Inspection on 28/04/05 for Broomfield Nursing Home

This inspection was carried out on 28th April 2005.

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 24/05/06

Broomfield Nursing Home 05/01/06

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 Sue Smith Unannounced 28th April 2005 9:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broomfield Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Broomfield Nursing Home Address Yardley Road, Olney, Bucks, MK46 5DX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 711619 chetan@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 (OP)(49) of places Broomfield Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2005 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 Service Users diagnosed with Dementia. The Home provides both Nursing and Care staff to meet the needs of Service Users, these staff are supported by sufficient numbers of ancillary staff. Broomfield Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over a 4.5hr period. During the Inspection 21 standards were assessed with 17 of these fully met. Three requirements and one recommendation have been made for those standards not met. The Manager was present throughout the Inspection and the Proprietor was on site undertaking a Regulation 26 visit. The Inspector spoke with members of the staff team, 5 Service Users and 2 Visitors during the course of the Inspection. Records sampled during this inspection were Pre-Admission Assessments, Careplans, Rota’s, Recruitment files, Fire Records, Risk Assessments, MAR (Medication Administration Records) sheets and Complaints received in the past 12 months. A full environmental tour took place. What the service does well: • • • • • • • • Pre-admission assessments take place for all Service Users prior to admission to the Home. A full Careplan is put in place within 48hrs of admission to the Home. The Staff Team ensure the privacy and dignity of Service Users is maintained throughout implementation of personal care. Staff have positive and supportive relationships with Service Users. Visitors feel welcomed to the Home and are supported to maintain contact with Service Users. Service Users spoken with felt the Home was homely and relaxed with staff listening and acting upon their wishes. The Manager and Proprietor are proactive in implementing changes to improve the Service and are supportive of the Inspection process. The Manager is available and supportive to the Staff Team. Broomfield Nursing Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broomfield Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Broomfield Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, All Service Users have a pre-admission assessment on file, however these vary on the amount of information provided which could lead to the inappropriate placement of a Service User. EVIDENCE: The Homes pre-admission assessments were fully completed however some of these assessments lacked substance. Areas of weakness identified were nutritional needs, pre-admission weight, skin integrity and social needs. The Inspector discussed this with the Manager and ascertained those that were lacking in detail were Service Users who had come directly from Hospital. The Manager has experienced difficulty in meeting with a designated Staff Nurse to obtain as much detail as possible and is relying on the Service Users notes held on the ward to obtain as much information as possible. The Inspector has made a recommendation for future practice that all referrals for assessment from the Hospital are undertaken with the designated Staff Nurse through an appointment system to ensure a thorough assessment can take place before a decision to admit is made. Broomfield Nursing Home Version 1.10 Page 9 Broomfield Nursing Home Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. Careplans for new admissions were assessed with all Service Users having a careplan in place within 48 hours of admission. Careplans were found to be up-to-date and were reflective of review dates, which enables staff to provide the required care. Several Careplans handwritten by this Nurse were found to be illegible, causing difficulty for the reader to follow the Careplan. Staff demonstrated a sound understanding of the needs of service users. Staff interactions and relationships with Service Users was positive, which enabled Service Users to express their thoughts, feelings and needs. Medication Administration Records were found to be appropriately signed with all medication administered, stored and disposed of in a satisfactory manner; Service Users appear to receive their medication as prescribed. Staff practive in giving and assissting with such elements as personal care and arrangements for medical examinations ensure the privacy and dignity of service users. Broomfield Nursing Home Version 1.10 Page 11 EVIDENCE: Five Careplans were sampled during the inspection; these were all found to be maintained to a high standard and were reflective of review dates. Careplans identify relevant information relating to health, personal and social care needs and how care will be implemented to meet these needs. Relevant Risk Assessments are in place to enable the Service User to reside in the Home as safely as possible. Skin/Pressure Wound management and Manual handling assessments were in place, with supporting plans of care, these were reflective of regular review dates. The Home provides equipment necessary to support the Service User in the environment, which includes hoists, handrails, parker baths and comfy adapted seating. The Inspector did have difficulty reading Careplans handwritten by one Nurse, which could cause confusion to newer staff or Service Users when trying to follow these plans. This issue was discussed with the Manager and a requirement is made that all