Inspection on 25/01/07 for Broomhill

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 19/07/07

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 25 , 26 January and 1st February 2007 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.V300395.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.V300395.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.V300395.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. 16th February 2006 Date of last inspection Brief Description of the Service: Broomhill is a 40-bedded home run by Bristol City Council. It is situated in the residential area of Brislington. The nearest shops are approx 300 yards away; these include a post office, newsagents, pub and supermarket. The home is on 3 levels with 2 lifts providing access to all areas of the building. There are 4 lounges around the home and a large, spacious dining room on the 1st floor. All bedrooms are single and contain a washbasin. Accessible toilets and bathrooms are close by. The garden is accessible with rails to assist residents on to the patio area and includes a rockery with a water feature. A first floor balcony offers residents the opportunity to sit and look at views across to Bath and surrounding countryside. Fees payable for care at Broomhill are £451.99 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 were seen displayed in the home. The manager also said she discusses outcomes from the report at residents’ meetings. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key or main inspection that took place over three days. Two days were spent in the home, speaking with residents and staff and looking at records. The third day was spent looking at staff records at Romney House, Lockleaze, Bristol. This is where Bristol City Council’s personnel department offices are based. Six residents and four staff members were spoken with at this visit as well as discussions with the registered manager. Records looked at included: care plans and assessments, residents’ daily records, complaints and health and safety records. Other information used for this report was taken from the results of our own survey done shortly before the visit, the independent quality assurance survey of the home done in August 2006, and the pre-inspection questionnaire sent in before the visit was arranged. The condition of registration about two residents under the age of 65 being cared for at the home was checked. One of the residents has now reached 65 although one is still under. The condition therefore remains for this person. What the service does well: What has improved since the last inspection? Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 6 Care records gave lots of detail that showed how residents’ care needs were being met. One care plan showed that all possible care was given despite a resident’s inability to agree with the actions that needed to be taken to keep her/him safe. Risk assessments covered all potential issues and use of mobility aids and other aids were well recorded. No residents were being restricted in their movements and they were able to move freely about the home. Bathing equipment was much cleaner at this visit. Chairs used to lift people in and out of baths were cleaner on the underside, as required at the last visit. One was seen that was less clean but was in a bathroom that was not being used. The hand basin water temperature in the visitors’ toilet by the dining room was much lower and residents or their visitors will not now be at risk of scalding. What they could do better: The Commission is concerned about the level of care some residents need and the home’s ability to meet those needs. The registered provider is reminded of the need to admit to the home, only people who fit within the registration category. This allows for people over the age of 65 but without dementia or severe mental health problems. Therefore the manager has responsibility for assessing the needs of potential residents to make sure the home and its environment is a suitable place for them. It’s acknowledged that the manager’s ability to make decisions about proper placing of residents is limited as it is the responsibility of the organisation as a whole to make sure this is done. From the evidence about a particular situation shown in this report it was clear that the manager didn’t receive the proper support she needed to make sure a vulnerable resident was kept safe. Further, when new residents come to the end of their trial periods, the home needs to confirm to service users that their needs can be met. A requirement about making sure clear and specific risk assessments i.e. about any resident having falls, was made to make sure such risks are identified and reduced. Recording of controlled medication needs to be improved. Two signatures are needed each time such medication is given to make sure correct dosage and correct quantities are left. Residents must be able to feel confident that their medication is given correctly and safely and that they are protected from harm. The manager must take responsibility for making sure that any suspicion of abuse happening to any resident, or any instances of abuse being recorded, must be referred through the Safeguarding Vulnerable Adults procedure. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 7 The recruitment of a number of casual staff has improved the consistency of care for residents. However, failure to make sure proper checks take place before staff members start work means residents aren’t protected. A requirement was therefore made to make sure that such checks are done and that issues coming out of the recruitment process are followed up. Further, casual staff must have the same induction, supervision and training – particularly moving and handling - as permanent staff to make sure that they know how to care for residents and keep them safe. All staff must have regular training in keeping residents safe from abuse. A number of staff had not done this training for three years or at all. Residents are therefore more vulnerable if staff are not trained to recognise the signs that abuse may have happened or report it properly. Further staff should be given training in dementia awareness and care from a recognised training organisation. Records showed that care staff don’t get regular opportunities to reflect on their work particularly where they are challenged by caring for vulnerable residents with varying degrees of dementia. One to one supervision sessions must therefore take place at the frequency laid down in the home’s own policy. Following serious accidents to residents using the stairs at the home, advice must be sought from the appropriate health and safety agency on ways to make them safe, particularly for people with dementia A number of good practice recommendations were made: Where personal care needs form part of the care plan e.g. teeth care, staff should record how those needs are met and if they cannot be met, why not. Because of the number of residents with varying degrees of dementia, consideration should be given to doing suitable activities with them so that they have the same opportunities as other residents. This should be included in the care planning process. Where residents ask for religious services at the home, the manager should make every effort to make sure this happens so that residents spiritual needs can be met. Vegetarian residents’ preferences should be given to cooks and a clear vegetarian choice should be offered at each meal so that their beliefs and requests are respected. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 8 Where residents are shown to be more vulnerable particularly because of dementia, the manager or a member of the management team should regularly check daily records to make sure their care needs are being met properly and they are kept safe. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broomhill DS0000035843.V300395.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.V300395.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Management of prospective residents fails to take into account whether the home is the proper place for them and whether staff can meet their assessed needs. The home’s design, staffing and routines of daily living fails to take into account the specialist needs of people with dementia. EVIDENCE: Three residents’ records were looked at in detail at this visit. Care assessments done before admission were seen together with the home’s care plans, moving and handling risk assessments and daily records. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 11 From two residents’ assessments seen it was clear that their situations had improved since coming to the home. One was spoken with and although the assessment showed a possibility for extra care housing as an option, s/he said that s/he liked it at the home and would like to stay. No information was available from the pre-inspection questionnaire about the number of residents with dementia or behaviour that challenges staff. However from observing residents and from discussions with the manager and staff it was clear that a high number of residents experience either dementia or some type of mental health difficulty. Further, it quickly became clear that for at least one resident with a definite diagnosis of severe dementia the home was having difficulty in meeting her/his needs or keeping her/him safe. The manager explained the circumstances of this resident’s admission and her responsibility to take in residents at the request of team managers and social workers – particularly in emergency situations. However the home isn’t registered to take in people over the age of 65 with mental health difficulties or dementia and at this inspection was in breach of its registration. Another example was later seen with a resident also admitted with a diagnosis of dementia with whom the staff had difficulties in keeping safe. When these situations happen management staff don’t visit the prospective resident to make sure the home is a suitable place for them. An Adult Community Care assessment and care plan was seen for the resident that clearly showed the problems that could arise when trying to meet her/his needs. The home’s care plan was less detailed and didn’t show how some assessed needs i.e. use of mobility and hearing aids, were being addressed. The manager explained the action she had taken to get an urgent review/reassessment of this resident’s situation and daily records showed this. Staff spoken with gave information about how they tried to meet this resident’s needs but also spoke about the conflicting pressures of trying to care for her/him as well as a number of other frail and confused residents. This didn’t leave them time to offer enough one to one care to the resident who clearly needed it. Staff also commented on the difficulties of trying to meet the needs of so many residents with dementia which means that other residents have to wait or do things for themselves as they get fed up with waiting. Further, the home is laid out over three floors. Residents’ bedrooms are situated on all floors together with lounges and bathrooms etc. For people with severe dementia or mental health needs the design of the building doesn’t meet their needs or keep them safe. Physical access for this group of residents may be difficult as no specialised décor or aids designed to help them find their way around was seen. (Please also see standard 38). Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 12 It was also not clear how the specialist needs of residents with dementia would be met i.e. through meaningful activity designed for people with dementia. The home doesn’t take people for intermediate care although it does help people to come for short stays. Therefore standard 6 doesn’t apply. Broomhill DS0000035843.V300395.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 at least once during a 12 month period. 