for fire awareness, infection control, Parkinsons awareness, health and safety and appointed person first aid. The manager is also trained to train others in moving and handling. In the AQAA, the manager states that an important part of their approach to quality assurance is to obtain the views of all their stakeholders, particularly those of residents and their friends and relatives. Minutes were available of resident meetings and also of six monthly relatives meetings. Within the first month after admission, residents are asked to complete a survey about the admission process that also ensures that people know who to speak to and how to make a complaint or suggestion. Annual surveys are also undertaken and the information from this and other sources are used to inform an annual development plan for the home. Reports were available that showed that the registered provider regularly checked on how well the home was running, which is good practice. It is disappointing that these had not identified the concerns noted by this inspection, so that timely action could have been taken to address them. As stated in the AQAA, residents are encouraged look after their own money but support is available were required. The system for managing residents’ money was found to be satisfactory. Safe storage was available and records of money paid out was supported by two signatures and individual receipts. Accident records were maintained and cross-referenced in the daily notes. Guidance was provided to the manager on keeping individual people’s records separately to comply with Data Protection. This would include accidents, weight and bath records and is an outstanding recommendation from the last inspection report. It would also ensure that all information relating to each person was part of their current care file/plan so that it was an accurate working document. An analysis of accidents was requested to review if there was any pattern to help prevent reoccurrence. The manager will consider introducing this as part of the quality monitoring audits. Concerns regarding the maintenance of some records has been identified in the relevant sections of this report. In the AQAA, the manager says that all staff receive a copy of health and safety at work literature and training is given to them to undertake their duties safely. Evidence of this was not available on all of the staff training files sampled. Aspects of health and safety were reviewed and not all was in place to support resident safety. A current inspection certificates was available relating to the heating but not for the fixed electrical wiring. There were weekly checks of the fire alarm system and monthly checks of the fire equipment. Checks of the water temperatures were being undertaken quarterly and the manager should review this to ensure compliance with the homes risk assessment and that it adequately promotes residents’ safety. A recent letter from Essex Fire and Rescue Service confirmed a satisfactory level Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 25 of fire safety in the home. Staff records sampled evidenced fire awareness training. The record of fire drills however evidenced that not all staff have had opportunity to participate. This is outstanding from the last inspection report. Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 26 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 2 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 2 2 X X 2 X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 2 Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1)d Requirement So that people can be reassured their needs will be met, the manager must confirm in writing to each prospective resident that, based on their assessment, they are able to meet the person’s needs in respect of their health and welfare. So that residents are cared for safely and in a way that meets all of their care needs, each person must have care plan. Care plans must identify all their individual assessed needs supported by risk assessment, for example relating to self medication, and give staff clear instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. This is an outstanding requirement from previous inspections with the most recent timescale of 17/09/07 not fully met. 3. OP9 13(2) Records of medicines DS0000018064.V370077.R01.S.doc Timescale for action 01/10/08 2. OP7 15(1) 01/10/08 12/08/08 Version 5.2 Page 28 Broadoaks administered to residents must be accurate and complete and that written protocols or guidance are in place for medicines prescribed on a “when required” basis. This will show residents receive the medication prescribed for them, and in a consistent way. 4. OP29 19, 17(2) Sch 2&4 So that residents are safeguarded, there must be evidence of robust and safe recruitment procedures and all the required records and documents must be available at all times for inspection. This includes for agency staff. This is an outstanding requirement from previous inspections with the most recent timescale of 17/09/07 not fully met. 5. OP30 18(1) a&c 13(5)&(6) Ensure that staff receive appropriate training to the work they perform. This refers to evidencing timely induction training and continuing basic training issues for all staff as well as training on specific conditions associated with the needs of people living at the home. This will ensure that staff have the competence, confidence and ability to meet resident’s care needs. This is an outstanding requirement. Previous timescale of 17/09/07 not met in full. 6. OP37 17 & Sch3 Ensure that records required by regulation are maintained in the home. This includes a photograph of each resident and a record of any correspondence DS0000018064.V370077.R01.S.doc 12/08/08 12/08/08 12/08/08 Broadoaks Version 5.2 Page 29 relating to each resident. This is an outstanding requirement. Previous timescale of 17/09/07 not met in full. 7. OP38 23(2)c The manager must ensure that the premises are safe for residents. A current safety inspection certificate relating to the electrical fixed wiring must be available. To promote the safety of residents and staff, all staff must be involved in fire drills and practices at suitable intervals so that they know the procedure to be followed in the case of fire, including the procedure for saving life. 15/09/08 8. OP38 23(4)d 15/09/08 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 OP1 Good Practice Recommendations To ensure people have the widest range of information available, the services of guide should be provided to interested parties and prospective residents prior to admission. The activities coordinator post should be recruited to and the availability and range of activities provided should continue to develop to meet resident preferences and needs. So that people have access to full and accurate information, an up-to-date complaints procedure should be available in the home. This should clarify that the Commission is not a complaint investigation agency. DS0000018064.V370077.R01.S.doc Version 5.2 Page 30 2. OP12 3. OP16 Broadoaks 4. OP18 So that staff have access to full and accurate information to safeguard residents, an up-to-date policy and procedure on protecting vulnerable people and whistleblowing should be available in the home along with a copy of the local safeguarding guidelines. So that residents have a pleasant environment, the stained carpets should be cleaned or replaced. So that residents’ needs are met suitable arrangements should be made to improve wheelchair access to their home. The level/designation/deployment of staff should be kept under review to be sure that they remain sufficient to meet residents needs at all times. To promote the safety and well-being of residents, visits undertaken as required by Regulation 26 and other audits should be sufficiently thorough and robust to identify areas that need improving or breach Regulation. To comply with the Data Protection and promote positive care outcomes for residents, all records relating to the resident and their care should be maintained on their individual file. To ensure resident safety, the manager should ensure that hot and cold water temperatures are undertaken at regular intervals. 5. 6. OP19 OP19 7. OP27 8. OP33 9. OP37 OP7 10. OP38 Broadoaks DS0000018064.V370077.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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