CARE HOMES FOR OLDER PEOPLE
BROOM LANE 174 Broom Lane Rotherham South Yorkshire S60 3NW
Lead Inspector Sarah Powell Unannounced 21 April 2005 06.40. 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 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. BROOM LANE Version 1.10 Page 3 SERVICE INFORMATION
Name of service Broom Lane Address 174 Broom Lane Rotherham South Yorkshire S60 3NW 01709 541333 01709 700850 broom.lane@fshc.co.uk Four Seasons Healthcare (England) Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Heather McGrath CRH (N) 60 Category(ies) of OP (Older Persons) 60 registration, with number of places BROOM LANE Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: To provide eight Intermediate Care beds in The Broom Unit is granted as a condition of registration. Date of last inspection 08 December 2004 Brief Description of the Service: Broom lane provides nursing and personal care for service users over the age of 65, it also has 8 beds for intermediate care. All the rooms are single with some being en-suite. The home is in two units Broom and Sitwell, which are connected by a corridor. Nursing care is provided in the Broom building.There is a small garden areas to the front and rear of the home and adequate car parking facilities. BROOM LANE Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection in the year 2005/2006 and took place over one day the inspection commenced at 6.40 and finished at 14.00. The previous requirements were looked at with the manager. 32 Service users, 9 staff, 3 representatives and 2 visiting professionals were spoken to. What the service does well: What has improved since the last inspection?
Many improvements have occurred since the last inspection the manager has now been in post a year and received positive feedback from service users, visitors and staff. The intermediate unit has a new unit manager a clearly defined area was provided with their own lounge, dining room, toilets, bathrooms and kitchen. The service users are being properly assessed and meet the requirements to be admitted to the unit and the majority are being rehabilitated and returned home. A physiotherapist and social worker both commented that Broom Lane was doing a very good job on the intermediate unit and it had much improved over the last few months. At previous inspections the home was using a large number of agency staff the home now has nearly a full complement of staff and does not use many agency staff. BROOM LANE Version 1.10 Page 6 All staff now receive formal supervision at least six times a year as this previously had not been happening, staff confirmed that anything highlighted at supervision as requiring attention is actioned by the manager. Staff felt they could raise problems and concerns at supervision in confidence; this helps provide a good atmosphere in the home for the service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BROOM LANE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection BROOM LANE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, and 6 Four Seasons have still to provide any service user with a written contract and statement of terms and conditions. Service users are unable to determine what overall care and services are covered by the fees and have no written confirmation that they are able to reside at the home making them feel vulnerable. Needs assessments in the plans of care were poor and could put service users at risk, as their needs may not be met. The intermediate care unit was very good it helped to maximise service users independence and enabled them to return home. EVIDENCE: The needs assessments in the care plans contained very limited information and in many cases was also out of date and therefore not all service users needs had been assessed and would not be met, which could put service users at risk. The assessments were to be reviewed by the manager and updated service users spoken to say they had been shown their plans of care some had expressed interest to be involved more in the implementation of the plans and
BROOM LANE Version 1.10 Page 9 reviews other had declined this had started to be documented in the plans. Care management assessments were seen in the plans of care for the service users placed by social services, however the home did not have assessments for all other service users this is something the manager is aware needs improving. Dedicated accommodation was provided for the intermediate care. There was a dedicated staff team with a unit manager. Specialist facilities and equipment was seen provided for the unit. A physiotherapist commented that the unit was very good and had improved in the last few months that staff delivered short-term intensive rehabilitation and were enabling service users to return home. Records seen on the unit confirmed that the majority of service users admitted for intermediate care were rehabilitated and sent home and only a few following full assessments are admitted for long term care. Service users spoken to on this unit were full of praise for the staff and services. One service users was going home that day another was going the following day, they both confirmed if it had not been for this service they may have never have been able to return home. Staff receive appropriate training to be able to meet the needs of the service users on the intermediate unit records were seen and staff also confirmed they received the training and if they found some training they felt was appropriate they were usually encouraged to attend. BROOM LANE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 10 All service users had a plan of care, the plans did not set out in detail the action to be taken by care staff to ensure all aspects of health, personal care and social care needs of the service users are met which may put the service users at risk of harm and protects privacy and dignity. EVIDENCE: The information in the care plans examined contained insufficient information regarding the service users needs although they were reviewed monthly. Risk assessments were not robust and one did not contain any, meaning both staff and service users safety and wellbeing is potentially put at risk. The service users were aware of their care plans and had started to be involved in the review process if they so wished and this was evidenced in some plans of care. Service users spoken to confirmed that staff respected their privacy and dignity, including knocking when entering bedrooms and toilets, giving personal care in own rooms or in a bathroom maintaining privacy. Staff spoken to talked about service users in a sensitive and respectful way and understood the need to promote their dignity. Staff observed during the day treated service users and visitors with respect.
