Inspection on 14/02/07 for Broadwindsor House

This inspection was carried out on 14th February 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

Broadwindsor House 29/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Broadwindsor House Broadwindsor Beaminster Dorset DT8 3PX Lead Inspector Marjorie Richards Key Unannounced Inspection 14th February 2007 10:10 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 DS0000068144.V330349.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. DS0000068144.V330349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadwindsor House Address Broadwindsor Beaminster Dorset DT8 3PX 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) 01308 868353 helen.dawe@btconnect.com Florence Lodge Healthcare Ltd Mrs Helen Elizabeth Dawe Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places DS0000068144.V330349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The schedule of requirements is completed within the agreed timescales. Any service users accommodated on the second floor must be fully ambulant and able to self-rescue to the first floor on fire alarm actuating. Mrs Dawe must complete NVQ level 4 in management and care by December 2007. Evidence of successful completion must be forwarded to the Commission. First inspection under new ownership Date of last inspection. Brief Description of the Service. Broadwindsor House is a care home providing personal care and accommodation for up to twenty-one older people. The registered provider is Florence Lodge Healthcare Ltd. and the registered manager is Mrs Helen Dawe. The provider also employs the services of a management company to provide additional support to the home. Broadwindsor House is a large detached house originally built as a rectory during the early 1830’s. The home is set in extensive grounds on the edge of Broadwindsor village and is approached by a private driveway leading to the home and a spacious parking area for the use of visitors. Broadwindsor House provides care and accommodation in a total of 20 bedrooms, including one shared room. Residents’ bedrooms are arranged on the ground, first and second floors. Just over half of these have either en-suite facilities in their rooms or adjacent facilities for their own use. There are sufficient bathrooms and W.C.’s to meet the needs of residents. A passenger lift is provided to assist access between floors. The communal areas include a spacious lounge, a small sitting area in the hallway and a separate dining room. The lounge and dining rooms overlook the landscaped gardens. Spacious grounds, with mature trees, shrubs and lawned areas, surround the home. A heated outdoor swimming pool is available and most of the grounds are accessible to residents. A range of garden furniture and a large patio area are available for those wishing to sit outside. Twenty-four hour care is provided. Arrangements are made for chiropodists, opticians and other health and social care professionals to visit individual residents. Laundering of personal clothing is carried out on the premises. DS0000068144.V330349.R01.S.doc Version 5.2 Page 5 All meals are prepared and cooked within the home. A choice of menu is offered and a variety of alternatives are available to suit individual taste and preference at mealtimes. Special diets can be catered for. Social activities and monthly entertainments are arranged to provide stimulation and interest for residents. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from £475 - £650 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoosing a care home .aspx Once published, a copy of the home’s first inspection report will be made available to anyone wishing to read it and is included in the Information File in the entrance hall. DS0000068144.V330349.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Broadwindsor House underwent a change of ownership on 22nd August 2006, when Florence Lodge Healthcare Ltd took control. This unannounced inspection took place over 9.75 hours on the 14th February 2007. The main purpose of this initial inspection since the change of ownership was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress with the planned refurbishment. On the day of inspection, 20 residents were accommodated. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with a total of nine residents. The daily routine was also observed during the inspection. Discussion took place with Mrs Helen Dawe the registered manager, a representative of the management company and also with members of staff on duty. For the purposes of this report, people who live at Broadwindsor House are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well: A Service User Guide is available which provides comprehensive information about Broadwindsor House. The home also has a thorough assessment procedure to ensure that prospective residents are able to make informed decisions about admission to the home and only those whose needs can be met will be offered places there. The home assures prospective residents in writing that their needs can be met. Clear pre-admission assessment information had been recorded for two residents who recently moved into Broadwindsor House. Mrs Dawe says that she always visits prospective residents or invites them to the home, prior to making a decision as to whether Broadwindsor House is suitable to meet their needs. An assessment form has been developed for this purpose. DS0000068144.V330349.R01.S.doc Version 5.2 Page 7 Broadwindsor House has a good care planning system in place, which ensures that staff have the information they need to meet the needs of residents. Wherever possible, care plans are agreed