Inspection on 24/05/06 for Broomfield Nursing Home

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Broomfield Nursing Home 02/09/08

Broomfield Nursing Home 27/09/07

Broomfield Nursing Home 02/04/07

Broomfield Nursing Home 05/01/06

Broomfield Nursing Home 28/04/05

Broomfield Nursing Home 25/01/05

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

CARE HOMES FOR OLDER PEOPLE Broomfield Nursing Home Yardley Road Olney Bucks MK46 5DX Lead Inspector Gill Wooldridge Unannounced Inspection 24th May 2006 10:00 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 Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 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. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Broomfield Nursing Home Address Yardley Road Olney Bucks MK46 5DX 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) 01234 711619 01234 717054 Atlantis Healthcare Ltd Mrs Margaret Richardson Care Home 49 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly physically frail 20 of whom receive personal care 5 (five) of the above places are designated for EMI care One service user under the age of sixty five Date of last inspection 5th January 2006 Brief Description of the Service: Broomfield Nursing Home is situated in the town of Olney; local amenities are within walking distance to the Home. The Home is registered for 49 Service Users. The Home provides Nursing Care for the elderly frail; in addition the Home is registered to cater for those residents diagnosed with Dementia. The Home provides both Nursing and Care. There is an established staff team which meets the needs of residents, the staff team are supported by a number of ancillary staff. A local General Practitioner and other health professionals support the care of residents. The environment is in need of some attention and provides single and shared rooms some of which do not meet the standard. The manager described the range of fees as: Nursing £534 - £635 Residential £450 - £485 Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken on the 24th May 2006 by Gill Wooldridge and Barbara Mulligan. The inspection was carried out with the full support of the Manager. The inspection was undertaken between the hours of 10am and 5pm. The Inspectors have assessed all the key standards. During this inspection a variety of documents were assessed which included, menus, health and safety, medication, pre-admission assessments, care plans, risk assessments, equipment and adaptations, policies and procedures, training, recruitment, supervision and rosters. In addition a full environmental inspection took place. this indicated that there are a number of issues which must be addressed in the coming months. During the inspection one inspector spent time talking with residents and visitors to obtain their views. These views and comments were then assessed against documentation and systems in place and are included in the body of the report. No written feedback from residents, relatives or any other stake holders has been received at the time of writing this report. As a result of the inspection several requirements for improvement and recommendations to support the homes professional development have been made. These include such things as additional training for staff, the reassessment of the homes activity management and review of gaining views from interested parties including actions to be followed through. Several staff members were spoken with throughout the inspection to obtain an insight of their issues and to discuss the care of residents. The Inspectors would like to take the opportunity to thank the residents, Visitors, Management and Staff for the support and time given to ensuring the inspection process could be completed. Residents, relatives, staff and the managers comments are included in the report. What the service does well: Staff provided care that was implemented in a sensitive and professional manner during the inspection. Families and other visitors are welcomed to the home with no apparent restrictions regarding visiting times. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 6 The home has a comprehensive complaints procedure which should ensure all complaints are investigated within the recognised timescales. There have been no complaints received at the home or to the Commission since the previous inspection. The home appears to be following the Milton Keynes Inter-Agency Policy for the Protection of Vulnerable Adults and staff are aware of who to report any potential or actual adult protection issue to. Large communal areas are available throughout the home providing adequate private areas for residents to meet with their visitors. Staff described the care of residents fully. The food at lunchtime looked appetising and residents generally commented that the food is good. Health professionals support the care of residents. What has improved since the last inspection? During the inspection it was evident that a number of requirements set at the previous inspection have been met. However, some areas have not been actioned by the manager and proprietor. The manager confirmed that she ensures that medication such as Lactulose and Senna are prescribed individually for residents this was noted in the medication trolley. The manager confirmed that she had advertised the post for an activity organiser, this was confirmed and seen in a local paper by an inspector. The manager is in the process of developing menus in consultation with residents. The manager had ensured that she had three references for a recent employee this is noted as an improvement in previous practice. The manager has started to develop a quality audit system, this needs to be implemented. Work has been completed with regard to a recent fire inspection. The manager has agreed to send the supporting paper work to the Commission. Following a recommendation at the last inspection a deputy manager is in post to support the care of residents. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 7 What they could do better: A Requirement was made for an action plan to be provided to the Commission within 2 months of this inspection, which reflects the following points: continued replacement of carpets takes place, damage to the kitchen floor will be adequately repaired or the floor replaced, adaptable beds be purchased for those Service Users who are infirmed. This requirement is still outstanding. Despite the manager advertising for an activity organiser the manager has failed to develop a comprehensive activities programme in line with the residents social and recreational needs. An immediate requirement was made at the previous inspection for all actions outlined in the previous Environmental Health Officers report are implemented. (An action plan of how these will be achieved needs to be submitted to the Commission within 28 days of this Inspection). A further Environmental Health Officer’s inspection took place on the 11th April 2006 indicates that much of this work has not been completed. The manager is reminded to keep a written record all telephone conversations regarding the authenticity of any references. The manager must formalise any supervision regarding staffs practice to ensure staff they are aware of any issues. The quality audit system should