BROOM LANE Version 1.10 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The diet provided was wholesome, appealing and balanced but not menued. The staff need to be more proactive in offering supper. EVIDENCE: The menus seen were varied, wholesome, appealing and nutritious. The lunchtime meal was observed the food was well presented, staff were pleasant and gave assistance where it was needed discretely and sensitively and the mealtime was unhurried. Three full meals are offered each day with plenty of choice, but many service users said, “Supper was never offered” this gives a large gap between meals over 12 hours. This large gap has the potential to leave some service users hungry and lacking energy. Menus were not displayed for the service users and comments received from service users stated they did not know what was for meals until they sat down whereas they used to be asked the day before what they would like and many felt this would be better. Service users spoken to say, “some staff shout across the room what would you like to eat instead of going up to the service users and speaking directly to
BROOM LANE Version 1.10 Page 12 them”. If meals were chosen the day before as service users seem to prefer it would not be necessary to shout at service users to determine what they would like to eat. Other comments from service users were that some staff cleared the tables very quickly and made the meal time appear very rushed which made them feel that they had to eat quickly and felt that maybe some service users even left food so staff could clear the tables. The same comment from all service users was the food was excellent. BROOM LANE Version 1.10 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none of these standards were assessed at this inspection. EVIDENCE: BROOM LANE Version 1.10 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 25 and 26 The home was accessible, safe and well maintained, the surrounding were clean and comfortable providing a comfortable and homely environment for the service users. An alteration in one bathroom reduced the number of accessible toilets by one. EVIDENCE: The standard of cleanliness observed during the tour of the home was very good and it was also well maintained. There is a rolling programme of routine maintenance, which is documented in the annual development plan the manager is currently devising, providing a safe environment for the service users. BROOM LANE Version 1.10 Page 15 The gardens were well maintained and easily accessible to all service users. The home meets the standard in the amount of lavatories and bathing facilities, however there was an alteration in progress in one bathroom, a new bath had been installed which prevented the access to the toilet reducing the number of accessible toilets by one. Some service users would not have a toilet within close proximity to their private accommodation. BROOM LANE Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 There is a staff training and development programme that was very good with all training up to date but the management have still to reach the target of 50 of staff with NVQ level2 training. EVIDENCE: The manager provides staffing number adequate to meet the needs of the service users a staff rota was seen showing staffing numbers, which are maintained without the user of agency although on occasions this is necessary. The three units are staffed separately the nursing unit always has a qualified registered nurse on duty to meet the needs of the service users. Service users confirmed that there were good staffing levels, you had to wait sometimes for a member of staff to attend to your needs but it was never long. Service users also said, “staff work very hard and really care”. 13 care staff are qualified to NVQ level 2 this is 35 of all care staff, 4 carers are currently completing NVQ level 2 and the manager hopes to have another 4 care staff on the course by June. Care staff interviewed stated that if they showed interest in doing NVQ’s this was encouraged. All staff have a training and development file showing the training they have completed but it does not clearly show when the mandatory training is next due for renewal. The training enable staff to be able to meet the needs of the service users putting no one at any risk of harm.
BROOM LANE Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 34, 36 and 38 The registered manager is a registered nurse with many years experience, enabling service users to live in a home, which is well managed. There are good accounting and financial procedures in the home, insurance cover is in place and the health and safety of service users and staff is protected. EVIDENCE: The manager has now been registered by the commission has been in post a year and feedback from staff and service users was that the home had improved providing a good atmosphere and a congenial place to live and work. The manager is given a budget each year this was seen and adequate monies were allocated for each area of the budget. The insurance certificate was
BROOM LANE Version 1.10 Page 18 displayed in the entrance hall and was up to date with all appropriate cover provided to protect service users and staff. Staff are regularly supervised records were seen and up to date and covered all aspects of practice, philosophy of care in the home and career developments to enable the staff to be staff to provide a good service to residents. The home has a comprehensive health and safety policies all staff are appropriately trained, staff interviewed confirmed they had received all the appropriate training and were knowledgeable on the subjects. All service records were seen and up to date. BROOM LANE Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 x 2 x x x 3 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x 3 x 3 x 3 BROOM LANE Version 1.10 Page 20 yes 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 OP2 Regulation 5 Requirement The registered provider must ensure all service users are issued with a contract. (previous timescale of 31 march 2005 not met) The registered manager must ensure service user assessments are fully completed giving sufficient detail to provide clear guidance to staff to enable a plan of care to be drawn up which provides the basis of the care to be delivered. Timescale for action 1.6.05 2. OP3 14 1.7.05 3. OP7 15 4. OP7 13 The registered manager must 1.9.05 ensure service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Service user plans must be kept under review. (Previous timescale of 31 January 2005 not met) The registered manager must 1.7.05 ensure all service users have risk assessments carrried out and documented plans of care to ensure the safety and wellbeing of staff and service users is not potentially put at risk.
Version 1.10 Page 21 BROOM LANE 5. OP15 16 6. OP21 23 The registered manager must ensure a supper is offered to service users to prevent a large gap between tea and breakfast. The registered manager must ensure the toilet that is not accessible is made accessible to ensure service users have a toilet in close proximity to their private space. 1.6.05 1.7.05 7. 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. 2. Refer to Standard Op28 Op15 Good Practice Recommendations The registered manager must ensure 50 of care staff achieve NVQ level 2 by 2005. provide menus in the dining room and allow service users to choose meals the previous evening if they so wish. BROOM LANE Version 1.10 Page 22 Commission for Social Care Inspection First Floor, Barclay Court Heavens Walk Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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