and signed by the resident themselves, or, if this is not possible, by a relative or representative. Health care needs are well met and there is good support from community health professionals. Staff were seen to be treating residents with courtesy and kindness during the inspection. Residents commented, I think the staff are very good on the whole, they look after me very well.” I feel I am well looked after. The staff are mostly mature and sensible people, who appear well trained and knowledgeable. The home has a piano and organ in the lounge and residents are able to participate in meaningful and enjoyable social and recreational activities. Entertainment is arranged on a monthly basis. During the day, a number of residents enjoyed going outside to see the wonderful displays of snowdrops in bloom in the grounds. Events are also arranged, such as a summer barbecue, to which residents and their relatives are invited. An interdenominational communion service is held in the home on the first Thursday in every month. Visitors are made welcome at any time. A telephone is always available to residents so they may make or receive calls from family and friends. Several residents have their own telephones installed in their bedrooms. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. They are able to bring their own possessions into the home to personalise their bedrooms. Residents confirmed that their individual preferences and routines are respected. For example, “I came here because I wanted the security of knowing help was at hand if needed, not to be told what to do. They respect my wishes and allow me to choose what I do and when. If they did not, I would not stay here.” Meals are appetising and of good quantity and quality; they are served in an attractive dining room and staff provide assistance to residents if necessary. Special diets are catered for. Local suppliers are used to provide regular deliveries of fresh fruit and vegetables, bread, meat, fish, eggs and cheese. The following comments were received from residents: I must admit that I enjoy the home-made cakes in the afternoon. We had shortbread today which was very good. The cook is very pleasant and very willing to please. The food is generally very good. If we dont want what is on the menu, we can have something else. DS0000068144.V330349.R01.S.doc Version 5.2 Page 8 The home has a complaints policy and procedure and residents seem confident that any concerns would be taken seriously and dealt with appropriately. Comments include: Any small concerns are dealt with straight away. I have never had to complain formally.” If something is wrong, I find the new manager to be very approachable and she soon sorts things out.” The home is spacious and comfortable and surrounded by attractive grounds. There is ample car parking available for visitors. A number of improvements are currently taking place, as part of the planned refurbishment of the home under the new ownership. Residents have access to a spacious lounge and a separate dining room, both of which overlook the gardens. Bedrooms are very individual, comfortably furnished and most are very well personalised. The home is clean and there are no unpleasant smells. Residents felt the laundry service was good and the home was kept clean and tidy. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. Staff appear well motivated and enthusiastic in their work. Residents commented, The staff are excellent, I cannot fault them.” I get on well with the staff. I know the families of some of them, as most are local people. This helps me to feel at home here.” Robust employment and recruiting procedures are in place to ensure the protection of residents when employing new staff. The registered manager, Mrs Dawe, has a good rapport with residents, visitors and members of staff and this was demonstrated throughout the inspection. Residents spoke highly of the manager: “I think this place is very well managed. It seems to run very smoothly.” “I think Helen (manager) is doing a good job. You know where you are with her; she is always very honest in what she says. What has improved since the last inspection? What they could do better: Some members of staff have received basic training in medication practice, which has been provided by the pharmacy. However, it is recommended that a more comprehensive Safe Handling of Medicines course is made available for all staff dealing with medication. DS0000068144.V330349.R01.S.doc Version 5.2 Page 9 Four staff have still not received Adult Protection training, to ensure a proper response to any suspicion or allegation of abuse. Mrs Dawe confirmed that this would take place as soon as possible. The inspection revealed some concerns about the environment and these were discussed with Mrs Dawe. Hot water temperatures at baths and wash hand basins were tested and some found to be much below the recommended temperature of 43°C, to prevent any risk of scalding. Some areas of the home felt cold and it was found that not all radiators were working properly. A few rooms in the home are not centrally heated, for example the suite on the second floor, where wall mounted heaters are used in the bedroom and lounge with a central heat/light fitment in the bathroom. Temperatures on the second floor landing and corridor measured only 17° to 18°C. It was also noted that many doors to bathrooms and WCs open inwards, which may cause access difficulties for staff if a resident fell behind the door. It is recommended that risk assessments be carried out, to see if alterations would be beneficial. (The provider has subsequently informed the Commission that a new boiler