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 the service. Although residents’ are properly looked after in respect of personal and healthcare needs recording doesn’t show what actions are taken to meet needs. Inadequate recording of controlled medication doesn’t keep residents safe from harm. Residents’ benefit from being treated with dignity and respect at all times. EVIDENCE: Three care plans were looked at in detail. Each resident had a photograph and what name they wished to be called was recorded. Staff and residents had signed their care plans except for the resident who was not appropriately placed at the home. Key workers sign care plans at the end of the four-week trial period together with the resident and/or their relatives. However this doesn’t make it clear that staff at the home can meet residents’ needs. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 14 It is recommended that staff confirm in writing, using suitable wording that they can meet new residents’ assessed needs. Quick action must be taken to find a more suitable place if this cannot be done. Care plans showed actions to be taken to meet needs, particularly about personal care and healthcare. One resident had been admitted to hospital and questions had been raised about her care whilst at the home. The resident’s care records were all thoroughly looked at and the inspector attended a meeting with social care and healthcare professionals to discuss the matter further. Records showed staff had been vigilant in trying to meet care needs, particularly about pressure area care. The GP and district nurses had visited regularly and daily records showed that staff had requested district nurse and GP visits promptly. District nurse pressure area care records were also seen that clearly showed when staff had raised concerns and had discussions with the nurse. Although teeth care was a part of this care plan actions hadn’t been recorded when care had been given or couldn’t be given. This had led to queries about whether the service user had had proper teeth care. Staff were able to explain the difficulties of caring for residents when residents themselves don’t want staff to do anything for them. However in this instance no records were seen to show what actions the care staff had taken to meet this need. Each care plan showed that healthcare needs had been picked up and actions taken to meet them were in place. This included: Chiropody, audiology and dental visits. Supporting letters from healthcare professionals were seen. Healthcare scored 93 in the home’s own survey and both residents and their relatives said they were satisfied with the quality of care given. For the resident with severe dementia the assessment and care plan showed a history of falls and the high risk of falls happening. Daily records showed that falls were happening and injuries occurring. However no falls risk assessment had been done to try and reduce the possibility of falls. A check of medication was done at this visit. A requirement made at the last visit about making sure residents had a continuous supply of medication was met. All residents had enough medication and the manager had dealt with the issue that prompted the requirement. The staff member giving out medications was observed to sign for these after they had been given. Administration record sheets were all signed correctly. Medications were all stored properly in secure cupboards in a secure room. A medication fridge with a minimum/maximum thermometer to check temperatures was in place. Temperature records were seen and showed all were correct. Allergies were written on the administration record sheets and all creams, lotions, inhalers etc were recorded. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 15 There was no overstocking of medication. Controlled medication was kept in a separate, secure cupboard inside the main one. The right numbers of tablets were entered on to separate sheets kept for the purpose. However there were lots of gaps seen on the sheets where there should have been witnesses’ signatures. Staff were seen and heard treating residents with dignity and respect. Residents confirmed this although one resident said that staff don’t always wait to be invited in to the room when they knock on the door – they just knock and walk in. Staff gave a lot of information about trying to meet care needs with dignity even though some residents, because of their dementia, are unable to understand what staff are trying to do for them. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the home continues to give most residents opportunities to have stimulating and variety of life where lots of activities happen regularly this doesn’t happen for people with dementia. Whilst meals at the home are well managed, give variety, good nutrition and social contact for people, the specialist needs of vegetarian residents aren’t met. EVIDENCE: Despite pressures of caring for a number of residents with mental health issues or dementia, staff spoken with said that they try and make sure activities, entertainment and outings are offered to residents regularly. From our own survey done just before this visit the answer to the question about activities showed a poor response. Some residents said there weren’t any, some said there were but they ‘don’t bother’ or were not interested and one said that ‘there’s not much organised. I haven’t been out since I’ve been here and would love to get out to the shops’. The response to the home’s own survey showed that 86 of residents were satisfied with the level of activities although again one person seemed unaware of trips out. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 17 However from talking with staff and the manager, looking at individual records and observation it was clear that activities do take place together with local outings (to the pub for lunch) and more formal outings to the theatre (to see ‘Peter Pan’ and ‘Cats’ the musical). On one of the inspection days a game of bingo was overheard and residents sounded as though they were having a good time. The manager said that residents are regularly told about activities and notices were seen about them around the home. The minutes of two residents meetings, one in February ’06 and one in January ’07 were seen that showed outings and entertainment was discussed with eleven residents. Staff said that although all residents are told about activities only six people usually turn up. Because of the number of residents with some degree of dementia this may impact on people’s awareness of what’s on offer. No evidence of activities suitable for people with dementia was seen at this visit. Staff said that if they had the time they would like to be able to do more for residents, for example, take them to more places and further afield. Activities are recorded in each resident’s individual file and were looked at for the three residents reviewed at this visit. One resident had a good mix of outings over a five-month period averaging two a month. However for the resident with severe dementia no activities were recorded and all daily records focussed on how to manage her/his behaviour or meet personal care needs. From the most recent residents meeting minutes it was noted that one resident had asked for a communion service to be held within the home. The vicar was contacted but was unable to visit due to her/his workload. The idea of arranging a visit to the church for a service was suggested but this may not be suitable for frail residents with physical impairments. The manager was advised to contact the diocesan office to find out if a service could be arranged within the home. The manager said that residents go out into the local community more than the community comes into the home because the pub, post office and shops are so close. Students from the local school come and sing carols at Christmas. The manager promotes residents’ rights and choices and showed how this is done. The February ‘06 residents meeting minutes reminded them that they have the right to have meals in their rooms on request and that they can get up and go to bed when they wish. One resident commented that ‘I’m always allowed to do exactly as I wish’. Menus were seen that showed a choice is available at both lunch and tea. The inspector had lunch with residents on one day of this visit. The meal of fish and chips was hot and tasty. Residents were offered drinks and asked what they wanted before the meal was brought to them. They were also offered second helpings. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 18 However one resident said s/he was vegetarian and asked for a vegetarian meal. It was clear that staff weren’t aware of this and no vegetarian choice had been prepared. The resident was therefore given a hastily put together meal of cheese slices, chips and mash. The lunchtime menu didn’t show any vegetarian choice and overall was geared to meat eaters only. Comments from our survey showed mixed feelings about meals: ‘They’re not bad’ ‘They’re all right’ ‘Good’ ‘I can always ask for what I want and get it – there’s plenty’ ‘Sometimes its great and then others not so but I can’t grumble’ ‘The food is excellent, you’re always offered more as well. They do excellent puddings’ ‘Don’t eat much of it’. The home’s own survey done in August 2006 echoed some of the above and again responses were mixed. However meals scored 94 out of 100. Broomhill DS0000035843.V300395.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to the service. Satisfactory complaints management and recording ensures residents can feel confident in raising concerns about any aspect of their care. Arrangements for protecting residents doesn’t always make sure that residents are protected from risk of abuse as far as possible. EVIDENCE: The home’s complaints record was looked at. There is a form used by care homes to record any complaints although it wasn’t clear if this was being used. Two complaints were recorded since the last inspection, one of which (about a resident’s behaviour) the inspector was aware of. The other was about missing laundry. Records showed that complaints were dealt with and proper actions taken. No complaints were seen recorded in the home’s communication book. The inspector had been involved with three adult protection plan meetings following incidents of alleged abuse and had been given full information by the manager about the issues. The manager and staff had acted properly to protect the residents involved and relatives expressed satisfaction at the way the home had dealt with the incidents. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 20 However for the resident with severe dementia the inspector found evidence in daily records that this person was being physically hurt by other service users. The manager was unaware of this and immediately contacted the social work team manager to arrange a Safeguarding Vulnerable Adults meeting. A review meeting was held that the inspector attended. However actions agreed at this meeting to protect the service user weren’t fully put in place. This failed to make sure the service user was protected from harm and her/his behaviour didn’t impact on others. Please also see standard 29 that gives information about further concerns regarding the protection of residents. Broomhill DS0000035843.V300395.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 at least once during a 12 month period. 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 the service. Although residents’ benefit from living in comfortable, clean and fresh smelling accommodation that is well looked after, the home isn’t designed to meet the needs of people with dementia. EVIDENCE: All areas of the home were clean and nicely decorated. It was clear efforts had been made to make each resident’s room homely and attractive and all were decorated differently. Individual personal items of furniture were seen that made the rooms more unique to the resident living there. The home is laid out over three floors and there are lounges and bedrooms on each. Lounges are spacious and well furnished and some are underused, as most residents prefer to spend time in their own rooms. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 22 However the way the home is laid out doesn’t meet the needs of people with dementia particularly with respect to stairs. Please see standard 38 that gives information about the lack of staircase safety. All furniture seen was in a good state of repair and fabric and all were clean. From the team manager’s visit report dated 24 January ’07 it was noted that repairs and refurbishment is continuing including repairs to the lift and replacement of hall carpeting. A requirement about cleaning of bath equipment was met. The underside of a chair to help people in and out of baths was examined and found to be much cleaner than before although another in a bathroom that wasn’t being used was not clean. However this chair wasn’t being used. The home’s own survey scored the environment at 94 satisfaction and residents commented that they felt secure. Broomhill DS0000035843.V300395.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Recruitment of a number of casual staff has eased the staffing situation within the home and gives residents consistent care. Continuing progress with National Vocational Qualification in Care training is needed to make sure residents are well looked after. Procedures used to recruit casual staff are not well managed and fail to make sure residents are protected. All new staff need basic training particularly in moving and handling, within a short time of starting work. Arrangements for training in protecting residents from abuse must be improved to make sure all residents are protected from risk of harm or abuse. EVIDENCE: The pre-inspection questionnaire and care staff rotas were looked at. These showed that on average three care staff are on duty each morning and three in the afternoons and evenings. Three were on duty on the first day of this inspection and said that they don’t feel there are enough care staff to cope with the dependency levels of current residents. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 24 Of particular concern to staff were the residents with dementia. The manager said that there was enough staffing at the time of this visit as several residents were in hospital, but with a full number of residents more staff were needed. The manager had taken the initiative to recruit five casual staff that were able to come in at short notice and cover for sick leave etc. This had had the effect of not only saving money but giving residents more regular care from the same people who are committed to working for them rather than reliance on agency staff. It was noted that these casual staff had been recruited in September/October /06. However not all staff records are kept at the home as all paperwork is sent to the City Council’s personnel department. The inspector therefore visited there on a separate day to look at documents relating to these staff. It was found that all five staff had been recruited without an essential part of the proper safety checks done by the Criminal Records Bureau that is necessary before any staff member can start work. This check matches names of any staff member against a Protection of Vulnerable Adults list (‘Povafirst’ of people known to be unsafe to work with vulnerable people). The manager said that she had sought advice and clearance to start the new staff members without the check and senior managers in Adult Community Care had granted this. However none of the staff had received their Criminal Records Bureau disclosures until January 2007 and for two of them no disclosure had been received at all. All had started work without the essential Povafirst check having been obtained. Information from application forms showed that a safe recruitment procedure had not been followed. A negative comment in one reference needed to be followed up but the staff member had just been asked about the matter and the referee had not been contacted. A handwritten reference on plain paper that was assumed to come from a teaching professional had not been followed up to verify that it was in fact a true reference. None of the five staff had any induction or supervision records so that it wasn’t clear what basic information and training they had been given. The manager showed that all of them were booked to do moving and handling training in February ’07 – four months after they had started working. Because of these findings residents aren’t protected by properly recruited, inducted and supervised staff. It was noted from the team manager’s report that the ‘National Vocational Qualification in Care pilot is going well’. Four staff are doing NVQ and two of the three staff spoken with had done it. The total number of care staff with the qualification is five out of sixteen. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 25 However the home is not yet meeting the recommended minimum of 50 of care staff with Level 2. One staff member said she had enjoyed doing the training and would like to go on to do more. All three staff said they had been given copies of the General Social Care Council Code of Practice. Staff training records were looked at. Training included: fire safety, moving and handling, basic food hygiene, effective recording and some mental health. However, from looking at staff training records at least eight staff (including some night care staff) had no record of any safeguarding adults training or none within the last three years. None of the casual staff recently recruited had been booked on any safeguarding adults training and no record was available to show whether this had been discussed as part of their induction. Although the home has a number of residents with varying degrees of dementia, there was very little evidence of training on the subject. The manager said that community mental health nurses from the local In-reach team (that supports care of residents with mental health problems), visit regularly to give advice and short sessions on behaviour management. Broomhill DS0000035843.V300395.