Inspection on 27/09/07 for Broomfield Nursing Home

This inspection was carried out on 27th September 2007.

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 02/04/07

Broomfield Nursing Home 24/05/06

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 Barbara Mulligan Unannounced Inspection 10:00 26 & 27th September 2007 th 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.V344339.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 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 from 1 Aug: broomfield@atlantishealthcare.co.uk Atlantis Healthcare Ltd 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.V344339.R01.S.doc Version 5.2 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 2nd April 2007 Brief Description of the Service: Broomfield Nursing Home is situated in the town of Olney and is privately owned. Local amenities are within walking distance to the home. The home is registered for 49 residents, and provides nursing and care for frail elderly people, and in addition the home is registered to care for five residents diagnosed with dementia. There is an established staff team to meet the needs of residents, although the post of manager is vacant. Residents are registered with local general practitioners and other health professionals are available to support the care of the residents. The original house has been extended and renovations are taking place to improve the environment. The fees range from £425 to £600 per week. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken on 26th and 27th September 2007. The visit consisted of discussions with the registered manager, the deputy manager, staff members and service users. A tour of the premises s undertaken and the homes records and other essential documentation were examined. As part of its equalities and diversity work the Commission has established an external stakeholder group made up of people who use services. This group is known as the Experts by Experience Equalities and Diversity Group. On the second day the inspector was joined by an “expert by experience”, who was asked to observe a lunch time meal and assistance provided, menu choice and observe for any issues regarding privacy and dignity. The inspection officer was Barbara Mulligan. The Operational Manager is Mandy Coleman and the manager for the home is Charlotte Jarrad. Twenty-five of the National Minimum Standards were assessed during this visit. Twenty of these are fully met, four are almost met and Standard 6 is not applicable. As a result of the inspection the home has received six requirements. Twenty-six of the National Minimum Standards for Older People were assessed during this visit to the home. Nineteen of these are fully met, six almost met and one assessed as not applicable. As a result of the inspection the home has received seven requirements. The inspector would like to thank the expert by experience, the operational manager, the manager, the staff team, service users and visiting relatives for their help, cooperation and assistance during this visit. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. What the service does well: The home provides a comfortable environment in which service users can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. There is an established staff team that consists of care/support staff and nurses who respond to service users in an appropriate manner. One service Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 6 user spoken to said “staff can’t do any thing wrong, they are always good I have no complaints they talk to me and always respond to the alarm” and another service user spoken to appreciated being able to spend “afternoons in her room with the TV and her CD’s.” Recruitment procedures are robust and records are well maintained. What has improved since the last inspection? What they could do better: The home must fully record nutritional and health screening records. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 7 The newly implemented medicine auditing system must be carried out on a more regular basis to ensure that accurate records are kept of all medication administered to service users, and action must be taken when problems are identified. All hand written entries on medication charts must be are legible, signed and dated by two staff. When medicines are prescribed to be given ‘as needed’, they must be included in the care plans so that service users are given these medicines in a clear and consistent way. The broken radiator covers must be repaired and soiled bedroom carpets need to be cleaned. The4 home must provide a place where the money and valuables of services users may be deposited for safe-keeping. Doors must not be wedged open, to ensure the safety of service users and a more suitable method of keeping doors open is used. The initial needs assessment, care plan documentation, and further risk assessment tools are reviewed, updated and are evidenced based. The treatment room door must remain locked when unoccupied. All personal records must be stored securely and only be accessible to staff. More nutritional and appetising alternatives could be offered to the main meal and liquidised meals should be blended and presented in separate portions. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broomfield Nursing Home DS0000062501.V344339.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 Broomfield Nursing Home DS0000062501.V344339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Potential service users receive a needs assessment undertaken by staff trained to do so, ensuring that the home can meet the care needs requirements of service users. The assessment tool needs to be reviewed and updated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined the care plans for four service users, including those most recently admitted to the home. All four service users have a completed needs assessment, however the assessment tool is dated and does not fully cover the areas detailed in standard 3 of the care home regulations for older people. During the previous inspection it was identified that the a review of the homes admission process and documentation was being undertaken. This does not appear to have been completed and is strongly recommended. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 10 The admission documentation seen is fully completed and demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not admit service users for intermediate care so this standard was not assessed during the inspection. Broomfield Nursing Home DS0000062501.V344339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. The care planning system provides staff with the information they need to meet the service users needs however the recoding of nutritional and other health screening needs to be improved. The medication policies and procedures are clear and informative, but there is no consistent implementation of the policies, that could result in unsafe working practices. Service users feel that they are treated with respect and dignity and that their right to privacy is upheld ensuring personal care is delivered appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care of four service users was case tracked and their care plans were examined. Following the initial assessment a plan of care is developed. Care plans seen are on the whole detailed and contain action plans that provide guidance for staff to follow. There is information about individuals personal care and likes and dislikes, family details, social care needs and some health screening. However there is a lot of dated and unnecessary Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 12 documentation contained within the care plans. A reduction of unnecessary information would make the care plans more user friendly and is recommended. Following the previous inspection it was recommended that all the assessment tools used at the home should be evidenced based, so that the needs of the service users are better understood. This has not yet been completed and the inspector was informed that the care plan documentation, the initial needs assessment tool and further risk assessment tools are to be reviewed and updated. This is strongly recommended. Care plans are reflective of review. Several entries recorded on the review sheets are illegible and this needs to be addressed. Service users at the home are registered with one main G.P. surgery. The inspector was informed that service users can register with their own GP if this is practical and agreeable to both parties. All have access to local NHS Services. At the time of the inspection there were service users who needed pressure area care and there is evidence that this is being monitored and treated by the nurses. A domiciliary optical service visits the home and can be accessed on a needs basis also. Referrals for a hearing test go through the service users G.P. Nutritional screening is not adequate in the care plans observed. In the care plans observed three of the four service users had not been weighed since May 2007 although there was evidence that at least of two of these individuals have experienced regular weight loss. Evidence of health screening is variable within the care plans and these areas need to be improved. A requirement has been issued for improvement in this area. Chiropody services visit the home monthly. Following the previous inspection four requirements were issued regarding the safe handling of medicines. The first requirement was that clear and comprehensive policies and procedures for the receipt, recording, storage, safe handling, administration, self-administration and disposal of medicines, specific to the home, must be produced so as to provide consistent care to the residents. The operational manager has written a new policy and procedure, which has been checked by the homes supplying pharmacist. This was observed by the inspector and found to be comprehensive and detailed. The second requirement was for all Controlled Drugs to be stored in a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. It is pleasing to see that this has been complied with. The Controlled Drugs register was examined and this was fully completed with two signatures for each entry. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 13 The third requirement issued was for an auditing system to be put in place to ensure that complete and accurate records are kept of all medication administered to residents, and action must be taken when problems are identified. The operational manager said she has implemented this but it is not being carried out as often as it should be. The inspector undertook an examination of the homes medicine procedures, records and storage facilities. There are two areas where medication is stored and records kept. These are the treatment room and the extension. The medication records show that there are numerous omissions in both areas. The medication records are kept within a single file for each area. Although there is a new medication policy and procedure both files still contain the old policy dated 2003. On the day of the inspection the morning medicines were still being administered at 11:00am. There are numerous hand-written entries on medication records and at least three of these were poorly written with one being illegible. Several of the hand- written entries were not signed. These must be signed by two staff and dated. Requirements have been made for improvements in these areas. The fourth requirement issued was for medicines that are prescribed to be given ‘as needed’, when they are to be given must be included in the care plans so that residents are given these medicines in a clear and consistent way. This has not yet been fully completed and the requirement will remain. During the examination of the homes medicine policy it was noted that the nurse would dispense the medicines whilst in the treatment room, then take the medicines to the service user. The treatment room was left open and unoccupied during this time. On the day of the inspection it was observed that