Inspection on 26/11/07 for Broadwater Lodge

This inspection was carried out on 26th November 2007.

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

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

Other inspections for this house

Broadwater Lodge 02/07/07

Broadwater Lodge 09/08/06

Broadwater Lodge 23/08/05

Broadwater Lodge 08/04/05

Broadwater Lodge 16/08/04

Broadwater Lodge 20/05/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Broadwater Lodge Broadwater Lodge Summers Road Farncombe Surrey GU7 3BF Lead Inspector Pauline Long Unannounced Inspection 26th November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broadwater Lodge DS0000013892.V352106.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. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadwater Lodge Address Broadwater Lodge Summers Road Farncombe Surrey GU7 3BF 01483 414186 01483 422232 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) manager.burroughs@careuk.com Care UK Community Partnerships Ltd vacant post Care Home 67 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (6), of places Physical disability over 65 years of age (4), Sensory Impairment over 65 years of age (3) Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 5 (five) persons may be aged 50-65 years in the categories PD or DE Up to 10 persons may be admitted to the home for short stays only Date of last inspection 2nd July 2007 Brief Description of the Service: Broadwater Lodge caters for the needs of older people, providing permanent and respite care, including specialist dementia care and a day care service. The home is situated in Farncombe a short distance from the local shops. Community facilities are nearby and easily accessible to the home. Residential accommodation comprises of 5 self-contained units. All bedrooms are of single occupancy, and the seventeen newly built rooms have en-suite toilet facilities. Each unit has its own bathrooms, toilets, lounge, dining area and kitchenette. The gardens are nicely arranged and safe for the residents to enjoy. Broadwater Lodge has spacious communal areas and the residents are encouraged to use and enjoy the whole building. The fees at this service range from £390.00 per week to £800.00 per week. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was a second unannounced ‘Key Inspection’. The inspector arrived at the service at 09.00 and was in the service for 7.5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The management arrangements at the home have changed since the last inspection. The registered manager left the organisation in July 2007. At present the home is being managed by a manager designate. For the purposes of this report she will be referred to as the acting manager. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. On the day feedback from some of the residents was limited due to their communication difficulties. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The CSCI would like to thank the residents, the acting manager, staff and visitors for their hospitality, assistance and co-operation during the site visit. What the service does well: The manager and staff demonstrated an open and inclusive approach to the residents care. The residents benefit from a long standing staff team, some of whom have worked in the home for years, and this was reflected in the level of knowledge and understanding of the needs and preferences of the residents. The home promotes and encourages contact with family/friends and the local community. Residents and relatives were complimentary about the care and services provided by the home. They commented, “that the care they received was good” and “the staff are very good, that they remained friendly and approachable and nothing was too much trouble”. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 6 From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. What has improved since the last inspection? What they could do better: Review the risk assessment process in respect of a resident being responsible for administering their own medication to ensure that other residents are not put at risk by staff leaving medications on a resident’s bedside table. Whilst it is noted that the home has a large and well-equipped activities room, there was little evidence of residents being provided with or being involved in meaningful activities. Some areas of the home are poorly cleaned and are unhygienic. Improvements must be made in the infection control measures throughout the home. The arrangements for the disposal of clinical waste must be reviewed to ensure that all bathrooms and toilets have appropriate clinical waste bins. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 7 All toilets must be kept clean, with particular attention paid to the aids being used. The carpets in some of the communal areas are heavily soiled and the stains cannot be removed. The carpets must be replaced to ensure that residents live in a clean and pleasant environment. Requirements have been made in respect of these areas. Please refer to pages 29 and 30 of this report. 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. Broadwater Lodge DS0000013892.V352106.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 Broadwater Lodge DS0000013892.V352106.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): 1,3,6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are provided with enough information in order for them to make a judgement as to whether or not the home can meet their needs. Residents are only admitted to the home following an assessment of their needs, ensuring the home can meet these needs. The home does not provide for intermediate care. EVIDENCE: The Statement of Purpose was sampled and evidenced that it reflected all information required in Schedule 2 of the Care Homes Regulations 2001 (as amended). It detailed what prospective residents can expect and gave a clear account of the services provided, the qualifications and experience of staff and how to make a complaint. It had been amended to reflect the details of the Acting Manager. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 10 The process of assessing a prospective resident needs had been improved. The Manager or Deputy will now go to a prospective residents’ home or to a hospital in order to carry out a care needs assessment. The care needs assessments sampled were satisfactory and included all daily living activities for example washing, dressing, mobility, manual handling, eating, drinking, skin, memory, night care, continence, nutrition/weight and life histories. The acting manager stated that several of the residents in the home are social service clients and that a community care needs assessment would be sought prior to accepting a referral from them. These assessments were evidenced in two of the files sampled. The home does not provide for an intermediate care service. Broadwater Lodge DS0000013892.V352106.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): 7,8,9,10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents health and social care needs are set out in an individual care plan, which gives clear guidance to staff as to how their needs are to be met. Changes in resident’s health care needs are appropriately identified, and referred to the relevant health and social care professionals in order for these needs to be met. Residents are not fully protected by some of the medication practices in the home. Residents are treated with respect and their privacy and dignity are promoted. EVIDENCE: The home has recently recruited a clinical manager who is responsible for supporting the team leaders in ensuring that all care related documentation is in place, up to date and accurately reflects the resident’s needs and goals. All the records related to care are recorded and stored electronically. Each unit and all offices are connected to the home’s IT system. Following the last inspection concerns were raised about the staffs abilities in using this system Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 12 and the subsequent quality of the information recorded on the system. All staff had undertaken further training in the use of this system and have been assessed in respect of their competencies in this area. One of the social service’s care managers commented that following this training, care plans had improved and provided more detail. Staff were observed entering information onto the system and they appeared confident in what they were doing. The information sampled gave a holistic view of a resident. Three residents care plans were sampled and were found to be satisfactory. They included information on all daily living activities and likes and dislikes. The information recorded gave the reader a good overview of a residents needs, identified risks, health care needs and goals. All the plans sampled had been regularly evaluated and updated according to ongoing needs. Discussions were had with the manager in respect of the involvement of relatives in developing the care plans. She stated that at present she was providing a hard copy of each care plan in order that relatives could read, and indicate their agreement by signing the care plan. To-date three relatives had signed their relatives care plans. A resident had signed one of the care plans sampled. Risk assessments had been undertaken and included falls, challenging behaviours, manual handling, risks around skin integrity, use of bedrails and nutrition. The acting manager commented that the organisation was reviewing the use of bedrails and that other equipment in respect of a residents safety in bed was being considered. There was evidence in all care plans sampled of referrals to General Practitioners, District Nurses and hospital appointments. Health care professions commented that “the home cares for older people well” and that the views of GPs and other professionals are sought in a timely fashion ensuring residents health care needs are appropriately met. In the previous inspection report reference was made to the shortfalls of the organisation’s Clinical Governance Team and their auditing of the home’s care records. A review has been undertaken and the acting manager now undertakes weekly audits with input from the Clinical Governance Team as required. Records of these audits were sampled and evidenced weekly checks. The previous inspection report referred to the considerable number of notifications of residents falling at the home. It should be noted that these notifications have decreased. Discussions were had with the manager in this respect, she stated that the home had involved a health care professional from the local Primary Care Trust, who carried out a comprehensive “Falls Audit” and as a result provided the home with more guidance and recommendations as to how to manage and minimise falls. She also stated that the home continues to work within the Organisations Falls Strategy Management process, for example: those residents at risk of falls are provided with Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 13 protective aids and referrals to the Falls Clinic. As mentioned in the previous paragraph, the Clinical Governance Team monitor the home’s records on a regular basis via the IT system in order to identify any falls and to offer guidance and advice to the home. The home’s policies and procedures in respect of administration, recordkeeping and storage of