Inspection on 24/04/08 for Broomhill

This inspection was carried out on 24th April 2008.

CSCI found this care home to be providing an Adequate service.

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 19/07/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Broomhill 92 Eastwood Road Brislington Bristol BS4 4RS Lead Inspector Sandra Garrett Unannounced Inspection 09:15 24 , 25 April and 2 May 2008 th 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.V360990.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.V360990.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.V360990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 40 19th July 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 recent addition has been a summerhouse so that people can enjoy sitting in the garden comfortably. A first floor balcony offers people 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.V360990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key or main inspection took place over two days. The Commission for Social Care Inspection (the Commission) had gathered information about the home before the visit took place, and drew up an inspection record in preparation for it. This record is used to plan all our visits so that we concentrate on checking the most important areas. We spoke to several people living at the home, assistant managers on duty, a relative and a group of seven staff. The manager was unavoidably absent at the visit but we went back to the home a week later to give her detailed feedback on our findings. Records we looked at included: Four peoples care records, Complaints, Residents’ meeting minutes, The home’s own quality assurance survey report dated July 2007, Health and safety records and: Staff training and supervision records. We case-tracked three people living at the home, closely. This means we looked at all their records, spoke to them and to staff caring for them. This shows a sample of the care given to people living at the home and gives us a view of the quality of care people get. What the service does well: 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. Relatives that filled in our ‘Have your Say’ survey about the home spoke positively about the care given by staff. When we asked ‘what do you feel the care service does well’? they commented: ‘There is a personal touch by all staff to the total welfare of my mother’ and: ‘I find the staff all very willing and helpful at all times and very pleasing and dedicated. My relative had been very fortunate to have such nice people who understand the problems s/he has’. 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. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: One requirement was moved on from the last visit and two new ones made: Part of a requirement made by the pharmacy inspector at her visit in 2007 hadn’t been met. Where staff were giving medicines to people, gaps were seen for some that didn’t show whether they had been given the medicine at the time they needed it. The requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. Staff spoke openly about trying to cope with what they saw as challenging behaviour from people living at the home. However there was little evidence to show what support they’d been given to help manage their own feelings about the behaviour. This had led to negative attitudes towards a person being displayed and recorded. Where this is the case staff must have training to help them to give care to people with any behaviours that challenge them. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 7 We looked at a number of staff records. From these it was clear that each staff member averaged only four opportunities to have supervision with a senior staff member in the last year. These included the yearly review that every staff member has. Long gaps were seen between some sessions and this doesn’t help staff that are challenged by staff shortages and the behaviour of people they care for. Four good practice recommendations were made: Where behaviour that challenges is an issue that staff struggle to deal with, behaviour charts that are person-centred (this means valuing the person as an individual and making sure they are treated with dignity and respect), should be put in place to avoid negative or discriminatory comments written about them in their own personal daily records. Whilst it’s clear activities and outings take place and people like them, there was a lack of recording of their enjoyment that showed this. Records should therefore show people taking part in and enjoying all activities and outings. Attention should be given to improving the nameplates on peoples bedroom doors. This will not only make them more attractive and less institutionalised but also help people with dementia recognise their own rooms. It wasn’t clear if concerns raised in the home’s last quality assurance survey report had been dealt with. The manager should have an action plan that clearly shows how she has tried to deal with issues raised. 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.V360990.