has been installed to resolve difficulties with radiators and hot water temperatures. Bathroom and W.C. doors are being risk assessed and alterations made where possible.) The home is currently not meeting the target of at least 50 trained members of care staff at NVQ level 2, to ensure residents at Broadwindsor House are in safe hands. Mrs Dawe is hoping to encourage more staff to undergo NVQ training. It is a condition of registration that Mrs Dawe must obtain an NVQ level 4 in management and care by December 2007. Mrs Dawe feels she is currently on course to meet this condition before this date. Risk assessments are in place where necessary and work is commencing shortly to fit guards to radiators and pipework to protect residents from potentially hot surfaces and ensure their safety. Mrs Dawe says it is also intended to fit limiters to some windows for safety purposes. It is advised that the banister rail on the main staircase be assessed by a suitably qualified person to ensure its safety. 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. DS0000068144.V330349.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000068144.V330349.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Broadwindsor House. Information provided about Broadwindsor House and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met by the home are offered places there. The home assures prospective residents in writing that their needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. The Service User Guide gives a good indication of what a resident can expect from the home. It can be found in an Information File in the hallway at Broadwindsor House and copies are also provided in every bedroom. This Information File contains details about the services available in the home, such as hairdressing, chiropody, opticians and dentists. Information is also provided about menus, DS0000068144.V330349.R01.S.doc Version 5.2 Page 12 activities and the results of a Quality Assurance survey carried out in the home in September 2006, with analysis and an action plan. A copy of the last inspection report (under previous ownership) is available. Details of the home’s procedure for making a complaint and the Terms and Conditions document (contract) are also available, alongside the Office of Fair Trading’s report, “Fair Terms for Care.” Clear pre-admission assessment information had been recorded for two residents who recently moved into Broadwindsor House. Mrs Dawe says that she always visits prospective residents or invites them to the home, prior to making a decision as to whether Broadwindsor House is suitable to meet their needs. An assessment form has been developed for this purpose. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs can be met. Copies of such letters were evidenced on file. DS0000068144.V330349.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Broadwindsor House. Broadwindsor House has a good care planning system in place, which ensures that staff have the information they need to meet the needs of residents. Health care needs are well met, with evidence of good support from community health professionals. The home has procedures in place for managing medication, to ensure the safety of residents. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. EVIDENCE: Following admission to the home, further assessments are carried out and a care plan is drawn up, identifying the needs of each resident and how staff are to meet these needs. DS0000068144.V330349.R01.S.doc Version 5.2 Page 14 To aid correct identification, each record contains a recent photograph of the resident. Care planning documentation is comprehensive. It includes questions about how the resident likes to be addressed, their wishes regarding the gender of staff caring for them, religion, ethnicity and spoken language. Care plans for three residents were examined. They inform how care is to be delivered to meet residents’ personal, social and healthcare needs. Detailed assessments, including general and specific risks are recorded. Corresponding care plans have been produced outlining how these risks are to be minimised. Subsequent meetings, observation and/or discussions with the three residents concerned demonstrate that care is being delivered as detailed in the care plans. Mrs Dawe says that, wherever possible, care plans are agreed and signed by the resident themselves, or, if this is not possible, by a relative or representative. This was evidenced on the care plans examined. Care plans give personalised information to assist staff in ensuring good quality care. For example, one of the care plans examined details twenty-one precise instructions for staff when carrying out personal care, to ensure the resident’s needs and particular wishes are fully met. Detailed daily records are written by staff to evidence the care being provided. During the inspection, members of staff demonstrated that they have a good knowledge of residents’ individual care needs. Examination of care plans shows that regular reviews are taking place and information is updated as necessary, to reflect any changing needs. The daily records evidence the care being provided. These show that residents have access to General Practitioners, district nurses, dentists, chiropodists, opticians etc and this was later confirmed in discussion with residents and staff. The home has systems in place for managing medicines. A medication policy is in place, which is concerned with the safe management and handling of residents’ medication. Medicines managed by the home for residents are stored securely. A monitored dosage system is in place. Administration of medicines is recorded onto the Medicine Administration Record (MAR) charts. Residents are able to look after their own medicines, subject to risk assessment. Lockable facilities for the safe storage of valuables and medicines are available to residents. Some members of staff have received basic training in medication practice, which has been provided by the pharmacy. However, the manager is looking to provide a more comprehensive Safe Handling of Medicines course for all staff dealing with medication. DS0000068144.V330349.R01.S.doc Version 5.2 Page 15 Residents expressed satisfaction with Broadwindsor House and in the presence of staff appeared relaxed, confident and at ease; staff interactions with residents were friendly and considerate. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff were observed throughout the inspection to be treating residents with courtesy and kindness, with due regard for dignity and respect. Residents commented, I think the staff are very good on the whole, they look after me very well.” I feel I am well looked after. The staff are mostly mature and sensible people, who appear well trained and knowledgeable. Residents confirm that they are able to go to their own bedrooms whenever they wish, thereby offering an opportunity to be on their own or allowing privacy for any visitors or personal care needs. A resident commented, I can go wherever I choose. I stay in my room much of the time, but the lounge and dining room are both attractive rooms and it is nice to socialise sometimes. DS0000068144.V330349.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Broadwindsor House. A range of activities and entertainment provides variation and interest for residents. The home is currently gathering information about residents social, cultural, religious and recreational interests, to ensure their needs and expectations are fully met. Residents are supported to maintain contact with family and friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. Broadwindsor House serves a balanced and varied selection of food that meets residents’ tastes and special dietary needs in surroundings of their choice and at times which are convenient to them. EVIDENCE: Basic information about the social, cultural and religious needs of people moving into the home is recorded in assessments and care plans. Residents, their relatives and staff are currently being invited to be involved in the DS0000068144.V330349.R01.S.doc Version 5.2 Page 17 preparation of “Life Histories,” giving information about each resident’s personal history, hobbies and interests etc. Such information will help to ensure that activities can be tailored to meet individual needs and wishes and will be looked at during the next inspection. The home has a piano and organ in the lounge. A new television, video and DVD player has also been provided. Activities are available, including gentle armchair exercises, soft darts, quizzes, card games and bingo. Entertainment is arranged on a monthly basis. During the morning of the inspection, a group of residents were sitting in the lounge taking part in gentle armchair music and movement and during the afternoon they enjoyed a general knowledge quiz with the staff. These were social occasions, with plenty of humour and conversation at the same time. During the day, a number of residents enjoyed going for a walk in the garden. Several commented on their appreciation of being taken in wheelchairs by the staff to get some fresh air and see the wonderful displays of snowdrops in bloom in the grounds. Discussion with residents during this inspection shows that many are satisfied with the activities being provided. Events are also arranged, such as a summer barbecue, to which residents and their relatives are invited. Arrangements are made for clergy to visit individual residents upon request and an interdenominational communion service is held in the home on the first Thursday in every month. Mrs Dawe says that visitors are welcome to visit the home at any time. Residents and staff confirm that visiting times at Broadwindsor House are unrestricted. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Several residents are able to go out alone and others with staff or relatives. A telephone is always available to residents so they may make or receive calls from family and friends. Several residents have their own telephones installed in their bedrooms. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that their decisions to spend their time as they please are respected by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in many of the rooms viewed during the inspection. Residents are encouraged to make choices, e.g., about what to wear and what to eat or drink and to come and go as they please. Residents confirmed that their individual preferences and routines are respected. For example, “I came here because I wanted the security of knowing help was at hand if needed, not to be told what to do. They respect DS0000068144.V330349.R01.S.doc Version 5.2 Page 18 my wishes and allow me to choose what I do and when. If they did not, I would not stay here.” I know I am not the easiest person to please, but the staff know what I like and do their best to provide it. At breakfast time, most residents enjoy a variety of cereals, with toast and marmalade etc but a cooked breakfast is also available on request. Lunch on the day of inspection was fruit juice, (apple, orange, pineapple or cranberry) roast pork with crackling, apple sauce and stuffing, or meatloaf, with roast and creamed potatoes, buttered cabbage and carrots, followed by lemon meringue pie or fruit and ice cream. A range of alternatives, such