medication were sampled. Medication administration was observed and found to be carried out in a sensitive manner. However, it was noted that some liquid medication and tablets had been left on a resident’s bedside table. This was brought to the clinical manager’s attention who stated that the individual liked to take their medication after their breakfast. No risk assessments were in place, nor was this recorded in the resident’s care plan. Whilst it was noted that this resident was not confused, the majority of the residents at the home have dementia, and can move around the home freely and therefore would be able to access this medication. Discussions were had with the acting manager in respect of the risks to other residents. She agreed that it was not acceptable and that the resident’s care plan and risk assessments would be amended to ensure that their medication would not be left on their bedside table. The acting manager confirmed that the care plan and risk assessment in respect of this resident had been amended and that other residents would not be put at further risk. The storage of medication was found to be safe as was the storage of controlled medication. Medication record sheets and the controlled drugs register were sampled, and were found to be well documented with no gaps in signatures noted. Discussions were had with the care staff about the home’s medication policies and procedures. It was evident through these discussions, that the staff had a good understanding of the policies and procedures, however the procedures and practices should be reviewed and reinforced with staff to ensure they are following procedures and not leaving residents at risk to their health and safety. The home has a medication audit in place where the clinical manager checks medication records sheets once a week for omissions in signatures. These records were sampled and evidenced checks being undertaken. The clinical manager discussed the medication training at the home. She stated that only staff who had undertaken medication training and who were deemed competent were permitted to administer medications. Care staff confirmed this. Training records evidenced that medication training had been undertaken in this respect. Throughout the inspection process, staff were observed carrying out various aspects of personal care for the residents, this support was offered in a Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 14 respectful and sensitive manner for example, knocking on doors and waiting to be invited in, before entering rooms. Bathroom doors were kept closed whilst attending to residents personal care needs. Relatives commented that the home had “dedicated staff who really care” and that the staff were “friendly and helpful”. Health care professionals, residents and relatives commented that, all of the staff were kind and treated them with respect. One relative commented that at times her relative was dressed in other peoples’ clothes. This was discussed with the manager at the time, she stated that no one had complained in this respect but that she would address any issues brought to her attention. A requirement and a recommendation have been made in respect of these areas. Please refer to pages 29 and 30 of this report. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from a well structured and implemented activities programme, their social and recreational interests and needs are not being appropriately met. Relatives and friends are encouraged to visit the home in order to maintain contact with their relatives. Residents are encouraged and enabled to makes choices in their lives and meal times at the home were observed as being a pleasant experience for the residents. EVIDENCE: The acting manager stated that the home is committed to ensuring that the residents maintain their relationships with their family and friends. Some relatives and visitors were observed visiting the home during the site visit. The staff commented that all residents are encouraged to take part in all activities and social events, not all wish to take part. All the staff had recently undertaken training in respect of Activity Based Care (ABC), discussions with them indicated that they were keen to put this training into practice and they referred to some activities that they had been doing, for example encouraging the residents to undertake some of the dusting, setting the tables and tidying Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 16 away the laundry. The home benefits from a large well-equipped activity room. On the day it was noted that no planned activities were taking place. Several residents were asleep in their chairs, televisions and radios were on, and some residents were chatting to each other. One resident was observed tidying up their own bedroom and appeared to be enjoying this as they were humming a tune whilst doing so. Care staff were unsure as to what activities were on. There was evidence of an up coming Christmas activity, with notices in various places throughout the home inviting families to attend. Relatives and Care Managers commented that the activities provided at the home were poor and one relative commented that their relative never goes out of the home. The lack of structured activities at the home was discussed with the acting manager at the time, who stated that there had been recent discussions with the activities organiser in this respect The home actively encourages all residents to practice their faith and staff are aware of the importance of spiritual support. Residents are encouraged to attend the monthly Church service held at the home, or if they wish to go to the local church the home would provide support in this