Inspection on 05/01/06 for Broomfield Nursing Home

This inspection was carried out on 5th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 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 Sue Smith Announced Inspection 5th January 2006 09:30 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.V266670.R01.S.doc Version 5.0 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.V266670.R01.S.doc Version 5.0 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 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.V266670.R01.S.doc Version 5.0 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 28th April 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 DS0000062501.V266670.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection undertaken on the 5th January 2006 by Sue Smith and Barbara Mulligan. The inspection was carried out with the full support of the Manager between 10.30am and 7pm. The Inspectors have assessed 30 of the 38 National Minimum Standards for Older People and have assessed 21 standards as fully met, 8 partially met and 1 not applicable to the home. During this inspection a variety of documents were assessed which included, menus, health and safety, medication, pre-admission assessments, Careplans, risk assessments, equipment and adaptations, policies and procedures, training, recruitment, supervision, rosters and the quality audit systems of the home. In addition a full environmental inspection took place. During the inspection one inspector spent time talking with Service Users and visitors to obtain their views. These views and comments were then assessed against documentation and systems in place. As a result several requirements for improvement and recommendations to support the homes professional development have been made. These include such things as additional training for staff and the reassessment of the homes menus and activity management. Several staff members were spoken with throughout the inspection to obtain an insight of their issues and views of the day-to-day management of the home. The Inspectors would like to take the opportunity to thank the Service Users, Visitors, Management and Staff for the support and time given to ensuring the inspection process could be completed. What the service does well: Provides Careplans that are comprehensive and informative. Provides care that is implemented in a sensitive and professional manner. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 6 Staff are suitably supervised to ensure they are able to discuss practice issues and the needs of Service Users in a supportive setting. Families and other visitors are welcomed to the home with no restrictions in place. The home has a comprehensive complaints procedure ensuring all complaints are investigated within the recognised timescales. There have been 2 complaints received at the home in the past 12 months, which have been concluded with outcomes that are in the best interest of the Service Users. The home is following the Milton Keynes Inter-Agency Policy for the Protection of Vulnerable Adults and its reporting systems. There is an evident programme of decoration of communal and personal spaces to further improve the environment. Large communal areas are available throughout the home providing adequate private areas for Service Users to meet with friends. The staff team are committed to providing ongoing nursing and care needs ensuring the privacy of Service Users is maintained. Staff are respectful of the Service Users in their care, delivering care in a sensitive manner in line with their personal preferences. What has improved since the last inspection? A full system of supervision has been implemented which is proving supportive to staff and management. Further improvements to the environment have been made as part of the business plan for the home. The Manager has settled into her role and is building a supportive and professional team. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 7 Training continues to be implemented with further improvements in the training programme and training records observed. Then Careplans have become comprehensive and informative working documents with supporting key worker files available to further support nurses when assessing the changing and ongoing needs of Service Users. What they could do better: As this was an announced inspection with the majority of the standards for older people assessed there have been a higher number of requirements than would be made during an unannounced inspection. It is hoped this inspection will be used as a baseline for the home to progress in the next 12 months. The 9 requirements made are as follows: A Requirement is 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, door guards are monitored for efficiency, damage to the kitchen floor will be adequately repaired or the floor replaced, bed rails to be risk assessed and replaced as necessary, adaptable beds be purchased for those Service Users who are infirmed. A requirement is made for all medications to be administered only to the person named on the prescription label. This includes such medications as Lactulose and Senna. A requirement is made to ensure there is an increase in the designated hours to implement an activities programme, which is in line with the needs and preferences of Service Users. A requirement is made for menus to be reviewed to reflect more choice, variety and foods that will entice those with diminished appetite. An immediate requirement is made for all actions outlined in the recent Environmental Health 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 Requirement is 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, door guards are monitored for Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 8 efficiency, damage to the kitchen floor will be adequately repaired