latex gloves, sterilizing solution and shampoo were in the treatment room, on display and accessible to any service user who may wander into the area. On display in both areas used for medication handling were communication books containing sensitive information about individuals. These must be stored securely and only accessible to staff. It is strongly recommended that the treatment room remains locked at all times when left unoccupied. Training records show that the nurses and two senior carers have undertaken Safer Handling of Medicines Training. Personal information was seen on display in several areas of the home and it is strongly recommended that records are stored securely and are only accessible to staff. During the inspection the expert by experience spoke to people who use the service about privacy and dignity. There are significant improvements since the last report and service users reported universal praise for the staff. Comments received from service users include, “previously staff would breeze into the room without knocking, they now knock before coming into the room” and “staff can’t do any thing wrong, they are always good I have no complaints they talk to me and always respond to the alarm”. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 14 One service user spoken to appreciated being able to spend “afternoons in her room with the TV and her CD’s.” As part of an extensive refurbishment her room has been tastefully redecorated/refurbished and she had been able to “choose the colours” from a selection. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. Post is passed to service users and they may make and receive telephone calls in private. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Systems have improved in the home so that where appropriate service users are supported to exercise choice and control over their lives, however these could be strengthened to ensure the home maximise service users capacity to exercise personal autonomy and choice. The presentation and standard of food is variable which does not always ensure service users enjoy a wholesome and appealing diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routines in the home are flexible and service users confirmed that they had a choice as to when they get up and when they go to bed. Relatives and friends are welcome at any time and the visitors spoken on the day were able to confirm this. One service user said, “when I first came here I was not happy, I could not go out but now its more liberal, I can go out on my bike and I can go swimming”. There are two part time staff members who organise the activities for the home. An activities timetable is displayed on notice boards around the home and these are changed every week. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 16 Examples seen of activities for the week include, tabletop games, mind stretching puzzles, flower arranging, movies and arm chair keep fit. The inspector observed a movement to music session taking place on the first morning. This was carried out in a respectful manner and staff interaction was sensitive to service users needs. Comments made by service users spoken to include, “ A… encourages activities and does a good job. They have introduced more physical activities like wheelchair exercises and seek to develop this further in the future, including, hopefully, using outside volunteers in the garden. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, Pat the Dog Scheme, various visiting entertainers and a monthly church service. Family and friends are invited to participate in some of the social event organised. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. One service user manages his own finances. Details of how to contact the local advocacy service were prominently displayed in the hall. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. When questioned about service users having access to their personal records, the manager said that this could be facilitated if it was requested. Service users are offered three meals a day. The expert by experience observed a lunchtime meal, both in the dining room and in the lounge. Observations made include sufficient staff available who seemed to have a nice balance of encouraging self-sufficiency and helping where necessary. This was particularly evident with one individual who needed liquidised food and who received help sensitively and appropriately. Staff were seen to frequently check on the progress of the service users. One individual commented on the adjustable lounge dining tables, “ they need more of these, they seem to have limited adjustment”. During feedback with the operational manager she said that they were already looking into this. Lunch was relaxed, unrushed and well organised. The quality of the food received various responses. “very good on the whole” and regarding the tart which was the sweet for the day, “pretty awful pastry and not that wonderful” and “the food is alright” and “generally satisfactory, I like the puddings.” A comment was received from an individual who did not live in the home “food could be better with more quality and choice”. The choice, especially for the main meal, is taken the night before. The meal for the day was turkey casserole with potatoes and carrots and broccoli with a sweet, cheese and biscuits and fresh fruit. One service user said, we never had a choice until recently” and “ supper can be changed if you don’t like it”. With the main meal a plate with an attractive Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 17 array of fruit to choose from is now offered; this provision of fruit has only commenced and was commented on positively by service users. The key issues arising from discussions held with service users were found to be that the alternatives to the main meal were usually a baked potato or omelette. It was felt that a more nutritional and appetising alternatives could be offered and is strongly recommended. The fruit platter is a very good initiative and individuals spoken to