respect. Some residents were observed moving freely around the home, making choices as to how they would spend their day. The acting manager stated that the home is committed to ensuring the residents maintain their relationships with their family and friends and that they are welcome to have their meals with their relative during their visit. Some relatives and visitors were observed visiting the home during the site visit. One visitor stated that he spent a lot of time at the home with his relative and that on occasion he stayed overnight and found this very helpful. They were also looking forward to the festive season at the home. Other relatives commented that they are encouraged to visit the home when they wish and that all of the staff are welcoming. The meals at the home are provided by an outside catering company and are prepared as Cook/Chill. The four-week menu was sampled and was seen to be well balanced, wholesome and allowed for seasonal changes. Two main courses and a vegetarian option are offered each day. Discussions were had with the cook in respect of residents likes and dislikes. He demonstrated a good understanding of each residents likes and dislikes and specialist diets, for example diabetic, vegetarian and soft diets. Residents and relatives commented that the food at the home was good. One relative commented that her relative was a vegetarian, but that at times they were given meat with their meal. Discussions were had with some of the care staff about residents likes and dislikes around food. They referred to one of the residents who was a vegetarian and the meals they were offered. The relative’s comments were discussed with the manager, and she stated she would speak with the cook and the staff about the feedback from relatives. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 17 Time was spent on each unit during the lunch time period. Residents were given choices as to what they would like to eat. The tables were nicely set, and staff commented that some of the residents had helped with this task. The food was nicely presented, it looked appealing and appetizing. Residents commented that the food was nice. A recommendation has been made in respect of these areas. Please refer to pages 29 and 30 of this report. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 18 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, 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints and safeguarding policies and procedures. EVIDENCE: Two complainants have contacted the Commission with information concerning a complaint made to the service since the last inspection. These were referred to the home for investigation. The home has received four complaints since the management arrangements at the home changed in July 2007. Evidence seen indicated that all the complaints had been investigated under the home’s complaints procedures and been satisfactorily resolved. Relatives commented, that they were aware of the complaints procedure, and if they had any reason to complain, they would speak with the manager. One relative however, commented that they were unaware of the complaints procedure. The home’s complaints procedure is provided in each of the residents bedrooms and various prominent positions throughout the home. We sampled a number of compliment and thank you cards received at the home since the last inspection, for example; “It is nice to know my relative is in good hands and being looked after well” and “thank you for all of your support over the last year, we could not have done it without you”. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 19 Following the inspection in July, information was received at the CSCI office in respect of incidents not being reported under Regulation 37 of the Care Homes Regulations 2000 (as amended). As a result of this information a referral was made by the home under the Local Authority Safeguarding Procedures. Meetings have been held in this respect, the issues have been investigated and have been satisfactorily resolved. Discussions were had with the staff on duty and scenarios put to them in respect of the home’s safeguarding adults and complaints procedures. Staff interviewed demonstrated a good understanding of the policies and procedures and how to report concerns. All were confident that any concerns raised with the acting manager would be dealt with appropriately and quickly. Following the issues discussed at the Safeguarding meetings all the staff group had undertaken further training in Safeguarding Adults. This was evidenced in the training records. Staff confirmed they had undertaken this training. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 20 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): 19,24, 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortable and able to meet the changing needs of the residents. However, areas of the home are poorly cleaned with inadequate infection control systems in place. EVIDENCE: The home is a purpose built property and has been extended to provide a further seventeen bedrooms with en-suite facilities, two smaller lounges/quiet rooms and conservatories, where residents and families can spend time if they wish. The acting manager discussed the plans for refurbishing and the purchase of further furnishings. A tour of the home was undertaken and it was noted that several areas of carpet were badly stained. This was discussed with the clinical manager, who stated that the carpet-cleaning machine had been broken for some time and that a new one had been ordered. The acting Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 21 manager confirmed this, however she stated that the carpets would need to be replaced, as