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about the home when they come into it. Satisfactory arrangements for people coming into the home make sure their needs are able to be met. However staff need more training and support to be able to deal with specialist needs. EVIDENCE: Each person is given a pack of information that makes up the service users guide. This includes the brochure about local authority care homes, a copy of a contract, a property list and a copy of the complaints leaflet. A copy of the most recently updated Statement of Purpose was displayed on the notice board outside the dining room. It includes a paragraph about Equalities and Diversity (this means respecting peoples race, culture, religion, sexuality, disability and age and meeting individual needs in relation to it). From the ‘Have your Say’ survey that we did with people living at the home before we visited, they weren’t always clear if they had been given enough Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 10 information about the home or about the terms and conditions for living there i.e. ‘I don’t remember’, ‘My son in law did everything’, ‘I didn’t have to sign anything’, ‘They told me about it while I was in hospital and I’m from the area any way’, and: ‘I think we did look round because I can remember thinking how beautiful the garden was’. We looked at four peoples social work assessments: These are part of the care management assessment process done by social workers before people come into residential care. Basic care plans were included with these. Staff that filled in our survey commented: ‘Admissions often come in without assessment from unit. Also social work care plans often out of date i.e. over 12 months old’, and: ‘But sometimes care plans are out of date when sent to the unit by social workers’. Staff also thought that what could be done better was to: ‘Provide more thorough assessment of need before placement’. However, assessments seen gave clear information about peoples individual backgrounds and needs. One staff member had commented on what the home does well: ‘Provide emergency care placements and excellent respite allowing carers time off’. Staff try to meet peoples specialist needs wherever possible. These are usually around their physical impairments and making sure they get the help they need. Two people needed more specialist help at this visit and the local Intermediate Care Team based in South Bristol was supporting one of them. This was to help with physiotherapy that was hoped would make the person better able to walk. Another person with severe arthritis was being given extra time to make sure all her/his physical needs could be met. Although staff are trained and experienced, not all were clear about how to work with people with dementia and when spoken with had different views about how to help them. These views were around entering into a person’s reality and distracting them rather than trying to change their behaviour, which could have a negative effect. Dementia awareness training should therefore be regularly continued so that all staff become experienced in working with this group of people. Please see Standards 27 to 30 for a requirement about this. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Keeping of good, detailed care and health records shows that residents are well cared for and can comment regularly on the care they get. However, lack of clear action to manage behaviours that challenge, fails to support people with complex care needs. Further, failure to make sure that medication is signed for, doesn’t make sure people living at the home are kept safe. Being treated with dignity and respect benefits people using the service. EVIDENCE: To the question in our survey ‘Do you receive the care and support you need’? All twelve people we asked said ‘Always’. Comments included: ‘To tell you the truth I couldn’t get used to it in the beginning but now it’s an entirely different matter. I get on with them all and am very happy here’ and: ‘I’m looked after very well, they’re wonderful’. From the home’s own quality assurance survey done in July 2007, care plan/care needs scored 81 out of 100. Positive comments were recorded Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 12 about key workers (staff that are allocated to work with individual people on a regular basis), and general care. A requirement made at the last inspection about each person having a care plan was met. Every person we case-tracked had a care plan, even if they weren’t living at the home permanently. One person had just returned from hospital and the assistant manager on duty told us she was about to do a review as her/his care needs had changed. Another person had said s/he didn’t want a care plan although s/he later told me there was a care plan ‘in the office’ and had signed it. A review had been done to include self-management of medication that had been a requirement from the pharmacy inspection. However as the person had then said s/he didn’t want a care plan this hadn’t been put in place. Members of the management team were therefore not clear as to the rights of people not to have a care plan, nor how to meet their needs without one. We advised that people have a right not to have a care plan if they wish. However there must be a list of care needs and how they are to be met that should be negotiated with the person. This will make sure that staff know what help they should be giving. Care plans covered peoples physical and emotional support needs. Staff we spoke with told us about difficulties in meeting peoples needs where they felt a person’s behaviour got in the way and caused them frustration. The frustrations centred around the length of time it took to meet needs and what they saw as ‘demanding’ behaviour that stopped them having enough time to give to others. We spoke with the manager about this who told us she was clear that everyone’s needs must be met in a person-centred way and had talked to staff about it. However there were no records to show this. We recommended that where peoples behaviour challenges staff a behaviour chart should be put in place. This will help identify ‘triggers’ or patterns of behaviour and be objectively recorded, so that staff are more aware of how to deal with it. It was pleasing to note that this had been done for one person by the time we visited to give feed back to the manager. Both staff and the management team were clear with us that whatever the challenges they face they make sure peoples needs are met. Please see standards 27-30 and 31-38 for more about this. For a person that had just