or the floor replaced, bed rails to be risk assessed and replaced as necessary, adaptable beds be purchased for those Service Users who are bed bound. A requirement is made for the Manager to ensure she is satisfied on reasonable grounds of the authenticity of references before employment commences. A requirement is made to ensure a full quality audit system is in place, which also reflects Service Users views. An immediate requirement is made to ensure a contractor is completes the following works within 28 days of this inspection: - the fire doors in the fire escape corridor be upgraded with a combined intumescent and cold smoke seal as required in the February 2005 Fire Authority Report. In addition the Inspectors made 3 recommendations to support the home to professionally develop in the next 12 months. These are as follows: It is recommended documented permission be sought from Service Users for families to access the key worker files. The Inspector recommends additional 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. It is recommended a replacement Deputy Manager is sought to support the Manager and ensure systems are maintained. 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.V266670.R01.S.doc Version 5.0 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.V266670.R01.S.doc Version 5.0 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): 1, 3, 4, 5, 6. A Statement of Purpose and Service Users Guide are available at the home ensuring all prospective Service Users receive relevant information when making a decision for admission to the home. A Pre-admission assessment is undertaken for all potential Service Users ensuring the needs of potential Service Users can be met before an admission is agreed. The home does not provide intermediate care services; therefore this standard is not applicable to the home. EVIDENCE: The home has provided the Commission with an up-to-date Statement of Purpose and Service Users Guide, the home needs to ensure this document is made available to all potential Service Users and families prior to admission to the home. Copies are available at the home and can be accessed on request. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 11 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 Service Users, however as a large number of admissions are directly from hospital this is not always possible. In these instances families are welcomed to the home to assess the suitability of facilities. Broomfield Nursing Home does not offer intermediate care services, therefore Standard 6 does not apply to the home. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 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. Careplans are in place, which outlines specific needs in a manner, preferred by Service Users, thus ensuring care is implemented in a sensitive and professional manner. Nursing staff are supported to implement health care by a dedicated and efficient G.P. service, thus ensuring the needs of Service Users are met. Medication procedures are in place, which are implemented by Registered Nurses to ensure the protection of Service Users. Service Users are treated with dignity and respect during all personal care and throughout their time at the home, thus ensuring they feel valued and are able to voice their concerns and opinions without fear of reprisal. EVIDENCE: Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 13 Each Service User has an individual plan of care, which is reflective of review and continued assessment. All Careplans include a photo and details page, admissions information, skin assessments, risk assessments, manual handling needs and individual plans of care. In addition to the nursing Careplans the home has also 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 Service Users and family members. This is a commendable implementation, which has supported the noticeable improvements made to the Careplan systems in place, however the Inspector does recommend that recorded permission is sought from the Service User for families to access these files. The home is supported by a dedicated G.P. service that has been actively involved with the Commission and the home to support improvements in their systems. A weekly visit by the G.P. is in place to review medical needs. There are good medication systems in place, which are supported by a comprehensive Medication Policy. Registered Nurses administer all medication with the exception of creams and topical ointments, this has caused some confusion when including these administrations on the MAR sheets, the Nurses have questioned the suitability of them adding their signatures when these have been administered when they have not themselves undertaken the administration. In all cases of medication administration it is the person who has administered who would be required to sign the MAR sheet, therefore it is appropriate for Carers to access these documents in these instances, if the home wishes this could be countersigned by Nursing staff as an added precaution. The implementation of this system should resolve the issue of gaps in MAR sheets. When assessing records held in the controlled drugs register it was noted that two signatures were not included in some instances. This could be attributed to only one Nurse being on duty at night or available during the day, however in these instances a Senior Carer who has received the relevant information on how to maintain this record and counter check controlled drugs is able to counter sign this document in the absence of another Nurse. The Nurses employed at the home are aware this is not an acceptable practice, therefore the home will receive a requirement that two signatures are recorded for all administrations of controlled drugs be recorded in the controlled drugs register. The home presently is using a stock