the stains could not be removed. Residents bedrooms had been nicely personalised with photographs, pictures, small items of furniture and ornaments. Several of the bedrooms benefit from specialist profiling beds, which provide those frailer residents with beds more suitable for their changing needs, and provide staff with a safer working environment. It was noted staff were observed using protective clothing and gloves in order to minimise the risk of cross infection. However there were concerns about the standard of cleanliness, hygiene and other infection control measures in some areas of the home. Several of the toilets were without clinical waste bins, a soiled incontinence pad was left sitting on one of the radiators. One of the legs on a raised toilet seat was smeared in dried faeces. These areas were brought to the attention of the clinical manager at the time and were later discussed with the acting manager. During the tour of the home a member of staff was observed on two occasions to leave the cleaning trolley unattended. This was discussed with the clinical manager and the acting manager at the time. Some relatives and health care professionals commented that there was a concern about malodours in the home. On the day of the site visit, however, the majority of the home was freshly aired. Discussions were had with the acting manager in respect of the comments made, she stated that she was not aware of any complaints about malodour and that the staff were working hard to minimise any malodour. Requirements have been made in respect of these areas. Please refer to pages 29 and 30 of this report. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff in the home are appropriately trained, and in sufficient numbers to support the people who use the service. Resident’s health, safety and well-being are protected by the recruitment and selection procedures and practices at the home. EVIDENCE: On the day the staffing levels were adequate for the dependency levels of the residents living at the home. The staffing rotas and observations evidenced that there were eleven care-workers, an activities co-ordinator, two domestic staff, one cook and one kitchen assistant on a morning shift. Ten care-workers on an afternoon shift including two team leaders, five care-workers and one team leader on a night shift. A new deputy/clinical manager has been recruited to work at the home and started working in September 2007. She has the overall responsibility for care practice in the home. She stated that she had been working closely with the staff in respect of all aspects of care practice, she also stated that she worked on night duty in order to identify and address any concerns and to support the night staff in implementing changes to the care plans. Staff spoken with confirmed this. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 23 Relatives commented that they were delighted with the staff at the home and the staff were kind, and helpful. One resident commented that the staff looked after them very well. The home’s recruitment practices were sampled, and found to be good. Four staff files were sampled and all had the required documentation in place, with evidence of CRB (Criminal Records Bureau) or POVA (Protection of Vulnerable Adults) checks. There was evidence of the staff interview process on each of the sampled files, indicating that the recruitment process was based on equal opportunities. Staff files sampled, and work based observations evidenced that the home employs a diverse staff group. Following the safeguarding referral and subsequent senior strategy meetings the Organisation was told to undertake further training with all staff at Broadwater Lodge. Discussions with staff indicated that this training had been undertaken. Training records evidenced that statutory and various current good practice training had been undertaken since the last inspection for example: management of falls, Activities Based Care (ABC), catheter care, manual handling, end of life, exploring difficulty’s, supervision and appraisal, accident incident reporting, risk assessment, fire, and dementia care. The L Box system of training can now be accessed by all staff through the main computer system and is no longer dependant on the staff sharing a laptop computer. Staff commented that it was much easier and they were more able to complete this training. The home is proactive in promoting NVQ (National Vocation Qualifications), the acting manager stated that 14 of the staff were undertaking an NVQ in care and several have achieved the qualification. The manager commented that training courses were arranged to ensure that all staff have an opportunity to attend, for example; training courses timed in the evenings and at night time to enable the night staff and staff with carer responsibilities to attend. It was noted that on two occasions a cleaning trolley was left unattended. Discussions were had with both the domestics about this practice. One was quite clear that these trolleys should not be left unattended due to the potential risks to the residents and also commented on the COSHH (Control of Substances Hazardous to Health) training they had undertaken. The other member of staff did not appear to know what this training was and why cleaning materials should not be left unattended. This was discussed with the manager at the time, who, stated that the member of staff had undertaken the training, and that further training would be undertaken with this individual. The manager confirmed the following day that this training had been booked for the 3rd of December 2007. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35, 36,37,38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents benefit from an open and inclusive management approach to the running of the home. Their views are sought, listened to and acted upon. Resident’s financial interests are safeguarded by the home’s procedures. The health, safety and welfare of the residents are not fully promoted due to the unsatisfactory arrangements in place for the disposal of clinical waste. EVIDENCE: The management arrangements at the home have changed since the last inspection. The previous manager left the organisation in July 2007. An acting manager has been in place since then. She stated that a permanent manager is expected to be in position in early January 2008. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 25 The acting manager is a registered nurse with thirty years experience in health and social care. It was observed that she interacted well with the residents and they appeared relaxed in her company. Care managers and health care professions commented that communication with the home was much improved since the acting manager started work at the home, one in particular commented it had improved 100 . Discussions with the staff indicated that they were confident that the acting manager would deal with any issues brought to her in a timely fashion. They commented that having a new manager was a very positive thing and they were optimistic for the future of the home. The acting manager stated that she was in the process of setting up more regular meetings with the residents and their relatives. At present meetings are held, but somewhat infrequently. A representative from the Alzheimer’s Society, the most recent one being in November 2007, chairs these meetings. The organisation undertakes a yearly audit of service users views and this forms part of the overall Quality Audit. The home also send out service user questionnaires to residents and their relatives. Some were sampled and were found to be complimentary of the care service provided at the home. As discussed earlier in this report we sampled a number of compliment and thank you cards received at the home since the last inspection. The acting manager undertakes weekly audits on all aspects of the service provided at the home. Records in respect of these audits were sampled. Discussions were had with the acting manager and administrator in respect of the resident’s personal finances. The home holds small amounts of monies in resident’s personal accounts in order to meet the day-to-day needs for toiletries, reading materials and other consumables. The records in respect of three of these personal accounts were sampled and were found to be accurate and well documented. Discussions with the manager and care staff evidenced that one to one staff supervision meetings are being held. All the team leaders have undertaken training in staff supervision and appraisal and have been allocated a group of staff in this respect. Care staff confirmed that they had meetings with the manager or a senior member of staff. Supervision records also evidenced this. Staff are also expected to attend regular staff meetings, the most recent one having been held on the 14th of November. Care staff confirmed this. Health and safety audits are routinely carried out at the home. Risk assessments are completed and reviewed in respect of risks to residents and staff. A member of staff fully qualified in first aid is on duty twenty-four hours a day. Records evidenced that water temperatures, fire drills and fire bells and other safety equipment had been regularly checked. All the equipment in the home had been properly maintained and serviced. Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 26 As discussed earlier in this report there were concerns around some medication practices, the acting manager addressed this on the day. Cleaning materials were left unattended, this was also addressed on the day. The cleaning in some areas of the home was unsatisfactory, and there was a lack of appropriate infection control measures in respect of clinical waste bins. Requirements have been made in respect of these areas. Please refer to pages 29 and 30 of this report. Broadwater Lodge DS0000013892.V352106.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 12(2) Requirement Review the process for risk assessing those residents who wish to administer their own medications. The risk assessments must include any risks to other residents who may have access to the individual’s bedroom. Clinical waste materials must be disposed of safely. Suitable arrangements must be in place for the disposal of clinical waste. All of the bathrooms and toilets must have the appropriate clinical waste disposal bins. All areas of the home must be kept clean. Particular attention must be paid to the aids used in the toilets. The badly soiled carpets in the communal areas must be replaced. Timescale for action 26/12/07 2. OP38 16(k) 26/12/07 3. OP26 23(d) 26/12/07 4. OP26 16(2)( c ) 26/03/08 Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 1. Refer to Standard OP10 OP12 Good Practice Recommendations To review the arrangements in the laundry for identifying residents clothes in order to ensure that residents wear their own clothes at all times. To undertake a review of the activities offered in the home in order to ensure that the arrangements in place are appropriate and that resident’s social, recreational interests and needs are met. To review the likes and dislikes of all of the residents in respect of their meal choices to ensure that they are being provided with their choice of food. 2. OP15 Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Broadwater Lodge DS0000013892.V352106.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!