Inspection on 16/02/06 for Broomhill

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Broomhill 24/04/08

Broomhill 19/07/07

Broomhill 25/01/07

Broomhill 27/09/05

Broomhill 11/03/05

Broomhill 15/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Broomhill 92 Eastwood Road Brislington Bristol BS4 4RS Lead Inspector Sandra Garrett Unannounced Inspection 16th February 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 Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Broomhill Address 92 Eastwood Road Brislington Bristol BS4 4RS 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) 0117 9779802 0117 9724091 Bristol City Council Penelope Baxter Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate two named individuals with mental health needs who are under the age of 65 years. The registration will revert when these persons leave the Home. 27th September 2005 Date of last inspection Brief Description of the Service: Broomhill is a 40 bedded home operated by Bristol City Council. It is situated in the residential area of Brislington. The nearest shops are approx 300 yards away; that includes a post office, newsagents, pub and supermarket. The home is on 3 levels with 2 lifts providing access to all areas of the building. There are 4 lounges around the home and a large, spacious dining room on the 1st floor. All bedrooms are single and contain a washbasin. Toilets and bathrooms are close by. The garden is accessible with rails to assist residents on to the patio area and includes a rockery with a water feature. A first floor balcony offers residents the opportunity to sit and look at views across to Bath and surrounding countryside. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to follow up requirements and recommendations made at the announced inspection in September ’05. Nine residents were spoken with and all expressed satisfaction with the care they receive from staff and the quality and quantity of meals. A range of documents was examined including care records, complaints, accident and health and safety records. What the service does well: What has improved since the last inspection? Several requirements made at the last visit had been met. These included: Complaints recording and investigation was improved. Residents can be confident their concerns are taken seriously and prompt action is taken to respond to any they may have. The uncovered heated towel rail in the middle floor bathroom had been removed, to ensure residents are protected from risk of harm. The inspector had received notices from the home in respect of incidents adversely affecting residents that had been followed up appropriately. The Commission for Social Care Inspection can be confident that the home takes appropriate action to ensure that residents are kept safe. Proof of identity for each staff member was seen in personnel records. Residents and their relatives can be confident that they are protected from harm. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 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 the following standard(s): None of these standards were inspected at this visit. Standards 1,3 & 4 were met at the last visit in September ’05. EVIDENCE: Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 9 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 Attention is needed to ensure care records accurately reflect information about residents’ assessed needs and actions taken by staff. Residents are well looked after in respect of their health although attention is needed to ensure medications are obtained in good time to meet healthcare needs. EVIDENCE: Three care files were examined in detail. Care plans were updated where necessary and reviewed monthly. One resident had been assessed as needing nursing care and the assessment confirmed this. The care plan had also been updated and a risk assessment for falls put in place. However care plans and risk assessments need attention to ensure that clear, accurate and up to date information is available in respect of assessed needs together with actions taken by staff that could be misinterpreted. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 10 Examples included: • a resident recently admitted was identified as having poor mobility. The resident was unable to walk but could stand and weight bear with assistance. A manual handling risk assessment done shortly after admission stated that the resident was ‘to be encouraged to walk short distances’. The manager had also written in the care records ‘is at risk of falling please see manual handling risk assessment’ – but nothing was seen on it regarding frequency or any risk of falling. It was pleasing to note that after discussion with the manager a new falls risk assessment was developed and sent to the inspector. However the manual handling risk assessment should be rewritten to more accurately reflect the resident’s mobility. Another example was in respect of a resident whose mobility had deteriorated. The inspector met this resident and noted the deterioration. However it was noted from care records that the resident’s walking stick had been removed as s/he had a tendency to hit out at others with it. However no risk assessment was seen for this and although the removal had been recorded on the manual handling risk assessment it was not as an assessed need for a mobility aid. From discussion with the manager it became clear why the action had been taken to remove the stick. However none of this was clearly recorded. The inspector advised that if a decision is to be made in respect of removing a mobility aid, this should be part of a multi-disciplinary team approach. Further, as the resident’s mobility has deteriorated a clear risk assessment in respect of the greater risk of falls, must be put in place. The decision to remove the aid also needs to be reviewed regularly. Although it was clear that the resident’s mobility had deteriorated her/his care plan had not been updated to reflect the changes that could lead to her/his assessed needs not being met. Care records showed that residents’ healthcare needs are prioritised. However from the home’s communications book the inspector noted several entries in respect of medication not being available when needed. The deputy manager explained the difficulty of getting repeat prescriptions that had led to a resident being without medication for 24 hours. Whilst it is accepted that staff have taken action to remedy the situation it continues to affect residents. The inspector advised the deputy manager on actions to be taken to ensure the situation doesn’t continue. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 11 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 Residents cannot be sure activities and entertainment that they enjoy will be provided at the home if the quality of their enjoyment is not monitored regularly. EVIDENCE: A range of activities and entertainments were seen displayed on the middle floor notice board, together with lots of photographs of events and outings i.e. a Christmas party, a trip to Chew Valley Lake and another trip to the Zoo. From records seen it was clear that lots of activities and entertainment are provided regularly and staff work hard to give residents a good quality of life. However none of the records reflected residents’ actual enjoyment of life in the home or of activities and entertainment provided. Records reflected things like: ‘Horse Racing’ or ‘pub for Lunch’ but gave no indication as to whether residents enjoyed or gained pleasure from these events. It was therefore disappointing to note that a good practice recommendation in respect of recording residents’ enjoyment of various activities and entertainments had not been implemented. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 12 A notice in respect of a forthcoming residents meeting to be held on 27 February ’06 was seen on the notice board. The agenda for this included issues such as residents’ rights, key time, amenity funds, outings and entertainment. One resident was seen dusting the corridor and said s/he had been ‘given permission’ to do this as she doesn’t like sitting and doing nothing and enjoyed being active. Another resident spoken with expressed clear anxiety about the proposed closure of the home and what would happen to residents. Other residents spoke positively about staff and the help they get and also praised the quality of the meals provided. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 13 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 Satisfactory complaints management ensures residents can feel confident in raising concerns about any aspect of their care. EVIDENCE: The complaints file was examined. Appropriate complaints forms were seen in use. The most recent complaint was recorded in March ’05. The form clearly recorded details, investigation and actions to be taken. A letter from the investigating team manager to the resident was attached to the complaints form. However the complaint record hadn’t been finished off – no final outcome had been recorded. The deputy manager was able to give information about it but nothing to this effect was seen in file. No new complaints were seen in the home’s communication book. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 14 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, 21 & 24 Residents’ benefit from living in an environment that is accessible, homely and meets their needs. Attention needs to be given to ensuring all equipment is regularly cleaned and that residents are kept safe from harm. EVIDENCE: Staff were seen carrying out cleaning and changing bed linen. The home was clean and hygienic. A requirement from the last visit in respect of removing a heated towel rail in one of the bathrooms was met. However in the same bathroom the ambulift was seen to be dirty on the underside. This and other such equipment needs to be thoroughly cleaned and added to the weekly cleaning rota. Some residents’ name labels on bedroom doors looked worn and torn. The deputy manager said that some residents don’t like their names on the door and tear them down. It was advised that residents could choose not to have their names on the door if they wish, but that if this is so it should be recorded in their care plan/daily records. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 15 A married couple had been admitted to the home prior to this inspection and were given separate rooms, although a double room had been identified as an assessed need. It was pleasing to note that the manager and deputy worked hard to find and prepare a double room together with another for use as a sitting room that met the couple’s needs. The couple expressed satisfaction with life at the home and were able to move into their double room shortly after admission. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 16 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): 29 Residents are kept safe and protected by the home having personnel records that demonstrate clear proof of identity, experience and qualifications of all staff. EVIDENCE: A requirement made at the last visit in respect of personnel records was met. A selection of staff records was examined and all found to have proof of identity e.g. driver’s licence, passport or birth certificate. Although the majority of records contained clear photographs of each staff member, some were poor photocopies taken from other records. One staff member had no photograph. The deputy manager was advised to make sure all personnel records contained both photos and current proof of identity. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 17 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): 32, 35, 36 & 37 Residents live in a home that is managed by trained and experienced staff. Attention is needed to ensure effective management of residents’ personal allowances. Whilst some care recording is objective and factual, records don’t fully reflect the quality of residents’ lives. Health and safety issues affecting residents must be given priority to ensure they are kept safe. EVIDENCE: The deputy manager was on duty at this visit, was welcoming and open to the inspection process and demonstrated clear knowledge of residents and their assessed needs. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 18 It was disappointing to note that the good practice recommendation in respect of ensuring residents are enabled to have their personal allowances paid regularly had not been implemented. It was noted that staff at the home still have problems getting personal allowances from relatives for at least two residents. No evidence was available to show that the home has taken action to address the matter. The manager was advised to write formally to relatives and make them aware of residents’ rights in the matter. It was further disappointing to note that supervision of staff had not improved since the last inspection. Examination of supervision records showed the majority of staff had supervision three to four times in the past year although some had only one session recorded. It is accepted this may be a problem of recording, but dates of supervision should show that staff are enabled to reflect upon their working practice at least six times a year. A sample of daily records was examined. Those seen were a mixture of qualitative and person-centred or factual and medicalized. Key time records that show residents’ one to one time with their key workers, in some cases gave little information about the quality of the interaction between them. Where activities took place when the daily records were written, no mention of the activity or the residents’ enjoyment of it was recorded. Attention needs to be given to ensuring all records are written from a person-centred perspective with a focus on the quality of residents’ lives, rather than just on continence, behaviours and healthcare needs. The temperature of the washbasin in the visitors’ toilet on the middle floor was extremely hot and residents or visitors using it could be at risk of scalding. This must be fitted with a device to ensure the temperature is delivered at not more than 43ºc. Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 2 2 2 2 Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15(1) 13(8) Timescale for action Care records must accurately 31/03/06 reflect residents’ assessed needs and management of situations that may affect them. Wherever a decision is made that could be interpreted as restricting residents’ movements it must be clearly documented to include background, reasons for the decision and to show consultation with the resident and/or relatives has taken place. No mobility aid must be 31/03/06 removed from any resident without the decision being reached by a multi-disciplinary team approach and a clear risk assessment being put in place The agreed decision to remove any mobility aid must be regularly reviewed. Action must be taken to 30/04/06 ensure each resident has a continuous supply of medication DS0000035843.V283736.R01.S.doc Version 5.1 Page 21 Requirement 2. OP8 13(7) Sch 3(3)(p,q) 3. OP9 12(1)(a)(b) Broomhill 4. OP21 13(4c) 5. OP38 13(4)(a) Bathing equipment such as 31/03/06 ambulifts must be thoroughly cleaned on the underside and added to the weekly cleaning rota Water temperatures in any 01/04/06 toilet or bathroom must be delivered close to 43ºc 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 OP36 Good Practice Recommendations Supervision records should show that staff have regular opportunities to reflect upon their work at least six times yearly Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Broomhill DS0000035843.V283736.R01.S.doc Version 5.1 Page 23 - 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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