Inspection on 22/03/07 for Broomcroft House

This inspection was carried out on 22nd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Broomcroft House 18/11/05

Broomcroft House 30/08/05

Broomcroft House 02/11/04

Broomcroft House 06/05/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Broomcroft House Ecclesall Road South Sheffield South Yorkshire S11 9PY Lead Inspector Marina Warwicker Key Unannounced Inspection 22nd March 2007 11:00 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 Broomcroft House DS0000021771.V320929.R02.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. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomcroft House Address Ecclesall Road South Sheffield South Yorkshire S11 9PY 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) 0114 235 2352 0114 235 2351 BUPA Care Homes (AKW) Ltd Post Vacant Care Home 87 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (52) of places Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th November 2005 Brief Description of the Service: Broomcroft House is situated in the suburbs of Sheffield, with the city centre being approximately four miles away. Located on the edge of Ecclesall Woods; it is on a bus route and within easy walking distance of the local shops, including the post office. This is a two-storey purpose built stone building specifically to meet the needs of eighty-seven elderly people who require nursing and/or personal care. The first floor of this home has been converted into a unit caring for residents with dementia. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Thursday 22nd March 2007 between 11am and 6pm. Seven residents and four relatives were consulted and ten staff were spoken to. A further fifteen relatives and ten staff were contacted by post to obtain feedback about the service. Comments received from the surveys up to the date of the site visit were shared with the manager. Time was spent observing and interacting with staff and the service users. The general manager and the care manager were away at training during the day. However, they were present at the latter part of the day and received the feedback from the inspection. The premise was inspected which included bedrooms of service users and the communal areas inside and the outdoors. Samples of records were checked. They were care plans, medication records, some service reports and staff recruitment and training files. I would like to thank the service users, relatives , staff and the management for their contribution towards the findings in this report. What the service does well: There is information available for the prospective service users so that they are able to make an informed choice about the home. The information in the brochure is clear, simple and real pictures of the service users and the staff at the home had been used, which helped those involved take ownership of the brochure and be proud. The management and other professionals carry out needs assessments before accepting service users. The service users receive contracts/ Terms & Conditions when they are admitted to the home. On the whole the staff at the home promote and maintain service users’ health and ensure access to health care so that the assessed needs are met. The routines of daily living and activities are flexible and diverse to suit the needs of the service users. The relatives and the service users are able to meet in private and there are no restrictions on visiting. The meal times are calm and efficiently managed by the staff. Those service users who need help receive appropriate assistance in a discrete manner. The Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 6 service users are given a choice of meals and the visiting relatives join in the mealtime if they so wish. Hot and cold drinks and snacks are offered to service users between mealtimes. The service users and the relatives made the following comments. “They serve good soup. I always enjoy it.” “The meals always look good and smell delicious. My mother seems to enjoy the meals”. “The portion size is just right they don’t over face us with food.” The physical design and layout of the home enables residents to live in a safe, and comfortable environment, which encourages independence. What has improved since the last inspection? What they could do better: The manager said that they were to introduce a care plan system which was easy to work with and fully comprehensive. But during this site visit the following were noted. Not all the information in the care plans was accurate. The assessment tools were not used correctly and appropriate information was not documented in the care plans of individuals. The lack of management of continence care should be addressed. All parts of the home must kept free from offensive odour at all times. Staff must be able to refer the service users to the general practitioner if they were to observe any adverse reaction due to the medication the service users were taking. Accurate records must be kept on all the medication received by the home and administered to the residents. If service users did not receive medication; the reason for this must be documented on the medication administration sheets. As part of the development of the dementia care unit the management must ensure that all service users are given the privacy and dignity and prevent service users wandering into other’s bedrooms without permission. All concerns and complaints must be investigated and complainants must be kept up to date with developments. Ongoing monitoring by the management Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 7 must include the areas of concerns and the staff must ensure that changes are sustained and not seen as ‘knee jerk actions’. The staffing numbers and the skill mix of nurses and care assistants must be appropriate to the assessed needs of the service users, the size, layout and the purpose of Broomcroft House at all times. This must include evenings, holidays and weekends. All staff must attend mandatory training such as moving & handling, health & safety, fire safety, protection of vulnerable adults, Infection control and service specific training i.e. dementia care, challenging behaviour, so that they are able to deliver appropriate care to the service users. The quality monitoring systems at the home must focus on the outcome for service users. Management must seek the views of service users, representatives and the staff employed. Following the site visit a meeting was held with the management and a response has been received. The explanation and further information received from the management has been included in the body of the report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose the home, which will meet their needs. Before the residents enter the home they have their needs assessed and on admission a contract is issued outlining the terms & conditions of their stay and the service the residents will receive. EVIDENCE: Four residents, two relatives and three staff were consulted with regards to the outcome of this area. Furthermore feedback from the residents, the relatives and the staff surveys were also used to confirm that there was information available for the prospective service users so that they are able to make an informed choice about the home. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 10 The manager made available copies of the statement of purpose and a service user guide. The information on the brochure was clear, simple and real pictures of the service users and the staff at the home had been used, which helped those involved take ownership of the brochure and be proud. Three service users’ contracts were checked and the service users/ representatives and the provider had signed them, so that both parties had agreed on the terms and conditions of the stay. A service user and a relative said that the management explained the contract to them and they were happy to sign and agree to the conditions. Five surveys (Relatives & professionals) specified that the management and other professionals carried out needs assessments before accepting service users. During case tracking four care plans were checked and copies of needs assessments were identified. The service users, the relatives and the staff said that a trial visit to the home was encouraged. It was evident that trial visits were more popular within the older persons unit i.e. Ground Floor and trial periods were used in the dementia care unit. This is to accommodate the specific needs of the category of service users within the home. The home does not provide intermediate care. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10&11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care, which the residents receive, are not always based on their individual needs. The risk assessment tools not being used appropriately highlight this. The principles of respect, dignity and privacy are put into practice in the older persons unit and in the unit where people with dementia are cared for more staff support and supervision is required to achieve this. There is a lack of staff training on end of life care. EVIDENCE: Through direct observation, speaking to the service users, the relatives and the staff it was established that all service users had their care plans generated from their individual assessments. However, whilst care plan tracking it was noted that some of the information in the care plans had not been updated to reflect the changing needs of the service users. On the whole the staff at the home promoted and maintained service users’ health and ensured access to health care so that the assessed needs were met. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 12 However, there had been difficulties with the assignment of general practitioners to the new residents. This has resulted in one resident not having the opportunity to have the medication reviewed to minimise the side effect s/he was experiencing. The home responded that if residents are admitted from outside the area they had experienced some difficulty with PCT allocation of general practitioner. In the dementia care unit there has been an increased demand for the promotion of continence. There has not been sufficient specialist input to address this need. This was confirmed by the offensive faecal/urine odour in one part of the home. Two relatives commented that during their visits they had not seen the service users being helped to use the toilet and questioned whether continence pad were in use instead of regular toileting. Following the site visit a meeting was held with the management and a response has been received it confirmed that the home has a continence management system. A registered nurse, a senior nurse and a senior carer are the continence link staff. All residents are assessed to determine whether or not they require continence aids and the appropriate product is used to aid continence. Residents are offered assistance to the toilet before and after meals. The community specialist continence nurse visits the home and is available to discus and advises on any issues with regards to continence management. On the day of the inspection Broomcroft house was experiencing diarrhoea and vomiting virus, which affected a number of residents and staff. Due to some confusion Commission for Social Care Inspection was not informed of this. The home has a nutritional screening programme/tool; the care plans checked did not have the assessments or periodic reviews of service users’ nutritional status. The manager was made aware of this at the feedback. Those service users who were spoken with did not want to self medicate and wanted the nurses to carry out this task. Three medication administration sheets were checked and there were gaps found where the staff had not signed after administering medication. However, the staff on duty checked the ‘blister packs’ and found that the tablets had been removed from the blister packs on the specific dates therefore the staff construed this as medication having been administered and the nurse had missed signing for them. One of the service users who was tracked according to the records was becoming more lethargic and sleepy. The staff had made comments on the daily records on several occasions. When questioned the staff said that this service user do not have a general practitioner assigned and they were trying to rectify this. The nurses on receipt of medication delivery from the pharmacy had not checked and signed on the medication administration sheet. On questioning the staff on duty they explained that this task was the responsibility of the night nurse. The manager was informed of this. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 13 During direct observation it was noted that the staff made sure that service users’ privacy, dignity and respect were maintained during the day. However, the staff on the unit where service users had dementia were experiencing difficulty managing service users entering bedrooms of other service users without permission and dealing with service users who were challenging. This is causing anxiety among some service users, relatives and staff. Four staff files were checked and two staff were spoken to. The staff said that they have had experience looking after service users who were dying but could not remember having formal training. The staff files checked did not have any record of training on Palliative care. The care plans checked did not have any documentation on service users’ wishes concerning terminal care or arrangements after death. One of the staff said, “Do you know how difficult it is to talk about death. We ask the family if we know that someone is going to die.” To assist the service user population at Broomcroft House it is essential that all staff are sufficiently trained to recognise when service users are in pain and/or support them during the end of life. Especially people with dementia require the staff to have understanding of their deteriorating condition and be familiar with their needs so that the staff are able to give support to the service users and their relatives. The management confirmed that 25 of the staff have had Palliative care training and further training has been planned. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their life style, social activity and continue to keep in contact with family and friends. On the whole, social, cultural and recreational activities meet residents’ expectations. However, there was a lack of short outings for service users so that they are able to enjoy the fresh air and the scenery of the surrounding area. Residents receive a healthy and varied diet with choices. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 15 EVIDENCE: Direct observations on the day of the site visit and consultation with the service users and the relatives demonstrated that the routines of daily living and activities were flexible and diverse to suit the needs of the service users. It was ascertained from the available information that the residents’ expectations, preferences and capacity were taken into account when organising activities. There were some comments from the relatives and two service users with regards to the same people taking part in the activities. Further comments were also made about more outings in small groups for the service users to break the day and give the service users opportunities to enjoy the fresh air and the neighbouring scenery. The management informed us that the residents had been out during winter months and as the weather improves trips will be planned for the summer months. Relatives and service users said that they were able to meet in private and that there were no restrictions on visiting. The service users either managed their own finances or their representatives/ advocates managed it for them. The meal times were calm and efficiently managed by the staff. Those service users who needed help received appropriate assistance in a discrete manner. The service users were given a choice of meals and the visiting relatives were included if they wish to join in the mealtime. Hot and cold drinks and snacks were offered to service users between mealtimes. The service users and the relatives made the following comments. “They serve good soup. I always enjoy it.” “The meals always look good and smell delicious. My mother seems to enjoy the meals”. “The portion size is just right they don’t over face us with food.” Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17&18 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives have access to the home’s complaints procedure so that they are able to raise any concerns with the management of the home and resolve them. But not all complainants are happy with the outcome of the investigations. Although the home has policies and procedures to protect the residents from abuse and promote their legal rights; not all staff have received training on protection of vulnerable adults. The lack of staff training could result in staff not understanding and therefore not identifying the different types of abuse. EVIDENCE: The residents, relatives and staff were aware of the complaints procedure. The service users’ and relatives’ surveys confirmed that on the whole the staff dealt with concerns and complaints satisfactorily. However, the comments from the surveys highlighted that most problems stemmed from lack of skilled staff availability at the home. Two surveys established that the manager helped to resolve the concerns and was understanding of their views. But there were some relatives’ whose feedback highlighted that when they had made complaints the home had not always thoroughly investigated and tried to give excuses for the actions. They also commented that the improvements in the care issues had not been sustained following a complaint. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 17 Those service users who were unable to exercise their rights received help from their relatives, friends or their advocates. Some staff had attended training on protection of vulnerable adults. Two staff were able to verbalise their action if they were to witness abuse at work. The staff said that they were not sure what should happen when they were the victims of abuse. It was also ascertained that whilst caring for service users with dementia not all staff were able to recognise abuse and were competent to take appropriate action to protect those vulnerable adults. ‘The response from the management said that the present manager is a registered mental health nurse (RMN) and a social worker trained with a professional background in mental health care for elderly people. They said that the dementia care unit is in its infancy and it has been operating as such for five months. An experienced RMN had been has been appointed to head the unit and give the staff support. The home manager has regular meetings with staff and the minutes demonstrate that the manager sought ways in which staff can engage with residents with dementia. They also added that the staff turnover is an indicator of staff satisfaction and that the turnover was 3 ’. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,23,24,25&26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enable residents to live in a safe, environment, which encourages independence. However, there are inadequate storage facilities for the equipment used at the home. The cleanliness and hygiene of the home on the whole promotes pleasant environment and the staff practices prevent the spread of infection. However, in parts of the home due to the lack of management of continence there is an offensive odour, which is unpleasant and does not promote comfort to those who use this area. EVIDENCE: The home is divided into two units. Older people requiring personal and nursing care occupy the ground floor. Service users with diagnosis of dementia occupy the first floor. Therefore the environmental arrangements have been made to accommodate the needs of the two categories of service users. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 19 The manager said that there was a programme of routine maintenance and renewal of the fabric and decoration that had been implemented in stages through out the year. Refurbishment was underway in one of the dining rooms during the site visit. During the tour of the premise it was noted that there had been leakage of rainwater from the roof and the manager assured that the arrangement to repair the leaking roof was in hand. The residents said that they had access to all communal and private parts of the home. The staff and the residents said that there were enough aids and hoists for the use of service users. The wheelchairs, aids and equipment were stored on the sides of stairways and in bathrooms since the home did not have storage facilities. However, the stairways were kept clear so that the fire escapes were not obstructed. When one of the service users moved away from a shared bedroom, the remaining resident was given the opportunity to choose to stay or move to a single room. This was observed on the day. Five bedrooms were visited with the permission of the service users. The rooms were furnished and equipped to ensure comfort and privacy. Most service users had some of their personal items in their bedrooms, which made the rooms individualised. The bedrooms were naturally ventilated. The rooms were centrally heated and the service users were able to control the heating in their bedrooms. Emergency lighting was provided through the home. Although on the whole the home was clean, one of the first floor corridors emitted offensive faecal odour throughout the day and the manager witnessed this. The staff said that this odour was due to those service users who were doubly incontinent. Efficient management of continence and supervision of service users were needed so that the dignity of those who were incontinent could be maintained. The staff or the manager on the day of the site visit did not inform the visitors to the home including the inspector of the episode of diarrhoea and vomiting affecting the staff and the residents. Laundry facilities were sited away from cooking and dining areas. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff working in the older persons’ unit are trained, skilled and in sufficient numbers so that they are able to fulfil the aims of the home and meet the needs of older people. The staff allocated to the dementia care unit are often not in sufficient skill mix and numbers. Although the staff have received specific training, they do not have the experience nor do they receive the appropriate support and supervision from the management to deal with the changing needs of residents with dementia. This is resulting in staff dissatisfaction; increased sickness and staff leaving their post. The staff competency and skills are in question in delivering the appropriate care to the service users since not all staff had attended the mandatory training and the service specific training. EVIDENCE: The surveys and interviews with the staff, the relatives and the service users highlighted the following. “The weekends are poorly staffed. There is a lack of staff visibility at the weekend and during the evening. Staff are not given a choice but instructed to work on the unit where service users have dementia. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 21 The staff reported that they were on occasions attacked by service users and this was not taken seriously by the management. There was no debriefing by the management when thing go wrong for the staff at work. On the day of the site visit the staffing numbers were low and the staff said that they were struggling to complete the work and that this was often the case. The staff comments stated that the service users and the relatives wanted the best care for the money they pay and therefore “As the frontline staff we often miss breaks and work without proper breaks”. The manager during feedback said that there had been some unexpected absence of staff and that it was not always possible to arrange agency staff cover in time to be helpful to the staff. During the day of the site visit it was ascertained whilst the dementia care unit is in its infancy there wasn’t enough staff in numbers, experience and skills allocated to the unit. Staff interviewed said that they had been given opportunities to work towards NVQ level 2 in care. Staff also said that the management were reluctant to use agency staff since this does not give the continuity of care to the residents. In the surveys there were positive comments about using agency/ bank staff. “Better to use agency staff than using tired staff. Then they go off sick.” It depends on the individual staff and some are like a breath of fresh air and some come to do as little as possible and get paid.” These comments highlighted that the management needed to monitor the quality and competence of the agency staff and keep the agency informed. Four staff recruitment files were checked and all files had appropriate information on recruitment and selection and complied with the requirements. Four staff training records were checked. Information with regards to mandatory training and the induction programme were not readily available. The staff were not sure when they had received training. According to the records available on the day not all staff had received fire safety training, moving & handling, protection of vulnerable adults, continence care and infection control. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 22 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): 31,33,335,36&38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration ethos of the home is based on openness and respect. But some see this as not transparent and not entering into discussion and consultation. There is a quality assurance system developed by the company. This system is not applied appropriately to measure the outcome for the service users. The change of management style is causing unsettlement among staff. The management need to take practical measures to ensure the health, safety and welfare of the service users and the staff working at the home to ensure the service users and the staff feel safe at the home. EVIDENCE: The manager has been in post since December 2006 and he said that he would be applying to be registered with the Commission for Social Care Inspection. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 23 ‘The management have requested that we include that the manager is an experienced Mental Health professional holding a RMN and Social Work qualification. He also has a Certificate in Business Administration’. There were quality assurance and quality monitoring systems in place. The Responsible Individual visits the home each month and continues to monitor and prepare reports on the findings. The findings on the day of the site visit confirmed that the audits did not sufficiently focus on the quality outcome for the service users and the staff working at the home. Although some of the service user and relatives surveys were positive of the running of the home, they questioned why they had not been introduced to the new manager and why there had not been any relatives’ meetings this year. The manager was informed of this comment. Regular staff meetings were held and the minutes were available for inspection. The following comments were received from the staff; “The staff meetings are usually critical of us,” “Those who are at work get the blame for those who were off sick,” “Instead of giving us support the management seem to undermine the staff capability.” The staff don’t feel that they can approach the management to get support. However, there were also comments made about the management style being so different to the last management and some staff felt that there were too many changes. They said that the present management were happy to listen to staff suggestions and allow them to put their suggestions into practices. The main observation on this section was that the staff were finding difficulty adjusting to the new management approach and the added concern for them was the management of the dementia care unit which the general consensus of the staff was that they were not adequately prepared and supported when difficulty arise. Written records of all financial transactions were maintained. Staff said that they received informal supervision when they had enough staff but recently this has been impossible due to staff sickness and holidays. The supervision records were not available on the day of inspection and therefore unable to ascertain how many staff had received formal supervision and how often they had been supervised. On the day of the site visit a new care staff who should have been supernumerary and on induction was included in the staffing number and s/he was not supervised. The manager was informed of this. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 24 Not all accidents were reported to the manager and the staff seem to decide on an individual basis, which is unsatisfactory and the staff need to follow the home’s procedure. One of the service user’s daily report identified that the service user had sustained a lump on the back of their neck. There wasn’t an incident form completed by the staff who noticed this. The staff on the next shift did not check this. Again the manager was informed of this. The pre inspection information confirmed that Gas and electricity maintenance records were up to date. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 25 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 2 X X 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 26 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 OP7 Regulation 15,13 Requirement Information in the care plans must be accurate. Previous requirement 16/12/05. The staff must ensure that assessment tools are used correctly and appropriate information is documented in the care plans of individuals. I.e. Nutritional assessments. Previous requirement 16/12/05 The staff must receive training on managing continence and deemed competent by the management. Service users must be helped with toileting regularly. Service users’ medication must be reviewed immediately if there were any adverse effects observed by the staff. Immediate and then onwards. Accurate records must be kept on all the medication received by the home and administered to the residents. DS0000021771.V320929.R02.S.doc Version 5.2 Timescale for action 15/05/07 2. OP8 14,17,13 15/05/07 3. OP8 13 15/05/07 4. OP9 13 22/03/07 5. OP9 13 22/03/07 Broomcroft House Page 27 Immediate and then onwards. 6. OP10 12 The management must ensure that service users who are unable to differentiate their bedrooms from the others do not enter rooms without permission of others. All care staff must receive guidance and training on dealing with death and dying of service users i.e. End of Life care. Previous requirement 27/01/06 All concerns and complaints must be investigated and complainants must be kept up to date with developments. Previous requirement 27/01/06 15/05/07 7. OP11 12,15 12/06/07 8. OP16 22,17 15/05/07 9. OP18 12,17 10 OP19 23 All staff must receive training on 15/05/07 Identifying abuse and adult protection. They must be familiar with the policies and procedures relating to these. Previous requirement 06/12/05 The leaking roof must be 15/05/07 repaired and the bedrooms affected by the leakage repaired and decorated. All parts of the home must be kept free from offensive odour at all times. Immediate and then onwards. The staffing numbers and the skill mix of nurses and care assistants must be appropriate to the assessed needs of the service users, the size, layout and the purpose of Broomcroft House at all times. This must include evenings, holidays and weekends. Immediate and then onwards. DS0000021771.V320929.R02.S.doc Version 5.2 11. OP26 13,16 22/03/07 12. OP27 18 22/03/07 Broomcroft House Page 28 13. OP30 12,18 New staff must complete induction training and be supervised at all times. Immediate and then onwards. All staff must attend mandatory training such as moving & handling, health & safety, fire safety, protection of vulnerable adults, Infection control and service specific training i.e. dementia care, challenging behaviour, so that they are able to deliver appropriate care to the service users. The quality monitoring systems at the home must focus on the outcome for service users. Management must seek the views of service users, representatives and the staff employed. All care staff must receive supervision at least six times a year and written records of the supervision must be kept at the home. Previous requirement 06/12/05 22/03/07 14. OP30 OP38 13,23 15/05/07 15. OP33 24,26 12/06/07 16. OP36 18 12/06/07 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 OP8 OP12 Good Practice Recommendations The manager should ensure that a general practitioner is assigned to the service users before offering admission. The service users should be given opportunities to go out on short outings with the staff. DS0000021771.V320929.R02.S.doc Version 5.2 Page 29 Broomcroft House 3. OP19 The management must ensure suitable storage facilities are provided for the equipment and aids used at the home. Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Broomcroft House DS0000021771.V320929.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!