Inspection on 29/11/07 for Broadwindsor House

This inspection was carried out on 29th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broadwindsor House 14/02/07

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 John Hurley Key Unannounced Inspection 29 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 Broadwindsor House DS0000068144.V345813.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. Broadwindsor House DS0000068144.V345813.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 Broadwindsor House DS0000068144.V345813.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. 14th February 2007 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. 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. 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. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced key inspection of Broadwindsor House care home for the inspection year 2007/8. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. The views of the people who use the service and people important to them were also sought by questionnaire and through conversation at the inspection where appropriate their comments are included in this report. The registered manager provided an Annual Quality Assurance Assessment document that has also been used to assess the performance of the home. The inspector toured the building, spoke with the management and staff on duty and where possible spoke privately with people who those who use the service on both an individual and group basis. They inspected a sample of the documentation relating to the individuals who reside at the home along with records relating to staff and other documents required by regulation. What the service does well: The information provided by Broadwinsdor House provides comprehensive information about the services on offer. This information ensures that prospective residents are able to make informed decisions about admission to the home. The home pre admission assessment process is good and ensures that prospective residents needs can be met. Broadwindsor House continues to have 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. The home works well with other agencies such as district nurses and doctors in ensuring peoples health care needs are met. Social activities and monthly entertainments are arranged to provide stimulation and interest for residents. The home has a good quality assurance programme where people’s views relating to the service are sought. The response’s received are then used to make improvements to the service where possible. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The registered manager needs to ensure that ; • • There is a recorded rationale and practice guidelines for the administration of medication via the per required needs (PRN)route. Staff receive regular documented supervision in order to ensure a consistent approach to meeting the needs of the residents. It is recommended that the home reviews it adult protection policy to ensure it reflects the local authorities policies. It further recommended that the home takes steps to improve the seating arrangements in the dinning room for the comfort and independence of those who use the service. Finally it is recommended that the management make plans to ensure staff have opportunities to train in dementia care. 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. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 7 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 Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has thorough pre-admission procedures that provide information and opportunities to assist the resident when making a decision about moving in. Care assessments are clear, concise and reflect the needs of the individual. EVIDENCE: The documentation relating to new and prospective residents continues to contain good details relating to the individuals presenting issues as well as a good social history. Their assessed health and social needs are clearly recorded and evidences that health care professionals, care managers and the individuals family had been involved in the admissions process. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 9 The residents spoken with at the time of the inspection confirmed that they were included in the admissions process. Through sampling the residents documentation there was good evidence available to indicate that people important to residents had been included in the admissions process, where appropriate. The homes management continues to carry out their own initial assessment to ensure that they can meet the needs and aspirations of any prospective placement. These assessments include areas such as pressure sore management issues, manual handling issues as well as individual risk assessments. These assessments were reflective of any local authority assessments. Intermediate care is not a feature of this service. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 10 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 this service. The care planning and review of existing plans demonstrate how needs are being met. Good links with health professionals have been maintained to enable residents’ health needs to be met. The home has a good medication management system ensuring the safety of residents but there needs to be a clear rationale for the administration of medication via the per required needs route. EVIDENCE: Twenty-four hour care is provided. Arrangements are made for chiropodists, opticians and other health and social care professionals to visit individual residents. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 11 The inspector observed staff being kind and caring towards residents. Staff spoken with demonstrated a good awareness of how to meet resident’s needs. Residents comments included ‘staff couldn’t be kinder or more friendly’ and ‘the staff are very good’. The feedback from people important to the residents further confirmed these observations. All of the care plans examined are based upon information provided from preadmission assessments. Following admission to the home, further assessments are carried out and the home draws up a care plan identifying the needs of each individual and how staff are to meet these needs. To aid correct identification of the individual each record contains a recent photograph of the resident. For those residents that require it pressure-relieving equipment is provided in partnership with the district nursing team. The inspector viewed the medication administration recording sheets and noted that in general terms these were kept well. However from sampling these records it was found that one issue needed to be addressed. Some directions are required relating to the administration of medication on a Per Required Needs (PRN) basis. The registered manager accepted these observations and agreed to look at making the necessary changes without delay. Residents are able to meet privately with visitors in their bedroom or in one of the lounges. Interaction between staff and residents was friendly and respectful. Through discussion with the resident the inspector established that the care staff fully respected their privacy and dignity and that they were not made to do anything they did not wish to, such as attending activities or having meals in the dining room. They further confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. The care plans and associated documents supported these representations. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 12 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): 11,12,13,14 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pace of life appears to suit the resident’s expectations and aspirations. Visitors are welcomed and residents are assisted with maintaining contact with relatives and friends. The food is home cooked and appears to offer a balanced diet to those who live at the home. EVIDENCE: The residents confirmed that they could spend their time as they want to and that they are given choices. The inspector toured the building and noted that many of the residents rooms were personalised with their own possessions. Residents spoken with were satisfied with the activities provided, some liked to join in others did not. Visitors are welcomed at the home. There are planned activities, which provide extra stimulation to the resident group. These range from singing and bingo, gentle exercise, ball type games and outings. Several residents told the inspector that they knew what activities Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 13 were taking place, some they liked others they did not. Given that the home provides two good sized communal areas those who choose not to participate do not have too. The inspector joined the residents for lunch. The food was home cooked and plentiful, the residents confirmed that this was always the case. The inspector observed one person who was finding the seat uncomfortable and was provided with extra cushions. (The inspector also found the chairs uncomfortable). The chairs did not have any arms on them to maximise independence when getting up nor did they have adequate cushioning. Several different staff assisted those residents who required support during meal times. This is not good practice and it is considered that the staff need to have a structure to support individuals in a more dignified manner during this period. Some residents choose to have some of their meals in their own rooms, staff work hard to ensure that resident wishes are met. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents felt confident that any complaints or concerns would be listened to and taken seriously. The registered manager needs to ensue that the homes adult protection policy reflects the local authorities policies in order to ensure a consistent approach to vulnerable adult concerns EVIDENCE: A complaints procedure is in place. The people who the inspector spoke with and feed back received via questionnaires informed them that people felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager is very approachable and will deal with any issues, no matter how minor, there and then if they could. The home keeps a record of any complaints made. The complaints procedure was displayed and issued to new residents. The Protection of Vulnerable Adults (POVA) training manual was available, staff confirmed having training regarding the POVA, and the manager confirmed that a POVA check is performed at the time of requesting a CRB check prior to starting work. On inspecting the homes vulnerable adults policy it was established that the policy does not reflect the local authorities policy, it would be helpful if it did. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,24,25,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have benefited from a number of improvements in their environment. A comfortable and clean standard of accommodation is being provided for the residents. The residents would benefit from a better standard of seat in the dining area. EVIDENCE: 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 Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 16 lawned areas, surround the home. A range of garden furniture and a large patio area are available for those wishing to sit outside. 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. Whilst there are some small steps to negotiate when entering the home there is also a purpose built ramp to ensure the building is assessable. The inspector toured the premises accompanied when they first entered the home inspecting a number of communal areas. They found that the home was generally clean in all areas observed. It was noted that all toilet and bathrooms were found to be clean and hygienic. A programme of maintenance is in place and the home is pleasant and well maintained. There has been a degree of inward investment into the home. There is new call bell system allowing staff to respond quickly to calls for assistance as well as the provision of new fire doors and fire detectors. It was also noted that one of the communal bathrooms has been upgraded to provide a purpose built wet room. The residents confirmed that on the whole they liked the new arrangements. When a residents room is vacated it is assessed for redecoration and refurbishment prior to any new admission. Laundry facilities are sited appropriately and infection control procedures are in place. 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. The corridors are well illuminated with a number of prints on the walls. There are a number of seats discreetly placed in corridors allowing individuals to rest if needed, handrails are also provided to aid independence around the home. As mentioned earlier there is a need to look at providing a better range of seating in the dining room to aid independence and comfort. The registered manager acknowledge the inspectors comments with regards to this matter and assured them that it has been highlighted as requiring updating when funds allow. Residents are able to bring personal possessions with them into the home. The rooms that were inspected had been personalised with pictures, furniture and photographs. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 17 The inspector pointed out to the manager that some of the window open restrictors were defective. The registered manager informed the inspector at the end of the inspection that action would be been taken to address this issue. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have received regular training with regards to the tasks they daily perform in order to meet the needs of the people who use the service. There is evidence that new staff receive a structured recorded induction into the care home. EVIDENCE: The registered manager confirmed there is enough staff on each shift to meet the residents needs. This was also confirmed by residents who commented that staff are always available to help and were very attentive. New staff confirmed that they have undergone a thorough recruitment and selection process by way of a formal interview and statutory checks to establish their suitability to work in the home. All new staff receive a comprehensive induction when they start at the home, one staff member has responsibility for supporting each of them through this process. All elements of the induction process are signed by both parties to confirm the element has been completed and understood. In addition to this new staff complete the mandatory training required by the regulations. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 19 This induction process is good as it ensures that new staff have the basic skills required to start supporting people at the service. Staff have undertaken mandatory training such as Fire Awareness, Moving and Handling, Food Hygiene and Infection Control. Some staff have also attended various day courses. Some care staff has undertaken the NVQ Award in Care at varying levels. As the home cares for some residents with a dementia type illness it would be helpful if more training was provided in this area to ensure staff can meet the future needs of that resident group. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home continues to be well managed and provides a needs lead service. Systems are in place for consultation with residents. More needs to be done to ensure that staff have formal supervision in order to evidence residents needs are being met in a consistent manner. EVIDENCE: Feedback from surveys from residents and relatives was very positive, and described the home as well run. There have been no changes to the homes management since the last inspection. The management continue to have a Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 21 good understanding of the National Minimum Standards required and how they should be met. The registered manager has now passed her NVQ4 in care management as required. Prior to the inspection the registered manager submitted an Annual Quality Assurance Assessment to the Commission. This assessment was both informative and objective. The staff continue to appear relaxed and confident in their roles and demonstrated good understanding and empathy with the resident. Staff continue to express appreciation for the assistance given during the induction process. Through discussion with the staff it was clear that they have discussions with the manager. These discussions could be described as a form of supervision but the inspector considers that they should be documented so as to demonstrate how the standard is being met. The feedback from the resident confirmed that they felt a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed the inspector that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. The home carries out a regular quality assurance assessment and uses the results to guide and inform future plans. The home is not involved in managing the finances of residents. A range of servicing and maintenance records was seen at this inspection, including gas and electrical certificates, service records for equipment such as the hoist; all were satisfactory. Accidents were recorded appropriately. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 22 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 3 3 x 3 3 x 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 3 X 2 X 3 Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered manager must record the rationale for the dispensing of medication on as required basis so that resident receive their medication in a managed way that prevents maladministration. The registered person must ensure that staff receive regular formal supervision. Timescale for action 01/02/08 2 OP36 18(2) 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations It is recommended that the registered manager updates the home vulnerable adults procedure so that it reflects the local authorities procedures. DS0000068144.V345813.R01.S.doc Version 5.2 Page 24 Broadwindsor House 2 3 OP19 OP30 It is recommended that the registered manager makes plans to purchase and provide new dinning room furniture It is recommended that the management make plans to ensure staff have opportunities to train in dementia care. Broadwindsor House DS0000068144.V345813.R01.S.doc Version 5.2 Page 25 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. 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