Careplans must be legible. The Inspector advised the Manager to support this Nurse when writing Careplans and to perhaps implement an option to type the individual plans of care to ensure they are legible. Staff interactions with Service Users were appropriate with positive relationships evident. Staff were able to demonstrate a clear understanding of the individual needs of Service Users and how care needed to be implemented. Staff were patient and caring towards Service Users who were confused or suffering with Dementia. Service Users spoken with at the time of the inspection were appreciative of the care and support they receive and felt the staff enabled them to voice their concerns and wishes. There were no negative comments concerning the staff team or the care and support they receive. There has been a notable improvement in the records held for the administration of medication. This had been an issue of concern during previous inspections. There were two gaps found in the administration records during this inspection, which was accounted for at the time of inspection. The Inspector is satisfied the previous issues of concern have been resolved through clear and decisive action by the Manager. Medication is stored and disposed of appropriately with a record of all administration of controlled drugs held in the clinic room, these were found to be appropriately signed by two members of Nursing staff. The Inspector randomly chose one Service User’s controlled medication and found the Broomfield Nursing Home Version 1.10 Page 12 number held in stock tallied with the records held. A new controlled medication storage cupboard has been purchased and will be fitted as soon as the appropriate screws are found. There was no evidence of out of date medication held in the Home. The clinic room is well equipped with relevant information to support Nursing staff available. All personal care is implemented in the privacy of the Service Users own room. The Inspector observed practice during the inspection and was satisfied all measures to ensure the privacy, dignity and individual wishes of Service Users are implemented. Broomfield Nursing Home Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 The Home is implementing activities suitable for the Service User group, this enables Service Users to interact on a social level and form new friendships with each other as well as staff. The activities offered still need to be further developed to ensure all Service Users are able to participate in activities that meet their spiritual needs, preferences and capabilities. Visitors are welcomed at the Home during all reasonable hours with no restrictions in place. This enables Service Users to maintain their friendships and relationships whilst residing in the Home. EVIDENCE: The Home welcomes visitors, those spoken with at the time of inspection were complimentary of the support relatives and friends are offered. Activities were taking place during the inspection; the Service Users taking part enjoyed these. The Home has received a previous requirement for the Home to designate an activities co-ordinator to further develop the activities programme. The Inspector spoke with the Proprietor during the inspection who is presently seeking options to fulfil this requirement. The Inspector is Broomfield Nursing Home Version 1.10 Page 14 satisfied this requirement will be actioned within the required timescale. Until such time as this requirement is fully actioned the Home will be unable to fully meet standard 12. Broomfield Nursing Home Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The Home has a comprehensive complaints procedure, with records of complaints and investigations open to inspection. The complaints procedure is made available to Service Users and significant others, which ensures all relevant persons, are able to make a formal complaint appropriately. EVIDENCE: The Manager made available to the inspector a record of all complaints in the past 12 months, at this time the Home has received one complaint from a relative, which has been acted upon appropriately. Service Users spoken with at the time of inspection confirmed they were given a copy of the complaints procedure on admission to the Home. In cases where there was diminished comprehension family members were supplied with a copy. Broomfield Nursing Home Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19. 20, 21, 22, 23, 24, 25, 26. The Home is well maintained with an evident programme of redecoration in place. Comfy furnishings, ornaments, T.V., fixtures and fittings are supplied in communal areas making the environment homely for service users. Suitable single and double sleeping accommodation is provided with evidence of personal possessions to make these more homely for service users. The Home has designated cleaners, which ensure the home is clean, hygienic and free from offensive odours. Sufficient numbers of toilets and bathrooms are available to ensure the needs of Service Users are met. The Home is situated in a pleasant country garden, which is accessible to Service Users. EVIDENCE: Broomfield Nursing Home Version 1.10 Page 17 During the assessment of the environment the inspector was pleased to see improvements undertaken by the new Proprietor in the decoration of bedrooms. New carpets are being laid in a variety of pleasant colours. Presently six bedrooms have been re-carpeted. One bedroom awaiting occupancy was being decorated using the potential Service User’s specifications on colour scheme and carpeting. Windows have been measured for new curtains, which will be co-ordinated with the carpet colours. Door guards and other self-closing mechanisms have been purchased following the risk assessment required by the Fire Authority, once these have been formally approved these will be