as jacket potatoes with a variety of toppings, omelettes and soups, is always available to suit individual taste and preference. One resident prefers to have their cooked meal in the evening, with only a snack at lunchtime and these wishes are accommodated. The evening meal was pâté on toast or a selection of sandwiches, followed by homemade scones with jam and/or fresh fruit. Residents may choose where to eat their meals and mealtimes can be flexible to fit in with personal wishes, care needs, appointments etc. Special diets are catered for and discreet staff assistance is available for those who need help with their food. The cook demonstrated a good knowledge of residents’ dietary needs, likes and dislikes. She visits residents each day to explain the menu and ask what they would like to eat. A new menu has recently been introduced after consultation with residents. This is displayed in the dining room. The cook demonstrated that she had ample supplies of fresh, frozen, tinned and dry foods available. Wherever possible, local suppliers are used to provide regular deliveries of fresh fruit and vegetables, bread, meat, fish, eggs and cheese. Mealtimes are unhurried and residents had plenty of time to sit and enjoy their lunch on the day of inspection. It is intended to refurbish the dining room in due course, including the replacement of all the existing dining furniture. The following comments were received from residents: I must admit that I enjoy the home-made cakes in the afternoon. We had shortbread today which was very good. The cook is very pleasant and very willing to please. The food is generally very good. If we dont want what is on the menu, we can have something else. The food used to be unimaginative, but it is getting better now. I enjoy my meals in the main. I think a score of 9/10 is about right overall.” I cannot fault the food served here. DS0000068144.V330349.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Broadwindsor House. A system is in place for dealing with any complaints. Residents are confident that complaints would be listened to and dealt with appropriately. The home has a comprehensive Adult Protection policy in place to ensure residents are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available to visitors in the Information File in the entrance hall. The complaints record shows that two complaints have been received by the home since registration in August 2006. Both were found to be partially substantiated and appropriate action taken. Discussion with residents demonstrates that they feel able to voice a complaint if necessary and their concerns are taken seriously, and acted upon. Comments include: Any small concerns are dealt with straight away. I have never had to complain formally.” If something is wrong, I find the new manager to be very approachable and she soon sorts things out.” DS0000068144.V330349.R01.S.doc Version 5.2 Page 20 The home has a comprehensive Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Secrets document, which is also available to staff. Four staff have still not received Adult Protection training, to ensure a proper response to any suspicion or allegation of abuse. Training is being booked for the remaining staff and Mrs Dawe confirmed that this would take place as soon as possible. DS0000068144.V330349.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Broadwindsor House. A programme of refurbishment and redecoration has commenced, to ensure that residents live in comfortable and well-maintained surroundings where standards are constantly improving. However, there are currently problems with the heating and hot water systems in some areas of the home and these need to be resolved for the benefit of those residents whose rooms are affected. Residents have access to pleasant communal areas, including large grounds, which surround the home. Bedrooms are comfortably furnished and individually personalised to suit their occupants. Broadwindsor House is clean and there are no unpleasant odours, so that all residents live in a pleasant environment. DS0000068144.V330349.R01.S.doc Version 5.2 Page 22 EVIDENCE: A tour of the building demonstrated that improvements are taking place, as part of the refurbishment of the home planned by the new provider. A new call bell system has been installed which allows the manager to monitor all calls to ensure they are answered in a timely fashion. New equipment has been purchased for the kitchen and water jugs with lids provided for bedrooms. New curtains and blinds have been provided in the lounge, along with a new television with Freeview channels. Some carpets have been replaced and others are planned for renewal. Moving and handling equipment has been purchased, along with new sit-on weighing scales. One of the smaller bathrooms is being converted to a wet room with shower facilities. Records show that continual work is carried out to keep the home and garden in good condition, with a member of staff employed to carry out maintenance tasks. Care staff confirm that prompt attention is always paid to any minor defects. The inspection revealed some concerns about the environment and these were discussed with Mrs Dawe. Hot water temperatures at baths and wash hand basins were tested and some found to be much below the recommended temperature of 43°C, to prevent any risk of scalding. In one bedroom, the temperature at the wash hand basin reached 41.7°C after forty-five seconds, but this was much slower in other bedrooms. For instance, at one wash hand basin, the temperature reached only 24.7°C after five minutes, which is clearly not acceptable for bathing, washing or shaving