Inspection on 06/05/09 for Broome End Care Centre

This inspection was carried out on 6th May 2009.

CQC found this care home to be providing an Adequate service.

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

Other inspections for this house

Broome End Care Centre 13/05/08

Broome End Care Centre 14/05/07

Broome End Care Centre 01/11/06

Broome End Care Centre 28/11/05

Broome End Care Centre 11/05/05

Broome End Care Centre 26/01/05

Broome End Care Centre 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Broome End Care Centre Pines Hill Stansted Mountfitchet Essex CM24 8EX Lead Inspector Jane Greaves Unannounced Inspection 6th May 2009 09:00 DS0000017785.V375287.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broome End Care Centre Address Pines Hill Stansted Mountfitchet Essex CM24 8EX 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) 01279 816455 01269 814598 broomeend@schealthcare.co.uk Southern Cross Manager post vacant Care Home 37 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (37) of places Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 37 persons) Persons of either sex, over the age of 65 years, who require care by reason of dementia (not to exceed 9 persons) The total number of service users accommodated in the home must not exceed 37 persons 13th May 2008 Date of last inspection Brief Description of the Service: Broome End is a three storey converted residence with a newer two storey extension, set in spacious grounds on the edge of the village of Stansted Mountfitchet. The home is registered to provide residential care for up to 37 people over the age of 65, with varying degrees of dependency, including nine places for people with diagnosed dementia. Residents are accommodated in twenty-nine single rooms and four double rooms, with communal space comprising three lounges and two dining rooms. The home has two passenger lifts to enable access to all floors. The gardens and grounds are at the rear of the home with ramps providing access. Ample off road car parking is provided to the front of the home for visitors, and bus services pass the building along the main road. Local shopping facilities are a short walk away. The weekly fees at the time of inspection in May 2008 ranged from £465.61 to £675.00. The fees did not cover hairdressing, private chiropody, toiletries or items from the tuck shop. Past inspection reports are available from the home, and from the CQC internet website. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit that took place on 6th May 2009 over 7 ½ hours At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Views expressed by visitors to the home during the site visit have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 8th May 2008. What the service does well: The staff recruitment process is thorough; this means that people living at Broome End are protected by the safe recruitment of professional and friendly staff. Relatives told us they were generally happy with the service and care provided, they particularly expressed they could approach the manager at any time with any concerns they may have and be confident they would be dealt with appropriately. Visitors to the care home are made to feel welcome Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Further training and personal development is required for staff to ensure that they have the skills and competence to meet residents’ needs. Particular attention must be provided for those conditions associated with the needs of older people. Daily records did not consistently provide information to reflect how peoples support was provided or how they spent their day. Entries such as ‘all care given’ do not describe the well being of the individual. Good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. The social care needs for people at the home and specifically for those people who have dementia needs must be improved so that they have a good quality of life with something to look forward to. Management and staff demonstrated awareness of the need to promote peoples dignity however daily practice needs to be reviewed to ensure this happens by ensuring personal information is not left around in communal areas. More should done to promote an enabling environment for the people who live at Broome End, especially those people living with dementia. Good signage would help people identify key areas, such as bathrooms and toilets. Since the previous visit to this service the staff team have been provided with more training to give them the skills necessary to look after people safely and meet their needs. This specifically refers to training for health and safety, infection control and the NVQ training programme. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Broome End Care Centre can be assured their health needs can be met through a comprehensive assessment. EVIDENCE: There was Statement of Purpose available at the home that detailed the aims, objectives and philosophy of care at the home. We noted this document indicated that the manager had completed the process to become registered with us. At the time of this visit the registration paperwork had been submitted however the process to register had not yet commenced. There was a Service User Guide provided for each person living at the home, the guide stated that the information within was also available in audio Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 10 cassette form for people with visual impairments. The document provided a clear picture of the services and facilities that people could expect to find at the care home. The manager reported that a full assessment of need was undertaken for any person wishing to move into Broome End Care Centre. This was undertaken to ensure that the staff at the home had the skills and expertise to meet peoples’ specific care and support needs and that the facilities at the home were appropriate to meet individuals’ needs. The manager reported that he visited people at home or in hospital to undertake a detailed assessment. The previous inspection for this service identified that the pre assessment documents had not been fully completed and did not contain detailed information. We looked at pre-admission assessments for two people recently admitted to Broome End. Both contained comprehensive information about various areas of need such as past medical history, medication, mobility, dressing, personal hygiene, feeding, eyesight, pressure sores, communication, social dependency and behaviours. This information together with the NHS hospital discharge information formed the basis of peoples’ initial care plans. There was a document, signed by a family member or representative, confirming that comprehensive reviews had been undertaken with a few weeks of admission, to ensure that the care plans were appropriate to meet the needs of the individuals. Relatives we spoke with on the day of this inspection told us ‘Before my relative moved into the home I visited on spec, with no notice. The manager showed me around; I liked the feel of the place and felt that people seemed happy here’. Standard 6 is not applicable, as the service does not provide intermediate care. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the support they need to keep them physically healthy however the support needs of people living with dementia are not always met. EVIDENCE: We looked at care plans for three people living at Broome End; these showed us that the information in the pre-admission assessments was reflected in the care plans. The areas covered included safe environment, communication, hygiene, dressing and undressing and mobilising. The care plans we looked at had been completed with details of the pre admission assessment and the health care needs of the person. All care plans had risk assessments in place detailing some generic risks that people may experience such as mobility and nutrition and strategies for staff to employ to minimise the risks. We noted a one size fits all approach to risk assessment with no emphasis on the risks people may be subject to when undertaking activities of their choice. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 12 People spoken with were all very positive about the care they received and our observations confirmed that people appeared happy, well looked after and were well dressed and groomed. The quality of daily recording varied, some records included good information about the care and support provided for people, whereas others we looked at stated ‘x seemed fine, personal care attended to by night staff’. Once record included comments from night staff ‘daily hygiene assisted’. The manager told us that report writing training had been delivered to all staff however not all had grasped the reason for recording all interactions and what the actions were. The deputy manager told us that report writing was ‘touched on’ during staff supervision sessions. Staff meeting minutes of 05/01/09 stated that the manager was to undertake a further report writing training session with some care staff members. Daily records, when detailed, are a good source of evidence to show that care is being provided as detailed in the care plan and help to provide the information necessary to base regular reviews. Care plans were signed by staff to confirm they were regularly reviewed to ensure each person’s care and support regime reflected any changes in their personal circumstances. Relatives we spoke with on the day of this site visit told us ‘We have been shown the care plan for our relative and asked if there is anything we would like to add’. The deputy manager told us that one to one time had been spent with individuals developing a one page profile to enable agency staff to have an ‘at a glance’ guide to provide person centred care. We observed staff trying to persuade one person to go to the toilet, the person became very distressed. Staff did not employ any other management strategies for this situation, just continuing with the same instructions but raising their voices louder and louder. This indicated to us that dementia awareness training has either not been absorbed by these staff members or the material delivered was not appropriate to the needs of the people that staff are supporting. The manager had already identified this shortfall in practice and had been working through this in supervision with the staff members. We observed one person on the dementia unit become agitated and wanting to leave the unit. The unit was extra busy at this time with company management, the home’s manager, the deputy manager, activity co-ordinator, a care staff member and us. There were 5 residents on the unit and this amount of other people around was clearly unsettling the person. The individual became more confused and distressed when they were asked questions causing them to try and muster their confused thoughts into Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 13 providing an answer. Once the manager took the individual for a quiet walk in the grounds they calmed and settled. We concluded that there was a mixed understanding demonstrated among the staff team with some staff relating to people better than others. Medication used in the home was stored within locked cabinets. Each resident had a Medication Administration Record (MAR) that included a photograph of the person to identify them. There was inconsistent recording of medications to be offered as required (PRN) with some staff members marking the chart with a code to indicate that the medication had been offered but refused and some people not marking the chart at all. This did not provide a clear and reliable audit trail. Some gaps in recording of the medication meant that it was not always possible to be sure if people had received their medications. We noted staff members administering medications were wearing a red tabard, thus indicating to other staff members that they were not to be disturbed. This meant they were able to concentrate completely on the important task of ensuring people had their medications safely administered. Staff told us they had received medication training approx 6 months prior to this visit. They told us that a pharmacist observed their practice and assessed competency and the deputy manager regularly monitored their competency. We saw daily handover sheets in the upstairs lounge providing personal details about individual residents. Care staff came into the main lounge to write up some care plans before lunchtime. The care plans were left in the lounge when the person went off to do other duties. This meant that peoples’ personal information was accessible to other residents and any visitor to enter the communal area, this practice did not promote or protect the dignity of the residents. Healthcare professionals we spoke with as part of this inspection process told us that the service was pro-active in requesting advice and guidance when needed. Relatives told us “Pretty pleased really, good care”, “We couldn’t have done better” and “They seem to be very person orientated”. Broome End Care Centre DS0000017785.V375287.