come out of hospital the care plan, although needing to be changed, was detailed. The person had lost a lot of weight, hadn’t been eating well and had serious health problems. However, eating and weight wasn’t recorded in the plan. We advised the assistant manager who was going to look at the care plan that the person must be weighed, a weight chart put in place and her/his condition and weight regularly checked. At the later meeting with the manager this had been done. A requirement from the last inspection about making sure care plans are checked regularly, was met. Monthly care plan review sheets were seen that showed staff had looked at the plans and checked if they needed changing. Six Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 13 monthly reviews were also seen that included comments from people and their relatives. All were signed. One relative we spoke to confirmed that six-monthly reviews are done that involve both the person and the relative. Peoples healthcare needs are clearly part of their care plans. These cover sight, hearing, chiropody and care needs associated with illness or impairments. Where people were concerned about sight or hearing, appointments with optician and audiologists were made. A local GP and district nurses were seen visiting the home during the two days of this visit and one consultant psychiatrist visited one of his long term patients. All twelve people who filled in our survey said they got the medical support they needed. Comments included: ‘I don’t need a lot, maybe a bit of advice from time to time and I know I could get that’, ‘I’m having the district nurse in regularly to teach me to do my own insulin. I can inject myself but have difficulty getting the dosage right’ and: ‘I had to go into hospital due to falling so my doctor has now made sure that I have the right walking aids to suit me’. We followed up requirements from the pharmacy inspector’s visit in July 2007. Some had been met. Medications were being stored properly and the returns book now had the reasons for the return recorded so that staff could track them more easily and reduce unnecessary waste. However other actions around self-medication were still lacking e.g. a risk assessment for a person self-medicating, and failure to provide a safe and secure method of keeping medicines in the person’s room. The assistant manager on duty did a risk assessment immediately, together with making sure the person had a set of lockable drawers to keep the medicines safe. We checked the medication administration sheets and saw recording of meds on them that had also been part of the requirement. However on one day in April there were several gaps for a number of different people. This showed that the person giving meds had failed to record every time a person was given them, which leads to doubt as to whether the person took the medicine or not. The requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. To the question in our survey ‘Are the staff available when you need them?’ People said: ‘If I want anything they’d come,’ and: ‘They always come when I ring my bell’. We asked people if staff wait to be asked in to their room after they knock on the door and the answer was usually ‘yes’, although one person said they sometimes knock and walk in. From the home’s own quality assurance survey report one person had commented: ‘Staff are happy for me to have my door shut – they always knock when they want to come in’. Someone else had said: ‘some of the staff think I can do things that I can’t’. This could show a lack of respect for a person knowing their limitations. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 14 However, staff were seen interacting with people in very positive ways particularly at lunchtime. Overall, all comments made about staff to us from people and their relatives were positive. One relative we spoke to said she feels staff treat everyone living at the home with respect. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a wide range of social and leisure activities that meet their needs. However lack of proper recording doesn’t always show how people enjoy them. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: Nine out of twelve people said ‘always’ to our question: ‘Are there activities arranged by the home that you can take part in?’ Two said ‘usually’ and one Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 16 said ‘sometimes’. Comments about activities were mixed: ‘There isn’t a lot no, due to lack of time’, ‘We have keep fit once a week, which I enjoy and they have entertainers in and plenty of trips out. They do a lot here I’ll give them their due’, ‘I’ve been on 2 or 3 of the trips and there was an entertainer in the other day and he was marvellous, we all told him to hurry back. I also enjoy my knitting’, ‘There are but I never join in. I know there was some entertainment on but I didn’t go down to it. I’m the quiet type and don’t mind being on my own’, ‘We had bingo earlier’ and: ‘I know of them but don’t bother’. From the home’s own quality assurance survey, daily living/activities scored 81 out of 100. Positive comments from people and their relatives were recorded about hobbies, interests, trips and entertainment. However a number of comments about things that could be improved were also made. These included more trips out and practical activities such as crafts. One relative commented: ‘my relative has poor eyesight and cannot read or watch TV – s/he therefore spends a lot of time on her own’. We recommend that this should be considered when planning activities so that people with sight or hearing impairments aren’t left out of enjoying them. Relatives we surveyed were asked what the home does well: ‘Keeping the routine of daily living because I believe older people like knowing when their bath time is and their meal times and so on’, However