include views from residents, relatives, and stake holders including health professionals, commissioning and care managers. It is recommended that documented permission be sought from residents for families to access the key worker files and permission should be sought for residents photographs to be held in care plans. The Inspector recommended at the previous inspection, training for caring for the elderly frail is included in the Induction package for all staff with further in house training put in place for all existing staff, this was not evident. An immediate requirement has been left with the manager and must be sent to the proprietor which outlines that the manager must send to the commission within 7 days a risk assessment to support the potential risk of residents and staff tripping on ill fitting carpets and the flooring in the kitchen. (The manager has sent a risk assessment to the Commission.) The carpets and flooring in the kitchen must be made safe or replaced within 3 months. Requirements set around the environment are detailed in the report. The manager needs to develop some better systems to ensure residents have a pleasant environment. This must include better housekeeping systems and the replacement of carpets if a cleaning schedule is not effective. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 8 Residents’ finances must be supported by a more robust system to ensure there is no impropriety. 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. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 9 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 Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. A Pre-admission assessment is undertaken for all potential residents ensuring the needs of potential residents can be met before an admission is agreed. EVIDENCE: A pre-admission assessment is undertaken prior to admission; the Manager or a qualified Nurse undertakes these assessments. A visit to the home is offered to all potential residents, however as a large number of admissions are directly from hospital this is not always possible. In these instances families and prospective residents are welcomed to the home to assess the suitability of facilities. The paper work regarding to the last admission to the home was studied and the information was satisfactory. However, some sections lacked the detail noted in other sections and it is recommended that the manager ensures that she continues to gain information from residents and relatives to ensure the assessment is complete. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 11 The manager should ensure that the good practice described is incorporated in the assessment procedure. Some residents described finding the home comfortable and caring, other residents comments are included in other sections of the report. Staff spoken to confirmed that they had not completed all mandatory training, this was supported by the training plan on the office wall indicates that staff are not all trained in mandatory or specialist training this shortfall indicates that residents needs may not be fully met. The manager confirmed that new contracts for residents are in hand, this must be made a priority. Broomfield Nursing Home does not offer intermediate care services; therefore Standard 6 does not apply to the home. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Care plans are in place, however the detail must be improved as must reviews and the involvement of resident and their relatives. This has potential to indicate that residents’ needs may not be met. Individual moving and handling risk assessments must be more detailed to include control measures to support residents safety. Nursing staff are supported to implement health care by a local G.P. service, this should ensure the needs of residents are met. Medication procedures are in place, however some inconsistencies noted have the potential to place residents at risk. Residents were noted to be treated with dignity and respect during all personal care and throughout the time of the inspection. However issues raised by residents and relatives must be addressed to ensure residents privacy and dignity is respected at all times Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 13 EVIDENCE: Each Service User has an individual plan of care, however these demonstrate inconsistent review and some continued assessments such as skin assessments and risk assessments were not always indicative of a recent review for example, one Norton scale was last reviewed on the 23/3/06. All Care plans include a photo and details page, admissions information, skin assessments, risk assessments, manual handling needs and individual plans of care. Risk assessments need to be developed and contain information regarding the frequency of turns. The pressure needed for the air mattress risk assessments must include the action and control measures to support the residents care and reduce any risk. The manager confirmed that staff were attending risk assessment training in the future. Moving and handling assessments although reviewed did not indicate how many staff were needed to support the residents care. The number of residents with pressure areas in the home is concerning. However, the manager confirmed that the Tissue Viability Nurse supports the care of these residents. Along with evaluation and a clear descriptions of the area contained in a detailed care plan these measures should support the care of these residents. It is advised that care plans interlink regarding moving and handling, diet and care of the wound. The manager should take the appropriate advice on the use of Cavalon in aiding wound healing. To further aid any healing process dietary advice should be sought for residents who may be loosing weight or have a pressure area. A skin assessment in a further care plan indicated high risk but did not indicate where the pressure area was. A further care plan reviewed on the 22/5/06 indicated that there was no pressure area however, there was a plan of care regarding a pressure area. This matter was discussed with the manager and she confirmed that the risk assessment had not been completed properly. A number of evaluations described ‘no change’ other evaluations were well thought through and documented clearly. One residents communication needs were discussed with the manager, this residents country of origin was identified in the care plan however, the detail of how to communicate with this resident was not fully ascertained from her family who could support the care. This detail would support staff in communicating with this resident. One care plan indicated that the resident needed help with toileting, this must be described in more detail. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 14 It is acknowledged that some care plans had clear information, these included those regarding Peg Feeds. Some paper work contained in the care plans was not clearly photocopied, this also made the documents difficult to read. In one care plan the use of ‘tipex’ was noted, this practice must cease. One assessment was last reviewed on the 27/7/05 and the hand writing was difficult to read. Review of care plans recorded‘no change’ however, staff described the care of residents and this indicated that there had been a change in the residents condition although this was not recorded in the evaluation seen. One resident was described as deaf in his care plan and the intervention is for ‘staff to write a message on a pad when communicating’ however there were no special aids indicated in the care plan. It is acknowledged that there is an appointment planned for the 6/6/06 to clear wax from the residents ear. This residents weight loss is of concern, the records indicated that in October, no specific date, they weighed 10 stone 11 pounds by the 23/5/06 the resident weight had reduced to 8 stone 4 pounds. An entry for eating and drinking Mrs X ‘has requested a small diet there are lots of things she doesn’t like to eat kitchen staff aware’. Staff must record all residents preferences and record that they are attempting to offer and feed this resident an appropriate diet following advice from a dietician. The particular approach and the level of support for this resident must be described, the resident or family must be consulted to enable staff to support this resident more effectively. Residents suffering with diabetes did not have their blood pressure taken monthly as a matter of routine, neither was their normal range of blood sugars described in the care plan. One care plans that indicated weigh monthly recorded last weighing as August 05 this is unacceptable. Turning charts seen in resident’s bedrooms were not completed for 12 hours, this is unacceptable. Since the previous inspection, in addition to the nursing care plans the home has implemented a key worker file, which contains documents with supporting recording tools, which are maintained by care staff. The registered nurses monitor these weekly with records held within used for the continuous review of the individual plan of care. These key worker files are available to residents and their families. This is noted as good practice. However, it is required that residents and relatives are involved in the process of the care plan and requested to provide a signature. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 15 It is also strongly recommended that the manager requests permission from residents or their representatives to hold photographs of residents in the care plan. A quality audit system will support the content of the care plan and the system should ensure regular review and involvement of residents and their families or representative in the process. All identified needs should be clearly met via a care plan. The home is supported by a local G.P. service that has been actively involved with the Commission since the previous inspection and the home to support improvements in their systems. A weekly visit by the G.P. is in place to review medical needs. The manager confirmed that medication for residents is reviewed every six months, this is noted as good practice. Records seen indicated support from the Tissue Viability Nurse, Chiropodist, Dietician and Speech Therapist. There are good medication systems in place and observed practice was sensitive and in line with the homes policy however, inconsistencies were noted on Medication Administration Records sheets and theses issues must be addressed by the manager. Trained nurses must be reminded formally of their accountability and practice regarding gaps and written over entries this must be supported by records held in the home for inspection purposes. This will include an audit system and competency checks, records must be maintained for inspection purposes. Registered Nurses administer all medication with the exception of creams and topical ointments. This issue was discussed fully in the previous inspection report and the manager stated that this issue was still in the discussion stage this issue must be managed with a sense of urgency. The manager confirmed that the controlled drugs records are always signed by two nurses. The issue of holding stock medication such as Lactulose and Senna has been remedied by individual prescriptions. Discussions with the trained nurse took place regarding the process of receiving the results of blood tests regarding Warfarin administration and the use of sedation in the home. She stated that ‘residents are not sedated as we use very little sedation’. This was confirmed by the lack of residents asleep during the tour of the home. It is strongly recommended that the trained nurses develop individual management plans regarding any PRN medication and a protocol regarding the process of receiving the results of blood tests regarding Warfarin. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 16 Residents spoken with at the time of inspection were complimentary of the care and support offered by both Carers and Nurses. There were however, reports from residents that some staff implementing care are ‘rude’, ‘snobbish’ and ‘most are Ok but a couple are not’,. This is a training issue that needs to be addressed with the team to ensure all staff understand the specific needs of individuals and how to implement care to elderly frail residents. Staff need to be always professional and provide care in a safe and sensitive manner. It is required that staff induction and training is reinforced and that the manager walks the floor to ensure she gains the views of residents and addresses these issues formally with staff, maintaining records for inspection purposes. It is acknowledged that in one care plan privacy and dignity regarding catheter care supported protecting residents dignity. The care plan stated ‘ensure catheter bag is covered when resident is sitting down’. During the tour of the home it was noted that one residents catheter bag was on show. Communication issues with staff for whom English is a second language were noted in some residents comments. The manager confirmed that staff are attending English classes to support the care of residents. Notices in residents rooms need to be contained in their care plans to protect their privacy and dignity. In one bedroom the resident was covered with a sheet and felt cold to the touch. The above issues do not always indicate that residents are treated with respect. The manager must have systems in place to observe staff and discuss the real issues for residents. It is acknowledged that during the inspection staff did treat residents with respect and dignity being particularly sensitive to toileting and feeding. All personal care takes place in the privacy of the residents own room or communal bathrooms with doors shut or screens in place (in double rooms) which provide additional privacy. Observed practice indicates that residents were spoken to with respect, turning was observed and was gentle and efficient. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The Home is providing limited activities to meet the social and recreational needs of residents, thus limiting the opportunities for social inclusion and stimulation throughout the day. Families and friends are welcomed to the home, thus ensuring residents are able to maintain their relationships. Menus need to be developed further to ensure the needs of residents are met., Further work needs to take place to meet the requirements of the last environmental health report to ensure the safety and wellbeing of residents is maintained. EVIDENCE: The Home is providing limited activities to meet the social need of residents. Relatives commented that ‘there is not much mental stimulation for the residents.’ One resident described a musical afternoon that was held the day previous to the inspection. Residents also described a programme of activities Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 18 put stated that they do not happen regularly and described the programme as ‘hit and miss’. Care staff provide some activities during the afternoon, it is acknowledged that the manager advertised for an activity organiser following a requirement at the previous inspection however, the manager must ensure that she has allocated staff and prioritises the residents wishes regarding any social needs and maintains records for inspection purposes. One relative described no relatives meetings. The manager should ensure that regular meetings take place so relatives and residents can air their views. One resident commented that another resident spends the day shouting, this was noted during the mealtime and at some periods of the day during the inspection. This may affect a number of other residents. There must be a management plans in place to support this resident and other residents effected by the behaviour. There are no restrictions on visiting times with families and friends reporting they feel welcomed at the home. The home provides adequate amounts of food throughout the day, which includes home cooking. At the previous inspection a number of residents and some relatives had commented on the lack of variety and that some of the options offered are not appropriate or tempting to their relative or friend, some examples of these were the hot dog option and sandwiches made with thickly sliced bread. Some work has been undertaken to revamp the existing menus in consultation with residents so they are reflective of meals that are both appetising and enticing to the elderly. The manager stated that she has developed menus in consultation with residents and relatives. However, these menus have not been implemented or discussed with the chef or a dietician. This requirement has partially been met and the manager must confirm in writing, within 28 days of receipt of this report that progress to meet the requirement has been completed. This must include appropriate meals and snacks for resident who are identified as under weight or those who are nursed in bed to aid any healing process. The lunchtime meal process was observed and the food appeared appetising, well presented and included roast pork, apple sauce, cauliflower, roast potatoes. Apricot tart and custard followed by cheese and biscuits. Staff were observed to offer residents a choices of drinks and residents were offered ice cream, fresh fruit and yogurt as alternatives. Staff were observed to feed residents sitting next to them at a pace appropriate to the needs of the resident. This is noted as good practice. Some residents commented favourably regarding the food. However, relatives stated that residents were not offered fresh fruit and the evening meal was always sandwiches Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 19 Cups and plates are tatty and plastic beakers are used. The manager must replace the crockery in the home and table cloths must be replaced. An immediate requirement was given at the previous inspection in response to the findings of the environmental health officer inspection, there are a number of requirements set at the previous inspection that have not at this time been actioned. One action that had been implemented was the repair to the kitchen floor, unfortunately this attempt has not been successful and will require further work or a replacement floor to solve the problem. The Commission will require an action plan inclusive of timescales to ensure all areas of concern raised by the Environmental Health Inspector are addressed. A further Environmental Health Officer’s inspection took place on the 11th April 2006 which indicated that much of this work has still not been completed. From checking the Commissions post system it is evident that an action plan was not sent to the Commission regarding the immediate requirement left at the previous inspection. A further immediate requirement has been left to ensure the safety of staff and residents regarding the kitchen floor. Risk assessments must be in place and sent to the Commission within 7 days and the flooring replaced within three months of the date of the inspection. This supports the mandatory requirement served by the environmental health officer. It is acknowledged that the manager has sent a risk assessment and plans to be able to complete the work on the floor within 3 months. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The Home has an accessible complaints procedure, which should ensure residents, and significant others can make a complaint appropriately. The home is presently using the Milton Keynes Protection of Vulnerable Adults from Abuse policy and its reporting systems, this should ensure the protection of Service Users from abuse. Residents money is managed poorly, which has the potential to place residents finances at risk. EVIDENCE: The home ensures all complaints are investigated within recognised timescales as stated in the organisation’s policy. There were no complaints recorded in the complaints system since the previous inspection. The issues discussed in the health and personal care section do not always indicate that residents are treated with respect or listened to regarding their concerns regarding staff attitude. The manager must have systems in place to observe staff and discuss the real issues for residents, addressing any issues that they wish to raise. Relatives raised concerns regarding the environment which again must be formally responded to through the complaints system. Relatives should be encouraged to write formally to the manager regarding Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 21 these matters and the manager is reminded to respond to any verbal concerns and these must be recorded and actioned in writing. Relatives also raised concerns that staff did not respond to the doorbell during the afternoon, evening and at weekends. One relative described going home following the failure of staff to open the door. The manager was informed of this shortfall and the administrator will continue her work in reception in the afternoon to assist in managing this concern . The manager and staff must ensure that the door bell is answered promptly. The home follows the Milton Keynes Inter-Agency policy for the Protection of Service Users from abuse. All issues of concern would be raised with Social Services following the reporting systems of this policy. Adult protection issues were discussed with the manager and staff. Staff indicated that any potential or actual abuse would be reported to the appropriate body. It is strongly recommended that adult protection is discussed in staff meetings as a regular standing agenda item. Care Line and Action on Elder Abuse should be advertised in the home. After ascertaining that the home does hold for some residents small amounts of money, it was noted that the system in place did not indicate that the records tallied with the amount of monies held. The system must be transparent and protect residents from any impropriety. The administrator is aware of the inconsistencies noted and plans to introduce a robust system to protect residents. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There is no evident programme of decoration at the home to ensure the environment is safe and homely. There are sufficient numbers of toilets and bathrooms available, which should ensure the needs of residents, are met however, some bathrooms are small and present a potential hazard to residents. Specialist equipment and adaptations are available at the home to ensure the safety of residents. Risk assessments that involve residents and their relatives must be in place to protect residents. The home provides both single and double bedrooms to meet the needs of residents, some of the double bedrooms are small which may effect their care. A dedicated team of housekeeping staff cleans the home however, insufficient housekeeping and a lack of a recorded cleaning schedule does not ensure all residents have a pleasant environment in which to live. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 23 EVIDENCE: The Proprietor and manager have not implemented a programme of decoration to address the ongoing maintenance and redecoration of the home. This will be a lengthy and costly task, which the Commission have been made aware of. However there are some areas of the home which need urgent attention to ensure the health and safety of residents and staff. These include the continued replacement of old carpets, which are ill fitting and are posing a trip hazard to residents. Door guards require a monitoring system which has been introduced. However, the door guards must be numbered and supported by a risk assessment, records indicated the door guards were last tested on 23/3/06 these tests and records must be maintained monthly. It was also noted that the manager was using a paint pot to hold open the office door and a number of residents bedrooms were held open with sand bags. Theses must be removed and after seeking advice from the fire officer an appropriate device should be fitted. The damage to the kitchen floor will require further attention or replacement and in the interim supported by a risk assessment. Adaptable beds, for those residents who require ongoing nursing care, or are bed bound will need to be purchased. The manager confirmed that this had not happened. Many of the above were part of a requirement set at the previous inspection, it is disappointing to note that the Commission had not received an action plan to ensure these points had a timescale for completion. As part of the requirement set at the previous inspection it was noted that bed rails were risked assessed. In addition to the ongoing decoration of the home it was noted that :• The manager and proprietor need to ensure rigorous cleaning of existing carpets to continue to eliminate (or minimise) offensive odours and stains until such time as replacement occurs. Records must be maintained for inspection purposes. This includes bedrooms 6 and 7. Bedroom carpets in rooms 8, 13, 14, 23, 24 & 27 are badly stained and need to be cleaned if this is not effective these carpets must be replaced. Bedroom carpets in 19 & 34 appeared not to have been cleaned for some time. A number of bedroom carpets must be replaced as they present a trip hazard to residents as the carpet or carpet tiles are ill fitting. The manager and proprietor have been left an immediate requirement to remedy this issue. In the interim the manager must send to the Commission a risk assessment outlining the risks and how, these can be Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 24 minimized. The bedrooms affected are 1, 2, 3, 7, 9, 12, 23, 25, 26 & 29. This is not an exhaustive list. • It is acknowledged that the housekeeping staff work hard to support the care of residents however, staff shortages may have led to the above noted cleaning shortfalls. A system to ensure residents have a pleasant environment must be in place and agency staff employed to cover any shortfalls in housekeeping staffing. The dining room is looking tatty and is not reflective of a homely environment. This must be re decorated. Curtains are coming off their rails in a number of bedrooms this must be attended to ensure they close effectively and are presentable. Some bedroom furnishings will need replacing and/or additional furnishings added to double rooms to ensure facilities appropriate for the usage of two residents including armchairs. The three above issues were part of the previous inspection report and it is evident that they have been ignored ,they are now part of a requirement set at this inspection. • • • • Issues raised at this inspection that must be remedied include :Bedroom 19 appeared cramped and there is no room for a comfortable chair for each resident. Bedroom 18 is very tatty and is in need of redecoration, ideally this should be a single room. Bedroom 20 indicated that a sand bag may have been used to hold open the bedroom door if this is the case this article must be removed and the practice ceased. Bedroom 27 door was wedged open with a sand bag. In bedrooms 5 and 9 the doors were wedged open with a door stops. This practice must cease. Where residents wish to have their bedroom doors open the fire officer must be consulted to ensure an appropriate device is fitted, these appliances must be risk assessed. Bedroom 1 curtains must be re-hung Bedrooms 4, 5, 7 & 8 need re-decoration. The chair must be replaced in bedroom 8 and be suitable for this residents needs. In bedroom 23 the bedside table is tatty and broken this must be replaced. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 25 In bedroom 33 the furniture is tatty and must be replaced and the skirting boards must be re- painted. In bedroom 31 the radiator cover is broken and must be replaced. One chest of drawers must be replaced. It is acknowledged that this room has two new chest of drawers. There are both double and single bedrooms available at Broomfield Nursing Home; these do vary in size with the smaller double rooms situated in the extension and large double rooms available in the older part of the house. Service Users are supported to personalise their bedrooms with their own furnishings (within reason) and pictures should they wish. All bedrooms were found to be clean and tidy on the day of inspection, there was a noticeable offensive odour in some bedrooms, which will require further cleaning to minimise. As previously mentioned in this section of the report, some of the bedrooms would benefit from refurbishment and decoration, this is part of the ongoing plans for the home and progress will be assessed at future inspections. A new bedroom table was requested as a resident hit their head on it no replacement has been found. A number of the resident’s bedrooms were not viewed as residents were asleep. The lighting needs to be brighter to aid residents with their mobility. The ensuite bath needed cleaning. The area where residents sit with 4 chairs and where the pay phone is situated needs a good clean and hoover. The kitchen floor has been discussed earlier in this section and the kitchen needs a deep clean. Food is stored in the portacabin the manager and proprietor must ensure that the food is protected from vermin and regular stock control is in place to ensure residents are not put at risk. These issues will be feedback to the environmental health officer. Administrative staff use the kitchen as a thoroughfare this practice must cease. The manager confirmed that she had ordered a liquidiser this is essential as the home has at least 16 residents who need their food pureed. The homes probe is not working and must be replaced. Damaged crockery must be replaced with crockery suitable for residents. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 26 Relatives confirmed that bedrooms are not cleaned every day this is unacceptable and supported by the inspectors’ findings during the tour of the home. Housekeeping staff were seen to work hard however the manager confirmed that staff sickness has effected the cleanliness of the home. The manager must ensure that she employs appropriately checked agency housekeeping staff to support the care of residents. One relative stated that their relative does not have access to the bath in the en-suite. The manager must consult with relatives and residents on any risk assessment to ensure that if there is a valid reason not to use the en-suite bath the relative is aware and consulted and advised of the alternative arrangements. As stated earlier in the report the dining room is looking tatty and must be repainted. This area is used to store wheel chairs during some part of the day this may pose a risk to residents. During this inspection ants were seen on the tables. One window in the door was stained and needs replacing or cleaning. One resident requested new curtains. The manager must ensure that all residents are involved in any redecoration or refurbishment. All notices regarding resident’s care must not be on view to ensure residents dignity and placed in the appropriate care plan. In many bedrooms commodes are provided and not all residents have a comfy chair. Some chairs are split and must be replaced. It is required that each resident is provided with a comfy chair. All residents must also be provided with a wardrobe. Where they indicate that this is not their wish this must be recorded in their care plan. In the lounge it appears that the gas seal has failed on the window or it needs cleaning. This must be investigated and remedied. Where radiators are not covered they must be covered or switched off and supported by a risk assessment until a cover can be fitted. Around the back door there appears to be a problem with damp, this must be investigated and remedied. The long corridor needs repainting. It is acknowledged that there is a nice carpet in the second lounge. From discussions with residents and relatives individually and in a small groups the overriding concerns were around the maintenance of the home and the odours. One relative stated that their relative’s room had not been decorated Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 27 for some time. A further relative described being promised redecoration of the bedroom on admission some 2 years ago this has not been completed. One bathroom was described by a resident as ‘terrible’ ‘the floor is uneven they have to wrestle to get me in’. ‘You’re tossed about like a cork on the ocean’ the bathroom was small and there would not be a lot of room to move a hoist. The resident must be consulted in any risk assessment to ensure they are comfortable in using this bathroom. There are sufficient numbers of toilets and bathing facilities all within close proximity to Service Users bedrooms, these have been pleasantly decorated and have the necessary adaptations and equipment to support the Service Users. One bathroom was used as a store for wheel chairs with a Parker style bath which leaks and is not in use. This must be rectified and or replaced. The wc is in use however, it is not appropriate to store wheel chairs in this area as they may pose a risk to residents. The sluice must be kept locked. There was a lack of foot pedal bins which when in place will aid infection control. There are a number of holes in walls that must be filled and painted. The toilet seats must be replaced in bedroom 17. There must be a schedule for removing fluff from the dryer to ensure that this does not pose a fire risk. The manager and administrator have on the 16th May 2006 toured the home and produced a list of repairs and refurbishment many of which has been outlined in the report. Their report identified carpet shampooing and many issues regarding health and safety including ill fitting carpets and poor lighting, these matters must be made a priority. All items of C.O.S.H.H. are stored in appropriate lockable facilities with supporting risk sheets available to the staff. An additional member of staff is employed to run the laundry, suitable facilities are provided to ensure there is not a build up of soiled linen. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 28 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 at least once during a 12 month period. 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 the home. Staff possess the relevant skills, however, this must be supported by training to ensure the needs of residents are met. Staffing competence and professionalism are issues which must be addressed by the manager to give residents and relatives confidence in the service delivery. The home has a recruitment procedure, which is in line with Schedule 2, however, the system must be more robust to ensure residents protection. The manager must follow through and record all issues that may arise from the process of recruitment. Telephone conversations to ensure the validity and authenticity of references should be recorded to ensure residents protection. EVIDENCE: During individual and group discussions with residents and relatives these comments were made. Relatives stated that staff do not take notice of residents sat in the lounge. Residents and relatives said ‘some of the carers have a don’t care attitude’ although ‘the nurses are very good’. ‘This is as good as it gets’ , ‘some staff are alright but some are rude’. ‘it is the odd one or two that you can’t get on Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 29 with’ ‘Staff are supportive although some are not’.The manager must make herself more visible to address these issues. Records must be maintained for inspection purposes. One resident described not being able to understand several staff as they ‘don’t have good English’. The manager is reminded that communication is the key to staff relationships with residents. Rotas viewed and staffing levels appeared adequate on the day of the inspection. The manager has a white notice board in the office which gives the reader information regarding the training for all the staff team. This information details many gaps and planned training is booked in the coming months. In the interim the manager must ensure that all trained nurses are first aid trained and all staff receive mandatory training including POVA training, dementia care and managing challenging behaviour. In the interim staffs competencies must be assessed to ensure that they can meet residents needs this is especially pertinent to first aid and fire safety. Records must be maintained for inspection purposes. At this time one Nurse and the Manager are accredited Moving and Handling