bottle to administer such things as lactulose or senna; this practice must cease, as all prescribed medication must Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 14 only be used for the person it is prescribed for. Presently the home is unable to accurately audit the use of these medications. A requirement is made for all medications to be administered only to the person named on the prescription label. Service Users spoken with at the time of inspection were complimentary of the care and support offered by both Carers and Nurses. There were however, reports of some staff implementing care in a rough manner, 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 Service Users, in a safe and sensitive manner. The Inspector recommends this training is included in the Induction package for all staff with further in house training put in place for all existing staff. Communication issues with staff for whom English is a second language were noted in feedback questionnaires, this does need to be addressed with suitable courses sought to support not only the Service Users at the home but also provide professional development and support to the homes staff. The Inspector will leave the resolution of this issue to the Manager and Provider. At all times Service Users are treated with dignity and respect by staff, ensuring all personal care takes place in the privacy of the Service Users own room or communal bathrooms with doors shut or screens in place (in double rooms) which provide additional privacy. Generally (as previously stated) Service Users were complimentary of the care provided and raised no issues of concern that could not be resolved without additional training for staff. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15. The Home is providing limited activities to meet the social and recreational needs of Service Users, thus limiting the opportunities for social inclusion and stimulation throughout the day. Families and friends are welcomed to the home, thus ensuring Service Users are able to maintain their relationships. Menus are nutritiously balanced to ensure the needs of Service Users are met, however the meals offered are repetitive and lack variety, which could become boring and unappealing to Service Users. Further work needs to take place to meet the requirements of the last environmental health report to ensure the safety and wellbeing of Service Users is maintained. EVIDENCE: The Home is providing limited activities to meet the social need of Service Users. Care staff do try their best to provide stimulating activities with one Carer designated 2 hours per day to implement activities. Unfortunately this is not adequate to meet the needs of Service Users, with feedback received supporting the need for more stimulation. The home does need to address this Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 16 issue by increasing the number of hours dedicated to activity management. A requirement is made to this effect. 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. A high number of Service Users and some relatives have commented on the lack of variety and that some of the options offered are not appropriate or tempting to elderly Service Users, some examples of these were the hot dog option and sandwiches made with thickly sliced bread. Work does need to be undertaken to revamp the existing menus so they are reflective of meals that are both appetising and enticing to the elderly. A requirement is made to this effect. An immediate requirement was given during this inspection in response to the environmental inspection, there are a high number of requirements set in this 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. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The Home has a comprehensive an accessible complaints procedure, which ensures Service Users, 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, thus ensuring the protection of Service Users from abuse. EVIDENCE: The home ensures all complaint are investigated within recognised timescales as stated in the Organisations policy. There have been two complaint raised in the past 12 months, both have been concluded with outcomes that are in the best interest of the Service Users. 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. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21, 22, 23, 24, 25, 26. There is an evident programme of decoration at the home to ensure the environment is safe and homely, however a number of areas require immediate attention to ensure they remain hazard free and comfy for Service Users. There are sufficient numbers of toilets and bathrooms available, which ensure the needs of Service Users, is met. Specialist equipment and adaptations are available at the home to ensure the safety of Service Users. The home provides both single and double bedrooms to meet the needs of Service Users; some of these require decoration or maintenance to ensure they remain safe and homely for Service Users. A dedicated team cleans the home to ensure it is pleasant and hygienic for Service Users Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 19 EVIDENCE: The Proprietor has 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 are going to need urgent attention to ensure the health and safety of Service Users and Staff. These include the continued replacement of old carpets, which are posing a trip hazard. Door guards require a monitoring system to ensure they are fit for purpose, this can be undertaken by the maintenance person as in some cases these are not working effectively. The damage to the kitchen floor will require further attention or replacement, all bed rails will need risk assessing and replacing as necessary, adaptable beds for those Service Users who require ongoing nursing care or are bed bound will need to be purchased. In addition to the ongoing