would like it to be offered at other times. Fruit was otherwise available in the kitchen but on a reactive rather than a proactive basis. Liquidised meals were observed to be blended together as one portion. This does not look attractive or appealing in terms of texture and flavour. It is strongly recommended that liquidised meals are blended and presented in separate portions. The kitchen staff said that there wasn’t a seasonal change in the menu but “last year there was a winter and summer menu” and that “ if someone wanted a salad they were able to have one”. The operational manager was asked how service users review/ influence the menu. This was responded to positively and she said that the menu is under review and they could implement a four seasonal change to the existing four weekly cycle menu. She is actively checking the NICE recommendations for menus. A resident’s forum is in the process of being set up and the menu’s will be part of the agenda for this. The overall impression gained of the meal times and the menus were of good initiatives having been taken already, a positive approach to further development ideas and scope as indicated to improve in certain areas. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The home is able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a newly developed complaints procedure, which is accessible to service users and their representatives. The Service Users Guide and Statement of Purpose are being reviewed and updated to include the new complaints procedure. A record of all complaints is maintained, and this was viewed. Four complaints have been received since the previous inspection and these have been dealt with within the stated timescales, record the investigation and outcomes of complaints raised. The Commission has not received any complaints about this service since the previous report. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. Training records demonstrate that staff have undertaken training in adult protection. There have been two safeguarding issues which have bee referred to the appropriate authorities and have been concluded satisfactorily. Broomfield Nursing Home DS0000062501.V344339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26. Quality in this outcome area is adequate. A refurbishment plan has been implemented and improvements continue to be made to the environment to ensure that service users have an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is divided into two main areas, the extension and the main house. In each area there is a lounge and dining area and a small kitchen. In the main house the lounge and the dining areas have been refurbished. The inspector was informed that this is scheduled to take place in the extension lounge and dining area shortly. The main kitchen was clean and the findings of the environmental health officer’s last report regarding works in the kitchen have been addressed. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 20 There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Some domestic baths are to be replaced with assisted baths. The operational manager said that the refurbishment plan submitted to the Commission following the previous report needs to be updated and the inspector requests a copy of this. There is a system in place to address day-to-day maintenance issues, so that the safety of service users and staff is safeguarded. Improvements made since the previous inspection includes the refurbishment of bedrooms in the extension part of the home and refurbishment of some communal areas. The home has purchased fifteen nursing beds since the previous inspection. The dining area has been refurbished and is bright and spacious. A sensory garden has been created and is accessible to service users in wheelchairs. Several areas identified for immediate action are, several bedrooms need to have the carpets cleaned and there are a number of radiator covers that are broken and must be repaired. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and eighteen staff members have attended infection control training, including laundry and housekeeping staff. The laundry is well managed by dedicated staff members. Broomfield Nursing Home DS0000062501.V344339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. The staffing numbers and skill mix is good and significant improvements have been made in staff training to ensure that service users benefit from staff who are who are up to date with their training and competent to do their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staff rota demonstrates that there are adequate numbers of staff on duty at all times with a good mix of registered nurses and carers available on all shifts to ensure the needs of service users can be met. This includes sufficient numbers of ancillary staff. The manager is extra to these numbers. One service user spoken to mentioned a “ member of staff to be designated to each person”. The operational manager said that a “ key worker” system has been introduced. At the previous inspection it was identified that the home was not meeting the national minimum standard of 50 carers trained to National Vocational Qualification (NVQ) Level 2, but arrangements had been put in place with a local college to significantly improve the numbers in the coming year. The operational manager said that ten care workers registered in September to commence NVQ training and she said that none staff have completed NVQ training, level 2 or above. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 22 A random selection of staff files were made available for inspection purposes, including those most newly recruited. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained. The home does not employ any volunteers. The home’s induction programme has been revised and now meets the Skills for Care standards. A local college is working with the home to help with a backlog in induction training, as historically induction has not been well managed. There has been a significant amount of training for staff from April 2007 and planned into 2008. Examples seen includes, four nurses who have attended tissue viability training, thirty staff who have completed moving and handling training through June to September, thirty staff who\have attended dementia awareness training, one senior staff member has completed palliative care training, and fifteen staff have attended diabetes awareness training. The improvements in the staff training are to be commended. Broomfield Nursing Home DS0000062501.V344339.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. A new manager is in post and the home has commenced quality assurance systems, resulting in the home being proactive in identifying issues that may affect the well being of services users. There are several areas of the homes health and safety procedures that need to be improved to ensure the service users health, safety and welfare are protected and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new manager in post who has been working at the home for five weeks. Prior to her employmenrt at the home she was working as a senior practitioner with the outreach team working with people who have severe and enduring mental health problems. The manager sais that she is going to Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 24 register to undertake the Registered Managers Award. Trainig completed in the previous twelve months inclusdes leadership at the point of care and mental capacity act training. A quality assurance survey to find out the views of relatives has been conducted recently. The general issues raised were regarding the maintenance of the environment, complaints not being listened to, and relatives did not appear to be aware of Safeguarding Adults Procedures. Action pans have been put into place for improvements in these areas. There is a new policy in place, “depositing and withdrawing personal allowance for clients” which provides guidance for the home when they are required to look after small amounts of personal allowance for service users. At the time of the inspection the operational manager said that there was no secure place to store valuables and money. However she could provide the home with a safe if needed. This will be a requirement of the report. The home has implemented a falls auditing tool and a report was produced following this. There was a service users meeting booked for the following week and the inspector was informed that this will be implemented on a monthly basis. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is dated 11/03/07. Training records demonstrate that fire training for all staff had been booked for 18th October 2007. During a tour of the premises three bedroom doors and the door to the sluice area were observed to be wedged open. A requirement was issued for improvement in this area. Evidence of mandatory health and safety training demonstrates that staff are mostly up to date with this training, however basic food hygiene training needs to be completed by a large number of staff. The operational manager said that this will be booked by January 2008. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for the gas appliances dated 04/10/07, electrical installation dated November 2003 and PAT testing dated May 2007. There are systems in place for water chlorination and kitchen hygiene. COSHH sheets are up to date and accurate. The inspector looked at Infection Control guidelines that are available for all staff. Broomfield Nursing Home DS0000062501.V344339.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 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12(1) Requirement Timescale for action 30/12/07 2 OP9 13(2) 3 OP9 13(2) 4 OP9 13(2) The registered person must ensure that nutritional and health screening records are fully completed and contain up to date information of all nutritional and health screening interventions. The registered person is required 30/10/07 to ensure that the newly implemented medicine auditing system is strengthened to ensure that complete and accurate records are kept of all medication administered to service users, and action must be taken when problems are identified. The registered person is required 30/10/07 to ensure that all hand written entries on medication charts are legible, signed and dated by two staff. When medicines are prescribed 30/10/07 to be given ‘as needed’, they must be included in the care plans so that service users are given these medicines in a clear and consistent way. Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 27 5 OP19 23(2) 6 OP35 16(l) 7 OP38 23(4) The registered person is required to ensure that broken radiator covers are repaired and soiled bedroom carpets are cleaned. The registered person is required to provide a place where the money and valuables of services users may be deposited for safekeeping. The registered person is required to ensure that doors are not wedged open to ensure the safety of service users and a more suitable method of keeping doors open is used. 30/12/07 30/12/07 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP3 OP7 OP8 Good Practice Recommendations It is strongly recommended that the initial needs assessment tool is reviewed and updated. It is recommended that unnecessary information contained within the care plans is reduced to make the plans more user friendly. It is strongly recommended that care plan documentation, and further risk assessment tools are reviewed, updated and are evidenced based. It is strongly recommended that the treatment room remains locked at all times when unoccupied. It is recommended that all personal records are stored securely and are only accessible to staff. It is strongly recommended that more nutritional and appetising alternatives could be offered to the main meal. It is strongly recommended that liquidised meals are blended and presented in separate portions. OP9 OP10 OP15 OP15 Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broomfield Nursing Home DS0000062501.V344339.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!