Inspection on 19/07/07 for Broomhill

This inspection was carried out on 19th July 2007.

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

The inspector 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

Broomhill 24/04/08

Broomhill 25/01/07

Broomhill 16/02/06

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 Key Unannounced Inspection 09:30 19 and 20th July 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 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 Fry Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 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. 25th January 2007 Date of last inspection Brief Description of the Service: Broomhill is a home for 40 older people run by Bristol City Council. It’s situated in the residential area of Brislington. The nearest shops are approx 300 yards away. These include a post office, newsagent, pub and supermarket. The home is on 3 levels with 2 lifts that give 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 each has its own washbasin. Toilets and bathrooms are close by. The garden is accessible with rails to assist people on to the patio area and includes a rockery with a water feature. A first floor balcony offers people living there the opportunity to sit and look at views across to Bath and surrounding countryside. Fees payable for care at Broomhill are £460 per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk . Copies of the latest inspection report weren’t seen displayed in the home. The manager said she discusses outcomes from the report at residents’ meetings. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit took place over two days. The manager Mrs Penny Fry was welcoming and open to the inspection process. Surveys were sent out before this visit and ten were returned. Comments from them are used throughout the report. Several people using the service and four staff were spoken with. Records were looked at and these included: staff induction, care plans and daily records, the Statement of Purpose, service users guide and contracts. What the service does well: What has improved since the last inspection? Nine requirements made had all recommendations had been adopted. been met. Further, good practice The registered provider had issued guidelines to all homes about referrals and new admissions following the last visit to Broomhill. The guidance makes clear Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 6 what managers need to do if someone is placed at the home and they cannot meet that person’s needs. Whilst a number of admissions had been made since the last visit none of them raised any difficulties for staff and the manager said she now felt more supported by team managers. Members of the home’s management team now visit to assess potential new people to make sure the home is the right place for them. Care plans looked at were all signed by staff to show that the home can meet peoples needs. Further, a number of individual risk assessments were in place for people who have a history of falls or are at risk. Risk assessments for other issues affecting individual people were in place that helps to keep them safe. The manager and staff had been attending training on safeguarding adults from abuse. The manager was able to show how incidents were picked up and properly managed to make sure people living at the home are protected from harm. Casual staff taken on before the last inspection had now had induction training and records were available to show this. Staff that had not done safeguarding adults training had dates booked to make sure everyone attended a session. Training in dementia awareness and mental health needs is being done as an ongoing programme by the In-reach team that supports homes to manage difficult issues. Three new staff had been taken on since the last inspection. Proper recruitment had been done including request of Criminal Records Bureau disclosures before the person started work, where this was necessary. Care staff supervision is better organised and newly appointed staff had all had supervision sessions recently. Work needed to make the staircases safe for people living at the home continues. Health and Safety officers had given advice about the matter. The City Council’s property services department are trying to find suitable ways of making sure people are kept safe from possible risk of harm when using them. Good practice recommendations that had been adopted included: Continuing work to try and make sure people with dementia are included in activities and outings. Reminiscence sessions are to start shortly. Further, short trips out with smaller groups makes sure people with dementia get the same opportunities for social stimulation as other people. Religious services are now offered regularly at the home again and attended by several people who live there. This means peoples spiritual needs are recognised and met where possible. The manager and other staff showed good knowledge of individual people living at the home that was gained from discussions with them and from reading care records. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 7 What they could do better: The Statement of Purpose was out of date and needs changing to make clear the types of needs that can be met at the home. Care plans looked at didn’t include all identified health or personal care issues. Further, not all care plans had been put in place at the end of the four-week trial period. This means that staff might be unaware of peoples individual needs that had changed since coming to the home. From those care plans looked at some had not been checked regularly since the beginning of the year although had been done so throughout last year. This means that peoples changing needs may not be picked up and met. Our pharmacy inspector did an inspection of medications at this visit. Medication is generally stored and handled safely in this home. People using the service are supported to look after their own medicines. To further safeguard peoples’ health, the home’s policy for self-administration needs to be followed and some records of medicines administration need to be improved. Permanent care staff are to be commended for their continuing commitment to meeting peoples needs. However there are not enough of them to make sure people living at the home have a good quality of life that includes one to one time. Reliance on use of agency staff that don’t know the home or the people living there means that people may not get the standard of care they are entitled to expect. Four good practice recommendations were made: Neither the current Statement of Purpose nor the service users guide gives any information about equality and diversity (the needs of people from different groups in society that make up the population of the home). Therefore people from these groups won’t have the information they need to decide if they wish to move into the home, or that it will be welcoming to them. The documents should therefore include a clear statement to show how the needs of people from these groups will be catered for and met. Staff should record the actual reason for disposal of medication so that they can monitor this and prevent any unnecessary waste. Whilst individual peoples dietary needs were met, it was disappointing to note that the menus remain largely organised for meat eaters. Clear vegetarian choices weren’t seen that could offer people a more varied menu. Further, although one person had an identified need for a cultural diet the menus didn’t show this was happening often enough. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 8 The environment within the home is of a good standard and individual rooms were nicely furnished and homely. However too many notices were pinned up on walls, giving an institutional feel to rooms and spoiling the décor. The use of these notices was more for staff benefit than people living there and should be avoided wherever possible. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 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 Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Outdated information doesn’t keep people fully informed. Further, people from minority groups may not feel welcome at the home without positive information available about this. People living at the home benefit from having clear information about their rights and responsibilities and the amount of money they have to pay for living there. Assessments carried out by the local authority and staff at the home makes sure individual peoples needs can be met. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Statement of Purpose was pinned up on a large notice board close to the dining room. However it was out of date and included details that are no longer correct. The responsible individual (the person named by the provider to make sure legal responsibilities under the Care Homes regulations are met) had issued recent guidance to all local authority care homes following an admission to Broomhill that broke down during the last inspection. This is good practice. This guidance states that: the Statement of Purpose had been revised and: ‘does allow us to provide care to people that have a level of dementia that is manageable providing the primary and presenting needs are concerned with their physical care and not their dementia’. The Statement seen in the home didn’t reflect this and was unclear about admission of people with dementia. Further, neither the Statement of Purpose nor the service users guide (copies of which were seen in peoples rooms) included any information about meeting specialist needs of people from diverse groups such as black or minority ethnic, sexual diversity, gender, disability or religion. (The Statement of Purpose is one that is the same for each Council home. Therefore each home’s Statement of Purpose should contain the same information). Equalities information is included in the Adult Community Care assessments that are done by social workers or care managers. However issues such as for example, religious needs aren’t transferred into care records when a person is admitted. Further, the manager had sent in the Annual Quality Assurance Assessment that asks questions about how many people from different groups are living at the home. The manager said she hadn’t filled those questions in as she didn’t have all the information and hadn’t asked people about their specific needs. We gave her some information to assist her with this. She also said that staff (including the management team) would be doing Equalities training in the near future. Contracts were seen in individual peoples rooms and care files. Each person had signed their contract that had the person’s room number and the amount they have to pay each week for living at the home. General information about the total fee payable isn’t in the service users guide however, so people may be unaware of how much it costs. One person had commented in our survey sent out before this visit: ‘Firstly it was difficult to understand as to who or what was paying for things’. Assessments were clear and detailed and gave information about peoples lives and care needs before they moved into the home. People spoken to confirmed the information given and care needs had been transferred into the home’s care plans. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 12 The manager said that nobody with severe mental health needs that could prove difficult to meet had come into the home since the last visit. She also said that since then she felt she had got more support from the management team that supports all of the Council’s homes. A requirement made at the last visit about making sure members of the home’s management team carry out their own assessments, had been met. The manager was heard arranging to visit a person in hospital and also heard discussing assessments to be done with assistant managers. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Documentation of care plans doesn’t make sure staff are given the information they need to care for people using the service. Irregular review means that not all care needs will be picked up and met. Proper storage and handling of medication keeps people safe. However, the home’s policy for self-administration needs to be followed and some records of medicines administration need to be improved to keep people safe. Being treated with dignity and respect benefits people using the service. EVIDENCE: Five peoples care records were looked at closely. Records included: care plans, daily records, risk assessments, weight recording sheets and review sheets. Care plans were factual and gave information about basic care needs. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 14 Daily records were improved and gave good information about issues affecting the person, particularly healthcare. Records of healthcare professionals’ visits were included, particularly chiropodist and community mental health nurses. Care plans looked at had all been signed by the person themselves and their keyworker. From our survey six people had answered ‘always’ to the question ‘Do you receive the care and support you need?’ Three people had said ‘usually’ and one person had said ‘sometimes’. Comments included: ‘Yes, I find all staff very helpful’ and: ‘The staff are all extremely helpful’. Although a number of people had come into the home since the last visit, not everyone had a care plan in place. For at least two people no care plan could be found, even though one had come to the home in March and the last review had been held in May. Staff were still using the social work assessment care plan. The home’s newly written plan for this person was later found on computer and printed off. For another person however, no plan was seen at all so staff may have been unaware of changing needs. Care plans must be put in place at the end of the four-week trial period or whenever the person’s stay is made permanent. A requirement made at the last visit about signing of care plans to show that a person’s needs can be met by the home, was met. All care plans looked at had been signed by the keyworker that had written it. As far as possible people had also signed their own plans. Information written in the plans covered care and health needs, plus individual issues i.e. leisure and social activities. One person’s plan gave detailed information about use of insulin injections and the help needed with this. The person confirmed exactly the actions written in the plan. However another person’s plan didn’t contain enough information about leaving the building although the risk assessment in place was clearer. One person’s care plan stated that a relative would regularly bring in a bottle of specific low alcohol drink and this happened during the visit. Further that the person liked to go out on trips and staff spoken with confirmed this. For each care plan a sheet for monthly reviews was seen. These had all been looked at monthly for 2006, but dates had stopped earlier this year i.e. one person’s review sheet hadn’t been signed since January ’07. Another person’s review sheet had been done up till May ’07. Where individual people living at the home were at risk e.g. from falling, risk assessments had been put in place that was a requirement from the last visit. A number of risk assessments for different issues e.g. behaviours, using stairs and falls (6) were seen. Moving and handling risk assessments were seen in each person’s file. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 15 Healthcare issues were properly recorded particularly for use of insulin, warfarin (a blood thinning medication that needs frequent blood tests), visits from the local doctor’s surgery and from district nurses and community mental health nurses. Chiropodist visits were also seen written up in daily records. From receiving regular notices about incidents affecting people that have to be sent to us, it’s clear that health concerns are responded to quickly and proper action taken to make sure peoples health remains good. From our survey seven people said ‘always’ to the question ‘do you receive the medical support you need’? Three said ‘usually’. Comments made included: ‘I find I could not be treated any better & I am settled & feel I am “at home” ‘. In one person’s records serious health conditions that were leading to a deterioration in health were seen. The person had been losing weight and the care plan had been amended to simply say that s/he needed some assistance at mealtimes e.g. making sure food was in a container that s/he could use easily. Staff had picked up that the person was losing weight and had started checking this regularly. A chart was in place and the issue was clearly written about in the daily records. However, diet issues weren’t featured in the care plan and no plan of how to address the weight loss was seen. This person had also had pressure sores in the past although these had been treated and resolved. However, there was nothing to show that staff were continuing to check pressure areas that because of the weight loss might return. The pharmacist inspector looked at medication. All the people living at the home are registered with one local doctor’s practice. Medication is supplied using a monthly monitored dosage system that is given from ‘blister packs’. Staff said that one person staying temporarily at the home was looking after her/his own medicines. There was no information about this in the care plan and no risk assessment to make sure that this would be safe, although the need to do this is documented in the home’s medication policy. At the time of this visit none of the other permanent people living at the home were able to look after all their own medicines. Some people were however, able to look after some of it e.g. someone manages their own injections for diabetes and another person manages a medicine to help their breathing. This shows that staff have considered individual peoples needs. District nurses come into the home to administer injections to other people with diabetes who are unable to manage their own. All medicines seen were stored safely and a medicines fridge is available. Daily records of the fridge temperature were in the recommended range. The medicine trolley used to transport medicines around the home was broken. Staff have ordered a new trolley, which is needed as a matter of urgency to make sure that medicines can be safely taken around the home. Suitable storage is available for controlled medication and a new register is used to record these. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 16 Suitable amounts of medication were seen. The monthly blister packs indicated that medicines had been given as prescribed. However an audit of the records for two medicines supplied in standard packs showed some differences between the number of signatures and the amount of medication used. Action must be taken to make sure that medication is administered as prescribed by the doctor and that administration records are accurate. Staff were seen giving lunchtime medicines to people. This was done safely. Medicines were taken from the labelled container supplied by the pharmacy and records checked and completed properly. People were asked if they wanted medicines that were prescribed: When required. The pharmacy provides printed medicines administration record sheets each month for staff to sign when they give medication. Some gaps were seen on these records although the medicine was missing from the blister pack, indicating that it had been given. One person is given some herbal medicines by staff (not prescribed by the doctor) and there was some discussion about how best to record how these were given. Many creams and ointments are applied by care staff in peoples own rooms but it was not clear that a record is kept of the administration of these as prescribed medicines. Staff must record all medication that they administer to people using the service. Records are kept of the receipt of all medicines and the disposal of unused ones so that an audit trail can be followed. The disposal record includes space for a reason for the return of medication and it is recommended that staff complete this accurately so that they can monitor it and prevent any unnecessary waste. All staff involved with medication administration had recently received updated medication training. This is good practice to ensure the safe administration of medicines. Staff were observed around the home and seen to be treating people with dignity and respect. It was clear from talking to staff and observing them that they have a good level of knowledge about each person and their needs. Call bells were answered promptly and good relationships between people living at the home and staff noted. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to activities recordkeeping show that peoples needs for stimulating and enjoyable social and leisure time are met where possible. Further, improved access to religious services helps people’s spiritual needs to be met. Menus don’t fully reflect all the various choices that people could have for a diet that meets their needs and aren’t displayed for people to see. EVIDENCE: From our survey only three people had said ‘always’ to the question ‘Are there activities arranged by the home that you can take part in?’ Two said ‘usually’ and four said ‘sometimes’. Comments about activities were mixed: ‘In my own room I go to bed at 8 o’clock, sometimes I read large print books, sadly there are very few of these. As I am 90 years old I am not able to take part, but enjoy the peace & quiet’. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 18 Relatives that had also filled in a survey form said: ‘They have singalongs & fetes at Christmas, but for people in there - nothing, it does need attention, and they just sit around or wander all day. (Making things like cards, bingo to keep mind active)’ and: ‘They seem to be left alone in the lounge with just TV to occupy them. I would like to see more activities arranged, they need more stimulation’. However the manager showed us information about forthcoming short trips (a list of the trips booked was seen on the noticeboard outside the dining room) and said that new activities such as reminiscence sessions would be happening for people with dementia. This had been a good practice recommendation made at the last visit. Further to this the newly appointed occupational therapist attached to the In-Reach team (that supports homes that have people with dementia or mental health needs), was coming to talk about specialist activities for people with dementia that could be simple and easy to do. Current activities included: Bingo and ‘horse-racing’ as well as singalongs and the ‘lunch club’. This means staff take people out for lunch to the local pub that is a weekly event. Staff said they would like to do more with people socially but had little time because there weren’t always enough staff to cover. People were seen and heard taking part in a singalong with a keyboard player from the local