decoration of the home the Inspectors also noted the following: • The home will need to ensure rigorous cleaning of existing carpets continue to eliminate (or minimise) offensive odours until such time as replacement is undertaken. The dining room is looking tatty and is not reflective of a homely environment. Curtains that are coming off their rails need attention to ensure they close effectively and are presentable. Some bedroom furnishings will need replacing or additional furnishings added to double rooms to ensure facilities appropriate for the usage of two Service Users are in place. • • • Apart from the areas posing a risk to Service Users the Inspector has not at this time made any of the above three points a requirement as she is confident the Proprietor will deal with these issues once the priority areas have been addressed. These will be reassessed at the next inspection. 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. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 20 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. The home employs dedicated cleaners to ensure the home is maintained to a high standard. 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. There appeared to be a large amount of clothes without labels or a marking that would give the laundry person an indication of whom they belong to, this is the responsibility of Care staff, a reminder to ensure they stay up-to-date with this task is given. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. Staff possess the relevant skills, undertaking training to ensure the needs of Service Users continue to be met in a professional and safe manner. The home has a recruitment procedure, which is in line with Schedule 2, however ongoing issues with the validity and authenticity of references are placing Service Users at risk. EVIDENCE: The Manager has implemented a new programme of training for all staff, this includes training files which are further supported by a large board in the Managers office which records the dates of planned and attended training for all staff. At this time one Nurse and the Manager are accredited Moving and Handling trainers, this ensures all staff receive regularly updated training. In the past 12 months staff have attended fire training, first aid, food hygiene, moving and handling and dementia care training. The NVQ training has fallen behind due to a change in NVQ provider, however the home have now found a new facilitator to ensure all Care staff are able to access this qualification. Presently the staff has one member of its team who Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 22 has obtained an NVQ3 and one staff member is currently working towards their NVQ 2. In addition to the NVQ training the home have two members of staff enrolled for the Foundation in Quality Care facilitated by Milton Keynes College and one staff member who has completed this course. Parts of this course can then be cross-referenced towards the NVQ qualification. The Inspector is satisfied the Manager is ensuring the professional development of staff through a programme of training, however as the change to the system is still in its infancy this will need to be assessed again at future inspections. The Inspector has advised additional training in the care for the elderly frail also be implemented through the induction pack and with additional training provided for existing staff members. Recruitment procedures in place are an ongoing issue of concern for this home, the past two inspections have highlighted a breakdown in the procedures when checking professional references. During this inspection there was an issue of concern raised over the authenticity of a recent reference received, this had not been previously checked, this was undertaken by the Manager on the day of inspection and was found not to be a true reflection of the applicants previous employment history. The Manager implemented immediate action and a disciplinary hearing will follow. The homes Manager has been instructed to ensure all professional references are received from a Manager or person delegated to undertake this task on behalf of the Manager, such as a Deputy Manager or the HR department. The Inspector agrees that in previous cases that have arisen at the home there was no indication that references were not authentic and does not believe the Manager could have detected the deception that had occurred. However in this instance the Inspector would like the Manager to pay special attention to Regulation 19 (4) c, of the Care Standards Act 2000, which clearly states: • “The employer is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person, and has confirmed in writing to the registered person that he is so satisfied”. In response to this issue of concern the Inspector issued an immediate requirement to ensure the protection of Service Users is maintained. Further advise was given to ensure all references are written by the previous employer not a colleague or friend, and that it would not be unreasonable for the Manager to verbally check all professional references before appointment. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. The Manager possesses the skills and training to support her in the role, ensuring the home is run in the best interest of the Service Users. The Home does have a quality audit system, however this is limited therefore it does not give enough opportunity for Service Users to express their views. Financial procedures adopted by the Home ensure Service Users are protected. Monthly supervision of staff is in place, which ensures practice issues, and development of staff can be discussed in an open and documented forum thus ensuring the needs of Service Users is met by a professional and well-informed team. Records are maintained to a high standard ensuring records held in relation to Service Users are maintained securely with Service User confidentiality maintained. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 24 Systems to protect the health, welfare and safety of Service Users are in place; further work needs to be carried out following the Fire Authority inspection to ensure the safety of Service Users. EVIDENCE: The Manager is competent in her role and possesses the relevant skills and qualifications to achieve her responsibilities. However at this time she is without a Deputy Home Manager as the previous arrangement was unsuccessful. This is causing concerns for the Inspector who believes without the support of a competent Deputy, the Manager is at risk of not meeting her regulatory responsibilities, which could then be placing Service Users at risk. An example of this is the recruitment procedures, which have been causing serious issues of concern. The Inspector recommends a replacement Deputy Manager be found as soon as is reasonably practicable to ensure the day-today management of the home is maintained safely. As the Inspector is aware this will take some time a requirement for this to take place has not been made, however the issue will be reassessed at the next inspection. The home does not take responsibility or hold monies in accounts on behalf of Service Users. The Service User either pays all additional charges for such things as toiletries, newspapers and hairdressers on an invoice system or directly. Further work needs to be undertaken to ensure the home has a thorough quality audit system in place that reflects the views of Service Users, 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, training, and health and safety. A requirement is made for improvements in these systems. All staff receive a documented supervision from a senior member of staff. This system is now up and running and has so far been successful in providing a forum where staff can discuss practice issues and the changing needs of Service Users in a supportive environment. The Inspector advised the Manager to include the setting of supervision dates on the training white board to ensure all supervisions are kept up to date. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 25 Records held pertaining to Service Users are maintained to a high standard, with noticeable improvements in the Careplans. All records are stored appropriately in lockable facilities. A selection of health and safety information was assessed during this inspection, all records were found to be up to date and relevant to the systems of the home. These have been listed in the Inspectors Contemporaneous notes should they be required. An immediate requirement was issued during this inspection in response to the recent Fire Authority inspection; there is still an outstanding requirement of this report, which will need urgent attention. In addition the Inspectors noted that some bed rails are broken, a requirement is made for all bed rails used at the home to be risk assessed and replaced as needed. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 2 3 2 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 2 Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement A requirement is made for all entries in the Controlled Drugs Register reflect two signatures for all administrations. A requirement is made for all medications to be administered only to the person named on the prescription label. This includes such medications as Lactulose and Senna. A requirement is made to ensure there is an increase in the designated hours to implement an activities programme, which is in line with the needs and preferences of Service Users. A requirement is made for menus to be reviewed to reflect more choice, variety and foods that will entice those with diminished appetite. An immediate requirement is made for all actions outlined in the recent Environmental Health report are implemented. An action plan of how these will be achieved needs to be submitted to the Commission within 28 DS0000062501.V266670.R01.S.doc Timescale for action 05/01/06 2. OP9 13 (2) 05/01/06 3. OP12 16 (2) m, n. 05/04/06 4 OP15 16 (2) i. 05/04/06 5 OP15 16 (2) j. 05/02/06 Broomfield Nursing Home Version 5.0 Page 28 6 OP19 16 (2) c 23 (2) n. 7 OP29 19 (4) c. 8 OP33 24 (1) 9 OP38 23 (4) days of this Inspection. A Requirement is 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, door guards are monitored for efficiency, damage to the kitchen floor will be adequately repaired or the floor replaced, bed rails to be risk assessed and replaced as necessary, adaptable beds be purchased for those Service Users who infirmed. A requirement is made for the Manager to ensure she is satisfied on reasonable grounds of the authenticity of references before employment commences. A requirement is made to ensure a full quality audit system is in place, which also reflects Service Users views. An immediate requirement is made to ensure a contractor is completes the following works within 28 days of this inspection: - the fire doors in the fire escape corridor be upgraded with a combined intumescent and cold smoke seal as required in the February 2005 Fire Authority Report. 05/03/06 05/01/06 30/04/06 05/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended documented permission be sought from DS0000062501.V266670.R01.S.doc Version 5.0 Page 29 Broomfield Nursing Home 2 OP10 3 OP31 Service Users for families to access the key worker files. The Inspector recommends additional 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. It is recommended a replacement Deputy Manager is sought to support the Manager and ensure systems are maintained. Broomfield Nursing Home DS0000062501.V266670.R01.S.doc Version 5.0 Page 30 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. 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