trainers. The training plan did not indicate that all staff are trained in moving and handling. This is unacceptable. It is strongly recommended that the manager develops a training matrix to ensure that she has a planned programme of training ensuring that staff are regularly updated. NVQ training has fallen behind due to a change in NVQ provider, however the home have now found a new facilitator which is ensuring a number of care staff are able to access this qualification. At the previous inspection the Inspector had advised additional training in the care of the elderly frail also be implemented through the induction pack with additional training provided for existing staff members. There was no evidence that this had been actioned. The inspector perused three staff personnel files at random. Recruitment procedures are in place. However, the manager needs to keep a written record of telephone conversations following up the authenticity of references. The manager was advised to exercise caution in circumstances where outcomes of a CRB check indicate that the applicant may not be a person fit to be employed in a care setting. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 30 The manager is advised that following any disciplinarily action she outlines the areas for improvement with set goals for staff to achieve. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 31 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The manager needs to be more proactive in ensuring that residents and relatives to ensure their views are incorporated in the service delivery. The manager needs to develop audit systems to support the care of residents. Financial procedures adopted by the home must be more robust to protect residents. Monthly supervision of staff is in place this process must be formalised to benefit residents care. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 32 EVIDENCE: Comments from visitors included ‘it gets very crowded in the lounge when all the residents are in the room’. This may pose a risk to residents and visitors and must be risk assessed. The manager describes the care of the residents as her priority. However it is evident from resident and residents comments that she needs to be more proactive. The manager has recently recruited a deputy manager who should support the manager in her task of meeting her regulatory responsibilities. Staff described the manager as supportive although more formal support needs to be documented clearly for some staff. The home holds small amounts of resident’s money securely. This money is held for hairdressing. It is acknowledged that there is an invoicing system and a number of relatives also hold residents money. The present system needs review and could indicate impropriety as the amounts recorded did not tally with the records seen for two residents monies checked. The administrator is keen to develop a more robust system to safeguard residents interests. It is the responsibility of the manager to oversee the system of holding any residents money. Further work needs to be undertaken to ensure the home has a thorough quality audit system in place that reflects the views of residents, this includes the necessity for monthly feedback for such things as care regimes, menus, activities and the general day-to-day running of the home. In addition the home does need to implement monthly audits of some of its systems, for example medication, care planning, training, residents money and health and safety. A requirement is made for improvements in these systems. A good quality audit system will support the manager in her task to ensure requirements are followed through with evidence to support her held in the home. The manager confirmed that all staff receive documented supervision from a senior member of staff. It is strongly recommended that the manager includes the setting of supervision dates on the training white board to ensure all supervisions are kept up to date. Records held pertaining to residents are maintained to a high standard, with noticeable improvements in the care plans. All records are stored appropriately in lockable facilities. A selection of health and safety information was assessed during this inspection; all records were not available. As the administrator had recently moved offices. Other records seen were satisfactory and they included a recent Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 33 lift service on the 2nd March 2006. Information detailed in the pre inspection questionnaire detailed that health and safety issues are generally regularly checked. however the manager needs to oversee that the door guards are tested and recorded regularly. The detail regarding the recent food hygiene inspection is discussed in the section of the report in Standard 15. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 34 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 2 2 X X X 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 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 2 X 1 Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 35 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 OP15 Regulation 16 (2) i. Requirement Timescale for action 30/08/06 2 OP15 16 (2) j. 3 4 OP38 OP19 16 (2) j. 16 (2) c 23 (2) n. A requirement is made for menus to be reviewed to reflect more choice, variety and foods that will entice those with diminished appetite. Previous timescale of the 05/04/06 not fully met. An immediate requirement is 20/07/06 made for all actions outlined in the recent Environmental Health report are to be actioned. An action plan of how these will be achieved needs to be submitted to the Commission within 28 days of this Inspection. Previous timescale of the 05/03/06 not fully met. As above (Requirement 2) 20/07/06 A Requirement is made for an 31/10/06 action plan to be provided to the Commission within 2 months of this inspection, which reflects the following points: continued replacement of carpets, door guards are monitored for efficiency, damage to the kitchen floor will be adequately repaired or the floor replaced, bed rails to be replaced as necessary, DS0000062501.V290009.R01.S.doc Version 5.1 Page 36 Broomfield Nursing Home 5 OP7 15 (1) & 15 (2) (a) & (b) 6 OP7 15(1) & 15 (2) (a) & (b) 14 (4) (c) 7 OP38 15(1) & 15 (2) (a) & (b) 14 (4) (c) 10 (1) (a) 17 (2) adaptable beds be purchased for those Service Users who are infirm. Previous timescale of the 05/03/06 not fully met. The manager must ensure that all care plans are audited to ensure there has been consultation with residents and the audit must ensure that the review of care plans is at least monthly ensuring all needs identified are covered clearly in the care plan. The manager must ensure that all risk assessments are audited to ensure there has been consultation with service users, review is at least monthly and risk assessments must detail control measures to minimise any risk. As above (Requirement 6) 31/12/06 30/08/06 30/08/06 8 OP7 9 OP9 13 (2) 10 12 (4) (a) & 22 (2) The manager must ensure that the use of ‘tippex’ on care documents ceases and must develop guidelines for good recording practice . Trained nurses must be reminded formally of their accountability and practice regarding gaps and written over entries on the Medication Administration