we also asked what could improve: ‘If they had time to introduce each resident to one another, so as when they go to the various lounges they would be able (if they wished) to converse with each other and not get the symptoms of a doctor’s waiting room - all sat in silence’. Key time was also commented on: ‘I would like to see more staff employed so that key workers could perhaps spend a little more time with the people they are caring for’. Staff echoed this by saying: ‘One to one time is often very restricted. Care needs in this home and others have become greater, stretching the staffing levels’. We asked staff about key time. This is held only once a month for people, which isn’t enough. Staff said key time is usually one to one and a half hours and that people like it. However they did say that they would prefer to have key time in the afternoons rather than in the mornings when they struggle to get all care needs met. Trips out had been discussed in residents meetings and people had asked for a trip to Longleat (staff said they love going there), Cadbury Garden Centre and a possible trip to see a summer show at the Hippodrome. The minutes of the meeting held on 4 March ’08 recorded that ‘residents said they enjoyed their keep fit sessions and also Bingo’. We spoke to the staff member that does the keep fit sessions. She said she’s been doing it for years and confirmed that people really like it. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 17 We saw in individual daily records brief reports of people doing activities. We also looked at the activities record file. From this we saw the number of people attending or joining in with the activity/entertainment but very little if at all, recorded about their enjoyment of it. The manager said that this is recorded in peoples daily records. However as we saw little in those records we looked at, this needs to be recorded more clearly and regularly. Further, as we only look at a sample of records at any visit and not everyone joins in, we have less opportunity to see how people enjoy them. We recommend that where a group activity is recorded, peoples enjoyment of this is written about so that both the home staff and ourselves can check that people are enjoying what’s on offer. We saw a notice in the home about regular religious services now held. People go out on a Wednesday (called the Wednesday lunch club). This usually involves a staff member taking two or three people out to a local pub for lunch, which staff said they enjoy. People are able to go to the nearby local shops if they’re able or with a staff member in key time. People have freedom of choice in the home and this covers choice at mealtimes, choice as to what time they get up or go to bed, where to spend their time and whether to join in with activities and entertainment. As discussed above, people can also choose not to have a care plan if this is their wish. Staff confirmed that people can stay in bed as long as they like – all day if they wish although this does impact on staff routines. Meals are a high point of life in the home and scored 87 in the home’s quality assurance survey. Lots of positive comments were seen from both people and their relatives and no action points for improvement. From our own survey people were equally positive: ‘I always eat it’, ‘They’re very good. They know I’m diabetic and cater well for that’, ‘The food is wonderful’, I’ve got no complaints there - it’s very good’, ‘I like the food very much. I had 2 weetabix, toast and marmalade and grapefruit this morning’, ‘I really like the chicken soup’ and: ‘Yes and I get plenty as well’. We had lunch with people in the dining room. The meal of roast chicken followed by Christmas pudding was hot and tasty and people said they enjoyed it. Salmon or cheese salad was offered as an alternative. People were offered and accepted second helpings – including us! Four-weekly rotating menus were pinned up on the notice board near the dining room. A good practice recommendation made at the last inspection about including clear vegetarian choices for people had been adopted. A list of twenty-seven different vegetarian dishes was added to the menus for people to choose from. Dishes included vegetarian curries, pizza, pasta dishes and meat free burgers etc. From the residents meeting held in March people Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 18 had requested more curries and trifle and some had asked for tripe and onions. However the menus only showed curry as a choice twice monthly even though people from different cultures live at the home. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 19 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. Good distribution of complaints information helps people feel confident about being able to raise concerns or complain about their care if they need to. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: We asked people living at the home: ‘do you know who to speak to if you are not happy?’ And: ‘do you know how to make a complaint?’ Comments included: ‘I’ve been here for 15 months and not found anything to moan about yet’, ‘I have a key worker and would talk to her if I were unhappy about something’, ‘Oh yes, because they’re all ready to listen to anything’ and: ‘I would speak to Penny’. About making a complaint: Yes I’ve had no need to as yet though and don’t think I ever will’, ‘I don’t think there would be any trouble there’, ‘I’ve got no complaints, they’re marvellous’ and: ‘If I needed to I suppose I would’. Complaints information was seen in various places, on notice boards and in individual packs. People had copies in their rooms. No new complaints had been made since the last visit although lots of letters of thanks were seen. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 20 Since the last inspection a situation had happened where one person abused another. The manager and staff had dealt with this quickly and staff had supported the person abused. The whole situation was managed well and the alleged abuser moved out quickly. No further incidents had happened. A list of staff that had done safeguarding adults from abuse training was seen. All staff had done it at various times including the management team. Dates varied and the most recent were between May and November 2007. Staff confirmed to us that they had done the training. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 21 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): 19,24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. However poor labelling of peoples rooms makes the home look institutional and doesn’t help people with dementia find their way around. Good, proper cleaning and hygiene makes sure residents are protected from risk of infection as far as possible. EVIDENCE: To our question ‘Is the home fresh and clean?’ People said: ‘They come in every day to clean it’, ‘It’s cleaned daily’ and: ‘It’s lovely in this place. I really feel at home’. From the home’s own quality assurance survey the environment scored 84 . Again lots of positive comments were seen, the majority of them from Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 22 relatives. People living at the home hadn’t made any comments that needed acting upon but relatives had raised concerns about the laundry service, the smell of the home at times and toilets not always being clean. One comment was made about lack of soap and hand towels in toilets and we found this also. One toilet had an empty soap dispenser that meant people aren’t able to wash their hands properly. All bathrooms were unlocked. However some items that may prove dangerous if swallowed were seen in one bathroom. These included denture cleaning tablets, aftershave and other liquids. Staff were immediately required to remove the articles. Because people with dementia could be at risk from swallowing things they shouldn’t, such items mustn’t be kept in bathrooms. The assistant manager said it was unusual to find them there and immediately arranged for them to be removed. However relatives had commented on this in the home’s quality assurance survey: ‘When my relative is bathed by agency staff they never return the toiletries to her room afterwards’. The manager must make sure that peoples belongings are returned to their rooms by all staff. We followed up a good practice recommendation about not putting notices up in peoples rooms that are for the benefit of staff. It was pleasing to see that this had improved and in only two bedrooms notices were pinned up. One was a moving and handling risk assessment (that included some confidential information) and two notices about making sure laundry is done properly were seen in another person’s room. We asked a relative that was visiting about this and s/he said that it was a problem as not all staff do the laundry properly so need constant reminders. We saw on some bedroom doors that although there were nameplates, names weren’t always on the doors. Further, some names were stuck on with sticky tape or blu-tack. This gives both an institutional feel and look to corridors and doesn’t help people find their rooms if the name comes off. Further, although the home has a number of people with dementia, there were no signs or pictures on doors that would help someone find their way to their own room. We recommend that thought is giving to making the doors easier to find and more attractive for people. The home smelled and looked fresh and clean at this visit. One person had just had a bedroom re-decorated that made it look fresh and bright. All toilets and bathrooms were clean and hygienic. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pressure on staffing levels fails to make sure people get the time they need both for care and social time. However, progress with training in National Vocational Qualification in Care makes sure people are looked after properly. Insufficient training in dealing with behaviours that challenge or dementia fails to make sure staff are supported to be able to deal with these issues in a person centred way. EVIDENCE: We met with a group of staff and asked them about rotas and workloads. Staff told us that they feel they struggle to manage and there are less staff on at weekends than in the week. We looked at rotas and found them unclear about numbers of staff on duty at any given time. Staff told us that ‘it’s tight’ and they ‘try and cope but struggle in the evenings’. They also spoke about the difficulties of caring for people with behaviour that challenges them as they find it takes longer to meet a person’s needs in that situation. However when we spoke with the manager she denied there weren’t enough staff and showed us a rota that included a sheet used to book agency staff. When the rota showed a gap the sheet showed an agency staff member had been booked to cover it. Therefore the manager said there were always the right numbers of staff on duty. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 24 However when we surveyed people about staff availability comments included: ‘Now and again they might be glad of a few extra but they do their best with what they’ve got and they are all lovely’ and: ‘I think they can be a bit short staffed’. We asked relatives and staff: ‘What do you feel the care service does well?’ Relatives commented: ‘Look after person making sure s/he is clean and cared for. I feel my relative is well looked after’, ‘Every task expected of them’, and: ‘Am quite happy with care service’. Staff commented: ‘Look after elderly service users who no longer can look after themselves. Our home is like a home from home to all residents and we meet their needs as best we can’ and: ‘Provide quality care. Provide excellent, loyal, committed staff at low rates of pay, provide safety, reassurance and enjoyment to service users’. We also asked what could be done better. Staff commented: ‘We could do with more staff on all shifts so that we can give best possible care’, ‘With this job, experience actually doing the job gets you to know what’s needed to do job properly’ and: ‘Time constraints and shift changes during day prevent updated handover being given to all staff’. The threat of home closures was also clearly in relatives and staff minds when they were filling in the survey about what could be done better. Staff commented: ‘Broomhill provides a service that is slowly being stretched beyond acceptable. I feel this will ultimately justify the unjust action of home closure’, ‘Stop giving residents the news about home closures. This upsets them no end and none of them wants to leave or change the care they are getting’, ‘Keep the homes open. Fill the vacancies so the service users have continuity’, and: ‘What is going to happen to service users when Bristol City Council close the homes? We’ve had six new residents that clearly need high levels of care. Where will these go?’ Relatives said what they felt could be better: ‘By reducing the constant threat of closure and dumping the residents on the private sector’ and: ‘yet again the council are trying to rid themselves of caring for the class of residents at Broomhill’. From the AQAA we saw that out of fourteen permanent care staff, eight already have National Vocational Qualification in Care Level 2 and six more are working towards it. This means that the home meets the recommended minimum level of 50 of care staff with the qualification. We asked staff about training. They told us that dementia training had been planned but then cancelled. They were also to have training from the In-Reach Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 25 team (that goes into care homes to support with mental health issues and talk with staff about their concerns and challenges), on a type of dementia that affects people who misuse alcohol. Staff said: ‘we can never have enough training – training helps’. We asked staff about caring for people with dementia that often throws up challenges to them. Some staff were clear about using methods designed to gently distract people by engaging with them in their own reality, whatever it is. However other staff weren’t clear about this or the different types of dementia and the way they can affect people. Further, staff discussed in detail the issues they found when caring for someone with behaviour that challenges them. It was clear from their views that they need more training in how to deal with such behaviours so that the person they’re caring for is treated properly. Other staff comments about training were made in the survey they filled in: ‘I have training once or twice a month. I am very satisfied with the way I am taught’, and: ‘New staff enter untrained and unqualified. Staffing levels don’t permit thorough induction or shadowing’. We looked at individual staff training records and the list of training dates that the manager has set up. From these, dementia and mental health training had taken place in 2007 for all staff (including domestic workers) although three night staff hadn’t attended. Eighteen staff including management, care and domestic workers had done training on Equalities and diversity – sexuality. However three day and three night staff hadn’t done it. All care staff had done moving and handling training in 2007/8. Staff also told us that there is Control of Substances Hazardous to Health training coming up shortly. Broomhill DS0000035843.V360990.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): 31,32,33,35,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both people living at the home and the staff team continue to benefit from an experienced manager who encourages an open style of management. Failure to use an action plan to pick up issues following quality assurance surveys, means people may not have a chance to help change the way the home is run, that will benefit them. Proper management of peoples money makes sure they are protected from financial risk. Failure to deal with staff issues around behaviour that challenges particularly in care recording means people may not be respected or cared for properly. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 27 Staff don’t get enough opportunities for regular supervision to reflect on their working practices, that could lead to poorer quality of care given to people. EVIDENCE: The manager Mrs Penny Fry was unavoidably absent at this visit. However three assistant managers were on duty over the two days and were welcoming and open to the inspection process. They gave us much information and assistance to enable the inspection to run smoothly. We later visited the home to give feedback to Mrs Fry and to get further information on some issues. Mrs Fry is a manager of many years experienced. She is qualified to National Vocational Qualification in Care Level 4 and also holds the Registered Managers Award. Her style is open and inclusive and her approach to care is personcentred. We asked staff how available Mrs Fry is to them. Staff confirmed that she is available to them when they need advice or guidance and works alongside them where possible. Staff said she is a good manager, has interests of both people living at the home and staff at heart and makes sure the home is managed properly. We also asked staff if they feel they get enough support from the whole management team. Staff said that a couple of the assistant managers work alongside them although they feel others don’t. Overall the home’s own quality assurance survey report was positive and showed that people feel they’re looked after well. Many positive comments were seen, some