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not always have their individual social needs and expectations catered for. EVIDENCE: The manager reported that the activity programme had improved since the previous inspection visit however was still in the development stage. The activity co-ordinator had been on extended sick leave and this had a negative impact on the development of the activities programme as people have missed out on scheduled trips away from the home as well as daily stimulation. Staff meeting minutes of 5th March 2009 acknowledged that ‘the current activities in the home need to be improved’ as a result of the previous inspection report and the residents’ survey from November 2008. Minutes from a residents’ meeting in January 2009 referred to discussion about trips out to the Tower of London and Colchester Zoo. It was decided at this meeting that a trip to Harlow Garden Centre would be arranged with the others Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 15 considered later in the year. At the time of this inspection there had not been any of these trips yet undertaken. Minutes from a relatives’ meeting in February 2009 showed that the introduction of a hairdressing salon and re-introduction of a trolley shop was being planned. The activity co-ordinator told us that residents sometimes helped with the tidying or laundry. People go for walks in the grounds of the home and trips such as to the garden centre. The activities co-ordinator reported she tries to go with the flow, “As needed to meet the needs of people on the day”. The activity folder contained clear and comprehensive profiles describing peoples’ social background with one section entitled ‘what is important to me’. During a tour of the home we observed a wool box, games, books and people were seated in the lounge reading and watching television. In the dementia unit there were dolls, games, large cards and a Wii computer game. Staff told us how residents enjoy getting involved with folding towels, laying the table, dusting and weeding the plant pots on the balcony. We saw care staff integrate and interact with the residents, however much of this interaction is not recognised by the staff as being an activity and doesn’t get recorded as such. There was no evidence available to show us that the people living at the home were provided with things to look forward to or enabled to take part in activities of daily life according to their individual physical and cognitive abilities. We saw people spending time in various parts of the home, communal areas and in their bedrooms. Peoples’ rooms were personalised, showing that individuals could bring their personal possessions into the home with them. Relatives visiting the home told us they were encouraged to visit at any time, and they can meet with people in the privacy in their bedrooms. The home operated a ‘protected mealtimes’ policy whereby people were discouraged from visiting during mealtimes and the medication rounds took place after mealtimes in order to promote a pleasant dining experience where people were encouraged to chat and enjoy their meal in peace. Where medications were prescribed to be taken before food or with food this was dealt with on an individual basis. People’s care files had information regarding their nutritional needs and dietary preferences, and the staff we spoke with were fully aware of these. Kitchen staff spoken with showed that good practice regarding health and safety, hygiene and nutritional awareness is in place and that they were aware of individual’s needs. Hot meals were taken to the dining room on a hot trolley. People were then asked what they would like from a choice of two main meals and these were then dished up individually according to preference of vegetables etc. We Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 16 looked at a 4 week menu that is offered to people living at the home. This showed us that people were offered a varied and nutritionally balanced diet with extra options if they did not like to two main meals offered daily. A new format of menu for the residents’ dining tables was being trialled at the time of this visit. The formats of the menus available on this day were not appropriate for people with impaired vision as the font was too small. The Operation’s Manager reported that daily menus were being developed in a larger font and in pictorial format so that all people living at the home could read them. These would then be available in transparent holders on the tables to help people chose their meal. The menus provided on this day initiated considerable conversation around the room and proved to be popular. The organisation has a dementia advisor to assist with strategies to enable people living with dementia. One initiative in the pipeline for the next few weeks was for moulds to be provided so that people requiring a soft diet can have their food presented in a more attractive manner. For example a fish mould and vegetable moulds so that food appear as they would naturally. People who chose to eat their meals in their rooms told us that the food was often cold by the time it reached them. A visitor told us that their relative had a cup of tea brought to their room in the morning before being assisted to wash and dress. This was always cold by the time the individual was able to drink it. A relative told us ‘There are good entertainers that visit the home such as pat dogs and singers”. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel comfortable raising any concern or worry they may have and have confidence that they will be listened to and taken seriously. EVIDENCE: There was a copy of the home’s complaints policy on the wall in entrance hall. All visitors that we spoke to during the course of the day said they were very confident taking any concerns to the management and had faith that they would be listened to and taken seriously. The complaints policy gave people a clear indication of what a person lodging a complaint could expect in respect of response times and procedures that the home would follow. There had been two complaints received by the management of the home since the previous inspection visit. There was documentary evidence available in the form of letters to complainants and records of investigations carried out to confirm they were dealt with appropriately in line with the homes’ policies and procedures. The manager reported that the findings from preliminary investigations was that too many residents required assistance at the same time of the day and therefore had to wait for staff to become available. The manager reported he was looking at strategies such as staff deployment at key times of the day to meet the needs of people. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 18 Minutes from a residents’ meeting held in January 2009 referred to the outcome of the residents’ surveys from November 2009 where people had expressed concern that they were unaware how to use the complaints procedure. The home’s manager took this opportunity to explain the procedure to the residents and provide them all with a copy. Since the previous inspection management had been proactive in referring many potential safeguarding incidents to the local authority. Most of these related to resident falls, and were managed at the time by staff at the home. Training records showed that staff members had received training in safeguarding vulnerable adults. When we spoke to staff they confirmed that they had undertaken training, and had a good awareness of safeguarding. They said that they would report any incidents to a senior or the manager. Senior staff said that the information and contact details to enable incidents to be properly managed were available to them at all times. Records showed that the correct forms to report incidents to the local safeguarding team were in use. The home’s own policies and procedures in relation to adult safeguarding were available; we were given a copy to take away with us. This clearly detailed the responsibilities of the management and staff to protect people living at the home from abuse and to live in a non threatening environment. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and comfortable home but some areas may not be appropriate to people’s needs. EVIDENCE: During a tour of the premises we noted that furnishings were domestic and comfortable and that overall people living in the home benefited from homely surroundings. Bedrooms were individual and contained personal possessions such as ornaments and photographs. Some areas of the home however were tired and worn; these areas were identified to the management during the inspection visit. The dementia unit on the first floor of the home did not provide an interesting or stimulating environment for the five people currently living there. Some Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 20 pictures had been placed on the walls in an attempt to introduce colour and a homely feel however people had no connection with the subjects of these pictures and did not relate to them. The manager’s AQAA stated that ‘we have improved by instigating a redecoration programme. We could improve the quality of the environment by continuing with the redecoration and refurbishment plan’. Discussion with people in their bedrooms showed us that each room had an easy chair and call bell cords were within easy reach of where the person was sitting. The operations manager agreed that the signage in the home did not enable people to find their way around. He reported the intention to utilise the skills of the activity staff and the residents involved in activities to create signage appropriate to the needs of the people living at the home. The garden had raised planters; there were plans for people living at the home to be involved in planting the garden this year. There was a Balcony garden on the first floor for the sole use of people living with dementia. There was a hutch with guinea pigs and some plant pots to bring some colour to the area. The manager reported plans to purchase some robust wooden furniture to replace the inappropriate lightweight plastic chairs currently available. All staff had training in infection control as part of their induction and annual training plan. Relatives comments included: ‘The gardens have not been done, they spent all that money on planters etc but they have not been planted out’ and ‘The décor is very good’. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broome End are not supported by a staff team that have all the necessary skills and training to promote the health, safety and well being of residents. EVIDENCE: The staffing arrangements were committed to a weekly rota and this stated that there were five care staff including 2 senior care staff on duty for the morning shift and four staff in the afternoon shift. The night staff shift consists of three waking staff including one senior. In addition there is the manager, activities co-ordinator, housekeeping and catering staff on duty during the day. Scrutiny of the staff rota for four weeks, including the day of this visit, showed us that on one occasion all five staff on duty had worked a long day shift from 0800 to 2000hrs. On a further 13 occasions 4 of the five staff had worked the long day shift with the norm being 3 staff working this long shift. There were no risk assessments in place in relation to the potential risks arising from staff members regularly working such long shifts. Working long shifts such as these is not best practice as staff may become tired and not as able to carry out their duties well. This could be particularly so on the dementia care unit where noise and behaviours can create a stressful environment. Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 22 We looked at recruitment documentation for two recently employed staff members. The recruitment process was thorough, including two satisfactory references, enhanced Criminal Record Bureau checks and copies of birth certificates, passports, and photographs being obtained before the individuals commenced employment at the home. Records seen on the day indicated that out of a total of twenty care staff there were five that had achieved a minimum of NVQ 2 in care (One certificate outstanding at this time) and the manager reported that five recently recruited staff members were working towards this qualification. The organisation’s training matrix appeared confusing and did not provide an accurate reflection of the training provision within the home. Instead of a clear annual training schedule providing the dates and various elements of training people had attended there was a month by month statistical analysis that indicated shortfalls in the training provision. Whilst there had been good progress made since the previous inspection visit, there were still some gaps remaining in the basic core training necessary to promote and protect the health, safety and well being of the people living at the home. For example, in the past 12 months 13 of the 29 staff employed at the home had attended health and safety training and 12 had attended infection control training. 