etc. Some areas of the home felt cold and it was found that not all radiators were working properly. A few rooms in the home are not centrally heated, for example the suite on the second floor, where wall mounted heaters are used in the bedroom and lounge with a central heat/light fitment in the bathroom. Temperatures on the second floor landing and corridor measured only 17° to 18°C. It was also noted that many doors to bathrooms and WCs open inwards, which may cause access difficulties for staff if a resident fell behind the door. It is recommended that risk assessments be carried out, as making alterations may not be possible in some areas of the home. Residents have access to a very attractive, spacious lounge, which overlooks a patio area and the gardens. A further small seating area is available in the hallway. There is a separate dining room, which also overlooks the gardens. Both rooms are attractively presented. A large bowl of fresh fruit is available in the dining room and residents are expected to help themselves whenever they wish. Residents also commented on the beautiful floral arrangements positioned around the home. DS0000068144.V330349.R01.S.doc Version 5.2 Page 23 (The provider has subsequently informed the Commission that a new boiler has been installed to resolve difficulties with radiators and hot water temperatures. Bathroom and W.C. doors are being risk assessed and alterations made where possible.) Bedrooms are very individual, comfortably furnished and most are very well personalised. A programme of refurbishment has commenced and so far, one bedroom has been redecorated and provided with new carpets, curtains, bed, bedding and high-quality furniture and a second room is almost completed. Residents commented, I am very pleased with my room, I have everything I need. My room is very comfortable. I have all my own things around me, so it is just like home as far as possible. They said they were refurbishing when they took over, but I havent seen much evidence of this. It seems to be happening rather slowly. I am very happy here. My room is very pleasant with a wonderful view.” The standard of accommodation is satisfactory. Some furniture is quite elderly but I am told we shall be having new furniture soon. The home is clean and there are no unpleasant smells, making life within the home more pleasurable for all. Residents felt the laundry service was good and the home was kept clean and tidy. The home has suitable facilities and procedures in place in respect of the disposal of clinical waste. DS0000068144.V330349.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to Broadwindsor House. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards achievement of the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to ensure the protection of residents. A training programme has been commenced, so that staff will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the current needs of residents. The home currently employs a total of 20 staff, including two cooks, two cleaners and a maintenance person. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to DS0000068144.V330349.R01.S.doc Version 5.2 Page 25 the needs of residents appropriately and demonstrating good care practice when dealing with residents. Residents commented, The staff are excellent, I cannot fault them.” The staff are very good and I feel I am treated well. The staff are good, mostly mature, caring local women. The standard of care is very good and I am very happy here. I get on well with the staff. I know the families of some of them, as most are local people. This helps me to feel at home here.” Two members of care staff have now attained National Vocational Qualification (NVQ) level 2 and two staff are currently studying for NVQ level 3. Mrs Dawe is now working to achieve the target of at least 50 trained members of care staff at NVQ level 2 as soon as possible, to ensure residents at Broadwindsor House are in safe hands. Progress will be monitored at the next inspection. Two files for staff recently recruited were examined. These demonstrate that the home is operating a thorough recruitment procedure, to ensure the protection of residents. All necessary documentation is in place, including: • • • • • • • • Interview assessment form Application form with employment history Two written references Enhanced Criminal Records Bureau disclosure Protection Of Vulnerable Adults check ID documentation Contract of employment Record of training, copies of training certificates An equal opportunities policy underpins the employment practice of the home. All new staff receive induction training and this is now based on the Skills for Care Common Induction Standards. An audit of staff training has been carried out and a document produced which clearly identifies the training achieved by all staff in the home and where further input is needed. Mandatory training has commenced in moving and handling, Protection of Vulnerable Adults, first aid, etc. However, there are still a number of staff that have not completed this training. Mrs Dawe gave an assurance that further training is planned and it is hoped to complete all mandatory training in the near future. Copies of training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. To further assist the training of care staff there is available a range of opportunities including www.picbdp.co.uk (the Partners in Care web site), www.skillsforcare.org.uk (the Skills for Care web site), www.traintogain.gov.uk DS0000068144.V330349.R01.S.doc Version 5.2 Page 26 (a programme and funding stream supported by the Learning and Skills Council and Business Link) and