community. People were seen sitting in lounges or in their rooms, watching television or reading. Peoples needs for leisure activities were recorded in care plans e.g. one person with dementia likes going out on trips and outings and staff confirmed this. For some people with different degrees of dementia, walking about the home may be a purposeful activity and this isn’t discouraged. Individual help is given to them if they join in with activities such as bingo. One person likes to go out on her/his own and this is recorded with proper precautions to make sure s/he is safe. One person said s/he liked being in her/his own room rather than in the lounge. The manager was seen going round to each person and asking if they wanted to go on a pub lunch trip to Clevedon the following week. Lots of large print books were seen on the ground floor of the home. A good practice recommendation made at the last visit had been adopted: religious services were now taking place at the home and several people attended them regularly. The person taking the services is a frequent visitor to the home and is well known to people living there. However not everybody’s religious needs were known about. One assessment recorded a person’s religion as Quaker but no information about how her/his needs in respect of this was seen in care records. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 19 From our survey, four people said they ‘always’ like the meals at the home, five said ‘usually’ and one said ‘sometimes’. Comments made included: ‘More variety in meals & more culturally appropriate meals’, ‘I am always satisfied with meals’; ‘If there is something not liked, you are usually offered an alternative & they do go out of their way to do this’ and: ‘Mum sometimes likes them, I don’t’. Both cooks were spoken with and menus seen. A good practice recommendation made at the last visit had been partly adopted. The person who is vegetarian is now offered a clear choice – although sometimes opts for a non-vegetarian meal. Menus were displayed in the kitchen but not around the home although the daily menu is written on a large Whiteboard in the dining room itself. People aren’t therefore able to see and remind themselves what is on offer during the week. Further, the menus looked at are geared to meat eaters only with only meat dishes offered at lunch each day (plus fish on Fridays) although teatime offers a wider choice for vegetarians. One person needs a cultural diet that is written on her/his care plan. The plan further stated that one of the management team would work with the cook at least once a week and the cook to be taught how to prepare and cook ethnic food, to make sure this need is met. No evidence was available to show that this had happened. Cooks said that the person also eats English food and that curry is available on the menu. However this was only seen recorded twice a month and it wasn’t clear if it was a curry that would meet that person’s individual cultural needs. Family members do bring in food of her/his choice on occasion but it can’t be assumed that eating of English food meets that particular need. Cooks said that they are aware of other diets that people need to have. One person has a gluten-free diet and specialist foods had been prescribed that were seen. Other people have need of diabetic diets and cooks were aware of who needed them and what to cook. They also said that they had spent time with a person who had very precise ideas of what food s/he would accept. A diet acceptable to the person had been worked out and this was seen. No diet charts for people with dietary/weight problems were seen although records were being kept for one person who was losing weight. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory complaints management and recording ensures people who use services can feel confident in raising concerns about any aspect of their care. Improvements in handling of abuse issues keeps people protected from risk of harm or abuse happening to them. EVIDENCE: The complaints log was looked at but no complaints had been made since the last visit. From our survey, six people said ‘always’ to the question ‘Do you know who to speak to if you’re not happy?’, one said ‘usually’ two said ‘sometimes’ and one said ‘never’. Seven people said they knew how to make a complaint although three said ‘never’. Comments about who to ask included: ‘I could ask my keyworker, she is always very helpful’ and:’ I do’. One person commented: ‘If I have a complaint it is always sorted out quickly’. Copies of the local authority complaints leaflet is kept in each person’s care file kept in their rooms and information is also written in the Statement of Purpose. None of the people spoken with had any complaints at this visit. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 21 A requirement made at the last visit about taking action to report any suspicion of abuse or actual evidence that it had happened, had been met. The manager said that staff had been made more aware of reporting issues and it had been discussed at a staff meeting. This wasn’t seen in the minutes of the May ’07 meeting although a general note about care staff responsibility for recording in daily records was. The manager had however drawn up a sheet that showed what staff had done safeguarding adults training with dates. Where staff had done the training three or more years ago new dates for refresher training had been organised and written on the sheet. Copies of emails confirming bookings on training were also seen. The manager said she had also spoken to the safeguarding adults co-ordinator about the training for managers in this issue and would book a place for herself on the next course. The manager said that a member of the home’s management team checks the daily records each day and would pick up if abuse had been recorded. No incidents were seen recorded in any of the records looked at. A safeguarding adults meeting was held at the home on the second day of this visit and we were aware of this. The minutes of the meeting were later sent to us by the safeguarding adults co-ordinator. From these it was clear that the manager had worked well with a situation that had happened in the home. Her actions were clear and person-centred, as were the staff’s in observing and reporting any suspicions that were making sure people are kept safe. This is good practice. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from having a comfortable, clean, safe standard of accommodation that is well decorated and maintained, physically accessible and meets their needs. However institutional practice doesn’t respect peoples rights and choice of a homely environment. EVIDENCE: The layout of Broomhill is over three floors. The office is on the ground floor together with some bedrooms and sitting areas. A lift takes people up and down to the first floor where the dining room and more bedrooms and lounges are situated. The top floor gives yet more bedroom and lounge space. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 23 Bathrooms and toilets are available on each floor and the home has had work done to meet needs of disabled people living or visiting there. There are selfopening front doors at the entrance to the home and adapted toilets for disabled people. The manager said money has been put aside to refurbish the toilets and they were seen to be somewhat dingy in appearance. Lounges are well furnished with comfortable suites of furniture or easy chairs. The home was very clean at this visit and domestic staff were seen around the home cleaning all areas. From our survey four people said ‘always’ to the question ‘is the home fresh and clean?’ although five said ‘usually’. People commented: ‘to me it’s always home like and that’s how I like it’ and: ’I found I settled in very quickly and my bed/sitting room is very homely’. However another said: ‘I would like the room to be warmer’. The manager had just been successful in getting a grant from the Department of Health for improvements to the home. The money will be spent on building a summerhouse for people to sit in and buying new, comfortable garden furniture. The garden that is to the side of the home is large and well tended. Individual bedrooms are decorated differently according to the person’s choice. Rooms seen varied in size but were homely and comfortable looking. However we saw in one room that information about medication/medical equipment used e.g. nebulisers, was pinned up on the wall. Where this had been frequently taken down to sign clusters of pinholes had appeared that spoiled the wallpaper and the homeliness of the room itself. Further, a notice for staff use was seen on another wall. It wasn’t clear if the person had been asked if the information could be pinned on the wall. In other rooms lots of notices were pinned up on the back of doors. Whilst some of the notices may be necessary e.g. what to do if a fire happens, too many of them give the home an institutional look and feel that should be avoided. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff aren’t available to meet peoples’ care and social needs or match their dependency levels. However, progress with training in National Vocational Qualification in Care and other care issues makes sure people are looked after properly. EVIDENCE: Rotas for the previous two weeks before inspection were looked at. These showed that at times there were only two permanent staff on duty in the mornings. At this visit three permanent staff were on duty plus one agency staff member (who hadn’t worked at the home before). Staff said they found it difficult to get through the workload and spend social time with people because of the low staff numbers on duty. They said they are able to give one to one keytime once or twice a month if there are enough staff on duty to enable them to do so. Records of key time were seen in individual care files. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 25 Staff showed a good level of knowledge about and commitment to people living at the home and clearly understood their individual needs. One casual staff member that had taken on more regular care hours said she really enjoyed working at the home and was keen to learn. The manager had drawn up a sheet showing progress with training in National Vocational Qualification in Care. The manager has NVQ Level4, one assistant manager has Level 2 and one has the assessor’s award (to assess staff doing the qualification). Seven out of fifteen care staff have Level 2 and five are currently doing it. Four domestic staff have Level 1 and the cooks have Level 1 & 2. The four casual staff don’t have the qualification although one said she would like to do it. The manager said that no new members of staff had been taken on since the last visit although one had transferred from a home that had closed. The manager had contacted us to make sure she had followed the right procedure for getting a Criminal Records Bureau check for this person, following a requirement made at the last visit. Casual staff that were subject of the requirement made now all had the proper Criminal Records Bureau disclosures and had all had induction training. Records were seen for this and were properly filled in and dated. A requirement about making sure staff had safeguarding adults training (see standard 18 above) and dementia awareness and care training was also being met. The training sheets the manager had drawn up showed community mental health nurses from the In-Reach team were doing dates of sessions for dementia training. The team visits a number of different homes and gives advice, support and training on a range of mental health issues that could affect older people. Dates for 2007 were seen for each staff member including cooks and domestic staff. This is good practice. Other training taking place includes regular fire safety for all staff and medication for the management team and night care staff. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved management particularly in staff training, supervision and health and safety, makes sure all aspects of running the home meets the needs of people living there and keeps them safe. However pressures on management may put people at risk. EVIDENCE: The manager was able to show that she had spent time making sure the requirements and recommendations made at the last visit had been met. In particular she had worked on developing good training record sheets and making sure casual staff had been inducted and trained. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 27 However it was clear that both the manager and other members of the management team are under pressure to cope with all the administrative tasks that are needed to make sure the home runs smoothly and peoples needs are met. From observation at this visit, frequent telephone calls and dealing with enquiries from a range of different people and organisations means managers are kept in the office instead of out on the floor with people using the service and staff. This can also mean that work such as making sure care plans, risk assessments and daily records are satisfactory and up to date isn’t done as often as it should be. The quality assurance survey that is done by an independent organisation was in the process of being done with a visit to carry out interviews with people living at the home on 25 July. A copy of the report will be sent to the Commission by the end of August ’07 and will be reported on at the next key inspection. The manager had worked on making sure supervision sessions were planned and done for all staff that was a requirement from the last visit. A sheet was seen that included dates of sessions and reasons for these not to be carried out i.e. because of sick leave etc. Supervision records were seen for casual staff that had been taken on late in 2006. Daily records were clearly written in respectful language. They were regular and gave information about social activities, outings and key time that were highlighted. Clear recording of issues affecting people, particularly about their healthcare were easy to see and showed that peoples needs were being met properly. The manager and team manager gave information about progress on making the staircases safe for people living at the home that had been a requirement from the last visit. Meetings had been held and a range of ideas had been put forward though none had been found to be satisfactory. The local authority property services department together with health and safety officers, is still considering the issue and all possibilities are being looked at. Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 28 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 2 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 6(a) Requirement Timescale for action 31/10/07 2. OP7 15(1) 3. OP8 12(1)(a) The Statement of Purpose must be reviewed and amended to make sure it is up to date and gives clear information about the types of needs the home can meet and the circumstances in which people are admitted. This will make sure that people considering a move to the home will get the information they need. 15/08/07 Care plans must be put in place and available for staff to read by the end of the four-week trial period. This will make sure peoples changing needs will be picked up and met. Care plans must then be reviewed regularly to make sure changing care needs are picked and met, and the review recorded. 15/08/07 Where changing needs are picked up, care plans must be up dated to include the changes e.g. in respect of diet and weight loss. This will make sure that people will be looked after properly if their health needs change. DS0000035843.V338192.R01.S.doc Version 5.2 Broomhill Page 30 4. OP9 13(2) All medicines must be given as 15/08/07 prescribed by the doctor. All medication administered by staff must be recorded. Self-administration of medicines must be assessed and recorded in the resident’s care plan as described in the medication policy. 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 OP1 Good Practice Recommendations The Statement of Purpose should be amended to show how people from different groups in society e.g. black or minority ethnic, sexual diversity, gender and different religions can be cared for and their needs met. Further the service users guide should be amended to have clear details of the total fee payable and the arrangements for paying the fee. Staff should record the actual reason for disposal of medication so that they can monitor this and prevent any unnecessary waste of medication. Menus should be looked at and changed to clearly show more regular cultural, ethnic and vegetarian choices. This will make sure that everybody’s needs are given equal importance. Menus should be clearly displayed around the home so that people can see and remind themselves of what is on offer throughout each week. General notices and those that are for the benefit of staff shouldn’t be pinned up in peoples rooms. This will make sure that people don’t feel they live in an institutional atmosphere. 2. 3. OP9 OP15 4. OP19 Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broomhill DS0000035843.V338192.R01.S.doc Version 5.2 Page 32 - 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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