Records sheets. This must be supported by records held in the home for inspection purposes. This will include an audit system and competency checks. The manager must ensure that issues that effect residents that have been discussed in the body of the report are explored to protect residents privacy and dignity. Records must be DS0000062501.V290009.R01.S.doc 30/08/06 30/08/06 30/08/06 Broomfield Nursing Home Version 5.1 Page 37 11 12 13 OP16 OP16 OP12 12 (4) (a) & 22 (2) 12 (4) (a) & 22 (2) 16 (2) (m) & (n) maintained for inspection purposes. As above (Requirement 10) As above (Requirement 10) The manager must develop a comprehensive activities programme in line with the residents needs ensuring staff are allocated to ensure residents social and recreational needs are met. Issues raised at this inspection regarding the environment and health and safety issues detailed in this section of the report must be remedied. A full regular audit must take place with the manager and proprietor to ensure that the items included in the report are actioned in a timely manner. This will support the upkeep of the building and ensure residents life in a safe home. Health and safety issues must be prioritised and acted upon promptly. This is not an exhaustive list the other main issues are detailed in the report. • A food probe must be purchased. • The home must be kept clean. • Bedroom walls must be repaired and redecorated as indicated in the body of the report. • Where radiators are not covered these must be covered or switched off and supported by a risk assessment until a cover can be fitted. • Risk assessments must be in place when equipment is used in a confined area. • The sluice must be kept DS0000062501.V290009.R01.S.doc 30/08/06 30/08/06 31/10/06 14 OP36 16 16 16 13 18 (2) (2) (2) (4) (1) (c) (g) (j) (c) (a) 31/12/06 Broomfield Nursing Home Version 5.1 Page 38 15 OP19 16 17 18 OP36 OP19 OP19 16 16 16 13 18 13 (2) (2) (2) (4) (1) (4) 13 (4) 16 (2) 13 (4) 19 OP26 16 (2) (c) (g) (j) (c) (a) (c) Any device not approved by the fire officer must not be used to hold open a fire door. (c) As above (Requirement 15) (j) An immediate requirement has (c) been left with the manager and must be sent to the proprietor which outlines that the manager must send to the Commission within 7 days a risk assessment to support the potential risk of residents and staff tripping on ill fitting carpets and flooring in the kitchen. The carpets and flooring in the kitchen must be made safe or replaced. It is acknowledged that the Commission has received the risk assessment which indicates that the flooring and carpets will be replaced within three months. (k) The manager and proprietor need to ensure rigorous cleaning of existing carpets continue to eliminate (or minimise) offensive odours until such time as replacement is undertaken and remove stains. Records must be maintained for inspection purposes. This includes bedroom 6 and 7. Bedroom carpets 8, 13, 14, 23, 24 & 27 are badly stained and need to be cleaned if this is not effective these carpets must be replaced. Bedroom carpets in 19 & 34 appeared not to have been cleaned for some time. DS0000062501.V290009.R01.S.doc locked. Pedal bins must be purchased to aid infection control. As above (Requirement 13) • 31/12/06 31/07/06 31/07/06 24/08/06 30/08/06 Broomfield Nursing Home Version 5.1 Page 39 20 OP19 16 (2) (c) These issues were also identified at the previous inspection. • The dining room is looking tatty and is not reflective of a homely environment. This must be repainted. • Curtains that are coming off their rails in a number of bedrooms must be attended to ensure they close effectively and are presentable. 30/09/06 21 OP30 18 (1) (a) 22 OP35 10 (1) 23 OP36 18 (1) (a) Some bedroom furnishings will need replacing or additional furnishings added to double rooms including arm chairs to ensure facilities appropriate for the use of two residents. 31/10/06 Staff must undergo mandatory training including POVA and specialist training (this will include dementia training , challenging behaviour, working with the elderly frail, epilepsy and any other training identified from residents needs. This will support staff in the care of residents. Competencies must be in place for those staff with no training in first aid and fire evacuation. Records must be maintained for inspection purposes until training can be organised. The manager must ensue there 30/08/06 are robust systems in place to ensure residents money is in safe hands. The manager must ensure that 31/07/06 following any disciplinarily action she outlines the areas for improvement with set goals for staff to achieve. • Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 40 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 OP2 OP7 Good Practice Recommendations It is strongly recommended that the manager ensures that all residents have an up to date contract. It is strongly recommended that the manager gains permission from residents and or their representative for the home to hold photographs in care plans. It is also recommended documented permission be sought from residents for families to access the key worker files. Residents should be weighed regularly as identified at assessment and records maintained for inspection purposes. It is strongly recommended that the trained nurses develop individual management plans regarding any PRN medication and a protocol regarding the process of receiving the results of blood tests regarding Warfarin. It is strongly recommended that the manager ensures that fluid and turning charts are completed to support the care of residents. It is strongly recommended that the manager records all verbal concerns and responds to these in writing. It is strongly recommended that the manager follows up concerns raised by relatives regarding staff answering the door bell in the late afternoon, evening and weekends. It is strongly recommended that adult protection is discussed in staff meetings as a regular standing agenda item. Care Line and Action on Elder Abuse should be advertised in the home It is strongly recommended that the manager keeps written records of all telephone conversations regarding the authenticity of any references. It is strongly recommended that the manager exercise caution in circumstances where outcomes of a CRB check may indicate that the applicant may not be a person fit to be employed in a care setting. It is strongly recommended that the manager develops the homes quality audit system which should include views from residents and stake holders including health professionals, commissioning and care managers. The DS0000062501.V290009.R01.S.doc Version 5.1 Page 41 3 4 OP8 OP8 5 6 7 8 OP8 OP16 OP16 OP18 9 10 OP29 OP29 11 OP33 Broomfield Nursing Home 12 OP30 quality audit system should ensure that all the paper work supports the care of residents. It is strongly recommended that the manager develops a training matrix to ensure that she has a planned programme of training ensuring that staff are regularly updated. Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 42 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 Broomfield Nursing Home DS0000062501.V290009.R01.S.doc Version 5.1 Page 43 - 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. 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