of which are included in this report. However we didn’t see an action plan to show what the manager is doing about less positive comments or ‘action points’ made throughout the report. These should be acted upon so that quality goes on being improved. We did a random check of peoples monies held by the home. The check showed no mistakes or discrepancies and all amounts checked were correct. Where possible two signatures were seen and balances checked regularly. Receipts were also attached to the sheets when items had been bought for people. We looked at peoples daily records when we case-tracked their care. For the person with behaviour that challenges staff that they talked to us about, lots of negative records were seen about her/his behaviour. Records suggested that at times some staff use them to express their feelings, including use of a negative approach, rather than a person-centred one. Therefore the content isn’t always respectful to the person and doesn’t take into account past history, age or the effect of any impairments or illness. As the records are about each person and they have a right to see them at any time, staff should avoid making ‘value judgments’ i.e. statements about a person’s behaviour as if the Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 28 person is the ‘problem’, that could be discriminatory or negative. The use of a behaviour chart as discussed earlier in this report is therefore more helpful. Staff commented in our survey: ‘Not enough is written about service users at times’. This wasn’t the case when we looked at peoples daily records. No lengthy gaps were seen and records showed clearly the actions staff had taken to meet peoples needs. However we agree that not enough is written about the more social aspects of peoples lives in the home (Please see Standards 12 –15 above). Staff also commented on supervision: ‘Every month I have supervision and every couple of months for my pmds’. However this wasn’t borne out by our findings when looking at staff records. PMDS (which is the form of yearly appraisal of a person’s work that the Council uses) are done once a year and each staff member had one in 2007. However supervision records looked at showed that many care staff had only had three sessions in 2007 and some of those were some months apart. The Council’s own policy states that staff should have supervision at least six times a year (i.e. every two months). One person had reached this target but this was because of checking on performance issues. The records showed the person’s performance had improved greatly that could have been in part due to regular supervision. Therefore it’s important that each staff member has the opportunity to reflect on their work with a senior member of staff regularly. This will make sure the standard of work is kept up. We looked at health and safety records. A Fire officer had visited the home to carry out an inspection under the new Regulatory Reform Order that has replaced fire safety regulations. We saw that the officer had made a number of recommendations to improve fire safety that the home had put in place. A new fire safety risk assessment was seen that had been signed by a senior manager in Adult Community Care. Regular weekly checks of fire safety equipment and alarms were seen together with other checks such as water temperatures. Staff had done fire safety training and fire drills had taken place regularly. Outside contractors had also visited to service fire safety equipment and copies of their visit reports were seen. Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 29 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 3 3 2 X X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X 3 2 2 3 Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement All medicines must be given as prescribed by the doctor. All medication administered by staff must be recorded. (Timescale not met from the Where coping with challenging behaviour leads to negative attitudes and recording, staff must be given training in how to deal with the behaviour. All staff must be given training in dementia awareness so that they are able to work with people with dementia in a person-centred way. This makes sure people are treated with dignity and respect and their care needs met by suitably trained staff. Care staff must be given 30/09/08 supervision at the frequency as set out in the Council’s own policy. This makes sure that people are treated properly and protected by staff that are supported in their work. DS0000035843.V360990.R01.S.doc Version 5.2 Page 31 Timescale for action 12/06/08 July 2007 inspection). 2. OP30 18(1)(c)(i) 30/06/08 3. OP36 18 (2) Broomhill 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 OP12 Good Practice Recommendations Records of activities and outings should be written in a way that shows their enjoyment of them. This makes sure that people benefit from the activities and outings planned for them. Attention should be given to improving the signs to peoples rooms by way of more attractive nameplates or pictures that will help people with dementia identify their rooms more easily. This will make the environment more personalised and less institutional for people. A clear action plan should be put in place to show how issues from the home’s own quality assurance survey will be dealt with. This makes sure that any issue or concern about quality of service that people raise will be taken seriously. Where behaviours that challenge prove difficult to manage, staff should avoid recording negative or discriminatory remarks in daily records. This makes sure that people are treated with dignity and respect and their behaviour properly dealt with. 2. OP24 3. OP33 4. OP37 Broomhill DS0000035843.V360990.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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