8 of the 20 care staff had attended training in nutrition. The manager reported that he is the in-house trainer for the Alzheimer’s training ‘Yesterday, Today, Tomorrow’ The manager demonstrated there was a monitoring tool in place to assess areas of staff skills and to feed this into the supervision programme. Records showed us that 17 care staff had attended training in Dementia awareness and managing challenging behaviours. Relatives we spoke with were generally satisfied with the standard of care provided however expressed some concerns with the numbers of staff available at certain times of the day. Comments included as follows: ‘It was better here years ago, carers used to talk more instead of rushing in and out seem to be less staff…….or less time anyway’ ‘Buzzers not answered quickly enough…could be an issue if a person needed urgent attention, this is possibly due to lack of staff’. ‘We’re very happy with the home, all the staff are happy, cheerful and give the impression they’re caring.’ Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in an open and transparent manner. EVIDENCE: The manager had been in post at Broome End since May 2008. The staff and relatives spoken with all reported that the manager had done a good job since he started at the home and believed that he had the skills and knowledge to undertake the role. The manager received good support from the organisation and the staff team. Once news of this inspection broke the operations director appeared at the home to support the manager and the deputy manager came in on their day off to provide support Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 24 The operations manager reported he held regional operations workshops for managers from other homes within the group to meet and share good practices and support each other with tried and tested methods to overcome problems. Operations manager supported the manager with 1:1 supervision and undertaking regulation 26 visits as was observed on the day of this visit. The manager had submitted an application for registration with the commission, however this had been returned as some information was out of date and some was incomplete. Relatives told us they felt the home could improve by having a permanent manager. Comments included ‘It would be nice if managers stayed longer. They don’t seem to stay long enough to put into practice all the improvements they make’. There was an established annual quality assurance system in place, supported by Southern Cross that included the views of people living at the home and their relatives and representatives. Evidence was available to confirm that regular residents, relatives and staff meetings took place at Broome End. These were all minuted and showed us the management ethos was open and transparent. Relatives told us that relatives’ meetings take place 4 or 5 times per year, but they don’t always get a copy of the minutes in a timely manner. Supervision systems were in place and both group and individual supervisions were being carried out. Senior staff meeting minutes of 05/01/09 included reference to supervision training at Harlow College for senior care staff, the manager and deputy manager. Broome End had a dedicated full time handyman who was responsible for all routine checks such as water temperatures etc. The manager told us that the maintenance man undertook a daily tour of the building to identify any issues. Maintenance issues around the home were dealt with once they had been identified and reported. Records examined show that appropriate maintenance checks were carried out. These included a Portable Appliance Testing certificate, emergency lighting, electrical installation, and gas certificate, lifting equipment and a current environmental services premises inspection. There were significant gaps in staff training for health and safety and infection control. Broome End Care Centre DS0000017785.V375287.R01.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 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12 Requirement The health and welfare of individual residents needs to be promoted and proactively managed, specifically those people living with dementia. This is to ensure that where people require support, records are detailed and staff members have the necessary skills to recognise when to provide appropriate interventions and how to enable people. Social activities must be provided consistently on a group or individual basis in a person centred way. This is so that people are able to enjoy a good social life in the home that promotes their independence and well being. All parts of the home must be maintained in a good decorative order throughout relative to the needs of the people living there. This is so that people live in an environment that meets their needs. Staff must be trained and competent to undertake the DS0000017785.V375287.R01.S.doc Timescale for action 31/07/09 2 OP12 16 31/07/09 3 OP19 23 30/09/09 4 OP30 18 30/09/09 Broome End Care Centre Version 5.2 Page 27 duties and responsibilities they have. This is so that people are cared for by a skilled and competent staff team. 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 OP7 Good Practice Recommendations The daily records need to be improved to reflect how the individual has spent their day, rather than entries all care given as stated in care plan, which does not describe the well being of the individual. For example, good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. Medication administration records should be accurately completed at the time of administration so that it is possible to be sure if people have received the correct medication at the correct time. Records relating to peoples’ health care and support needs should be maintained in a manner that promotes and protects their privacy and dignity It is recommended that appropriate signage be in place around the care home so as to aid people’s orientation and ability to find their way around the care home. Consideration should be given to improving the environment for people living with dementia in line with current good practice guidelines, for example clear symbols, photographs and use of colour for recognition and orientation etc. It is recommended that a review of the staff deployment is undertaken to ensure there are sufficient numbers of staff available to meet peoples’ needs at peak times and that staff do not consistently work long days meaning that they may become overtired and unable to meet peoples’ needs effectively. 2 OP9 3 4 5 OP10 OP19 OP22 6 OP27 Broome End Care Centre DS0000017785.V375287.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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