www.lsc.gov.uk/bdp/employer/eggt_intro.htm (the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility). DS0000068144.V330349.R01.S.doc Version 5.2 Page 27 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Broadwindsor House. The home is well managed and Mrs Dawe demonstrates a good knowledge of the operation of the care home and the needs of its residents. It is a condition of registration that Mrs Dawe obtains National Vocational Qualifications, level 4 in care and management by December 2007. The home is reviewing its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. The premises and equipment are properly maintained in good condition but some work is still needed, for example fitting guards to radiators and pipework to protect residents from potentially hot surfaces and ensure their safety. DS0000068144.V330349.R01.S.doc Version 5.2 Page 28 EVIDENCE: Mrs Dawe is the registered manager at Broadwindsor House. She has worked in the home for a number of years in a variety of roles including more recently, acting care manager. She has experience in caring for older persons and is currently working towards her National Vocational Qualification (NVQ) level 4 in care and management. It is a condition of registration that Mrs Dawe must obtain an NVQ level 4 in management and care by December 2007 and this Standard cannot be fully met until this has been achieved. Mrs Dawe feels she is currently on course to meet this condition prior to December 2007. Mrs Dawe clearly has a good relationship with residents and staff. She says she always feels well supported by the registered provider, Florence Lodge Health Care Ltd. Residents spoke highly of the manager: “I think this place is very well managed. It seems to run very smoothly.” “I think Helen (manager) is doing a good job. You know where you are with her; she is always very honest in what she says. Staff commented: Helen is very good. She was one of us, so knows all of the problems.” Helen is very fair, very open and honest with staff. She tells it as it is. You always know where you are with her.” Quality Assurance questionnaires were sent out to residents, staff, relatives and other visitors to the home to obtain their views in September 2006. Feedback from these is available in the Information File in the entrance hall. One resident commented, I rate Broadwindsor House second only to my own home. In order to protect residents, the home prefers to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs have a relative or other representative to deal with their finances. At present, the home pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment. Information about advocacy services is available to residents and their relatives in the Information File within the home, should they need independent advice or support. From touring the premises, looking at records and discussions with staff and residents, it is evident that a number of measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, hoists and gas appliances etc are regularly serviced and maintained. All substances that could be potentially hazardous to health are handled and stored safely. Regular DS0000068144.V330349.R01.S.doc Version 5.2 Page 29 maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. Routine checks are carried out at appropriate intervals. Risk assessments are in place where necessary and work is commencing shortly to fit guards to radiators and pipework to protect residents from potentially hot surfaces and ensure their safety. Mrs Dawe says it is also intended to fit limiters to some windows for safety purposes. It is advised that the banister rail on the main staircase be assessed by a suitably qualified person to ensure its safety. DS0000068144.V330349.R01.S.doc Version 5.2 Page 30 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 DS0000068144.V330349.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP18 Regulation 13(6) Requirement The registered person must ensure that all staff receive suitable training in Adult Protection. The registered person must ensure that residents have access to an adequate supply of hot water for the purposes of washing, bathing and shaving etc and that heating levels are adequate in all areas of the home. The registered person must ensure that all staff receive training, including mandatory training, which is appropriate to the work they are to perform. It is a requirement that the registered manager obtains a National Vocational Qualification level 4 in management and care. Timescale for action 01/05/07 2 OP19 23(2)(j) and (p) 01/05/07 3 OP30 18(1) 01/05/07 4 OP31 9(2)(b)(i) 31/12/07 DS0000068144.V330349.R01.S.doc Version 5.2 Page 32 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 OP9 Good Practice Recommendations It is recommended that all staff who administer medicines should have accredited training on medicines, how they are used and how to recognise and deal with problems in use. It is recommended that a risk assessment be carried out to ensure the best possible staff access to bathrooms and WC’s in case of emergency. It is recommended that a minimum of 50 of care staff achieve NVQ level 2 training. It is recommended that, subject to risk assessment, windows should be limited and radiators and pipework guarded, or have guaranteed low temperature surfaces, to ensure resident safety. It is recommended that an assessment of the banister on the main staircase be carried out to ensure resident safety. 2 3 4 OP19 OP28 OP38 5 OP38 DS0000068144.V330349.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000068144.V330349.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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