fitted. Bedroom accommodation is both single and double with facilities such as screens, curtains, call bells and additional sockets in place for each Service User. Personal possessions of the occupants were seen to be on display. Further redecoration of communal areas and hallways is underway with one hallway wall re-plastered, the contracted decorators were on site during the inspection with work carried out in a manner that does not affect the safety of Service Users. Toilets and bathrooms are situated throughout the Home in close proximity to bedrooms, these were found to be clean and tidy and free from offensive odour. Water temperatures are thermostatically regulated to ensure the safety of Service Users. The Home has a large accessible garden, which is pleasant and well kept, spring weeding, and grass cutting is taking place as the weather permits. There were no issues of concern observed during the environmental inspection of the Home. Broomfield Nursing Home Version 1.10 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29, 30 The Home has a full recruitment procedure in place, which is in line with Schedule 2 and Standard 29, however on inspection not all procedures had been followed leaving Service Users at risk ofabuse. Staff training has increased since the last inspection, which will further improve the skills of staff in meeting Service Users’ needs. EVIDENCE: The Inspector assessed two recent recruitment records. It was found one Carer had been employed after receiving one character reference with no other reference on file. Another staff member had returned to the Home to work as a cleaner. Her previous recruitment information, including the previous CRB and references obtained for the role of Carer at the Home were used instead of requesting up-to-date information. The Manager was strongly advised this was not an acceptable practice in both cases. A requirement is made for the Home to ensure all recruitment procedures for the Home are followed with documents listed in Schedule 2 to be obtained prior to employment. The Manager is now seeking appropriate training courses through Milton Keynes College to support the Care and Nursing staff to meet the needs of Service Users. An NVQ provider has been found for Care staff. Broomfield Nursing Home Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 The Manager of the Home has the necessary skills and training which supports for her role to ensure practive in the home is in the best interests of Service Users. Staff supervisions are not taking place at regular intervals, which leaves staff limited in their options to discuss practice issues. Individual records were up-to-date and stored appropriately, ensuring the Home are safeguarding Service User information and working within guidance of the Data protection Act 1998. EVIDENCE: The manager has recently undertaken a successful fit person interview, once all necessary information is received at the C.S.C.I. office the Manager will be named as the Registered Manager of the Home. The Manager and the new Proprietor continue to work towards improving the environment. The Manager Broomfield Nursing Home Version 1.10 Page 20 will begin her RMA, which will enable the Home to fully meet this standard once it is completed. There is a supervision procedure in place; at this time the frequency of supervisions taking place is still erratic. This was addressed as a requirement during the last inspection. The Manager is going to schedule supervisions with all Nursing staff to discuss the way forward for supervisions of the Care Team. The Manager needs to demonstrate her own commitment to conducting supervisions and ensure this issue is resolved before the next inspection. As there has been some improvements noted in this standard the Inspector is going to leave the implementing of a supervision programme to the Manager to resolve, however a repeat requirement has been made of the Home for supervisions to take place regularly. Generally records held for Service Users were found to be up-to-date and reflective of review, the issue of legibility has been discussed in standard 7 of this report. All records are stored appropriately and available to Service Users on request. The Health and Safety standards were not fully assessed during this inspection, Fire safety procedures were inspected which found regular recorded drills and alarm testing taking place. There was no evidence of C.O.S.H.H. items laying around the Home and no issues were highlighted in line with Health and Safety legislation and guidance during the environmental tour. Broomfield Nursing Home Version 1.10 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x x 2 3 x Broomfield Nursing Home Version 1.10 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 12 (1) b Requirement Timescale for action 27/5/05 2. 29 19 (1) 3. 36 18 (2) a requirement is made that all handwritten Careplans must be legible.as stated in the NMC code of conduct for registered Nurses. A requirement is made for the 28/4/05 Home to ensure all recruitment procedures for the Home are followed with documents listed in schedule 2 to be obtained prior to employment A second requirement has been 28/7/05 made of the Home for supervisions to take place regularly. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations a recommendation for future practice is made for all referrals for assessment from the Hospital. These are to be undertaken with the designated staff Nurse through an appointment system to ensure a thorough assessment can take place before a decision to admit is made. Broomfield Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire 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 Version 1.10 Page 24 - 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. 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