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Whilst the manager has received training and has been in post for a significant period she has failed to keep up to date with regulations – particularly those relating to admission of residents and safeguarding adults through clear and proper recruitment processes. Residents and their relatives have regular opportunities to comment on life at the home and their satisfaction with it. Residents’ finances are well managed that makes sure they are protected from financial abuse. Staff don’t get full opportunities through regular supervision to reflect on their working practices. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 27 Residents’ health and safety isn’t fully managed to make sure they are kept safe from harm. EVIDENCE: The registered manager Mrs Penny Fry, is experienced and trained to National Vocational Qualification in Care Level 4 and holds the Registered Managers Award. Mrs Fry was welcoming and open to the inspection process. Mrs Fry said that she kept up her training and showed that she had done fire safety, budget training and medication refresher training recently and was about to do training in dealing with hazards. However Mrs Fry was unaware of essential information under the Care Homes regulations about the recruitment of staff that meant residents were put at risk. She has also accepted residents into the home whose care needs can’t be properly met and for whom the home isn’t registered. It is however accepted that Mrs Fry didn’t receive the support she needed from senior managers when trying to deal with these situations. The home benefits from having yearly quality assurance surveys done by an independent organisation. A copy of the latest survey was sent to the Commission and has been commented on elsewhere in this report. Residents and their relatives scored all aspects of the home very highly. Satisfaction levels ranged from 86 –96 out of 100 . A check of residents’ cash was done. A number of cash sheets were looked at and amounts checked. All were found to be right with no errors. The manager said that all residents were getting their personal cash allowances regularly and this is discussed with relatives at six monthly reviews. Staff supervision records were looked at. From these it was clear that staff have a yearly review of their work done with a manager. Staff confirmed this and said they feel that they get supervision three-monthly. However records showed lots of differences with the level of supervision and the number of sessions recorded. These ranged from between 2 and 5 sessions a year. (Please also see standard 29 about casual staff supervision). A requirement made at the last visit about water temperature in the visitors’ toilet had been met. This toilet is situated close to the dining room and is open to residents to use also. The hand basin water temperature was close to 43°c at this visit so that no one would be scalded when using it. Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 28 Notices are sent to the Commission under regulation about accidents or any events that affect residents. Recent notices showed that residents with mental health problems or dementia, using the staircases, had had serious accidents and continued to be at risk from further accidents. Because of the number of residents with dementia this risk is increased. A newly developed risk assessment had been done following one serious incident. However this didn’t go far enough to show how residents would be protected from harm and didn’t have an action plan about additional precautions to put in place. Further, the overall risk level was too low given the seriousness of the accident that had already happened. From the team manager’s visit report it was noted that notices had been put on stairways to warn residents of the danger. However these may not be suitable for either people with dementia whose awareness is limited or sight impaired residents. It wasn’t clear what other actions were being taken i.e. by use of keypads, or seeking advice from the Health and Safety Executive to make sure residents are protected from harm. All staff have training in fire safety, first aid and Control of Substances Hazardous to Health. Several staff have first aid certificates. The home has a regular programme of fire safety checks regularly carried out by the gardener/handyperson. Records showed that checks and fire drills were being done regularly. From the residents meeting minutes residents were reminded about fire safety procedures, health and safety and security of the home. This is good practice. Broomhill DS0000035843.V300395.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 X X 1 1 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 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 1 Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 14 (1) (c) Timescale for action The registered person shall not 31/03/07 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so and there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. (The manager must assess prospective residents to make sure the home is suitable to meet the needs of individual residents and to stay within the boundaries of registration). The registered person shall not 31/03/07 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so and the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of health and welfare. DS0000035843.V300395.R01.S.doc Version 5.2 Page 31 Requirement 2. OP7 14(1)(2) Broomhill 3. OP8 13 (4)(c) (Care plans must be amended to make it absolutely clear when signing them that each resident’s’ needs can be met). The registered person shall 31/03/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Where a history or risk of falls is apparent on admission a clear and specific risk assessment must be put in place to show how the risk will be managed and reduced). The registered person shall 01/03/07 make arrangements for the recording handling, safekeeping, safe administration and disposal of medicines received into the care home. (Where controlled medication is administered to any resident this must be checked by two staff and their signatures must be recorded on the Medication Administration Sheet) The registered person shall make arrangements by training staff or other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 4. OP9 13(2) 5. OP18 OP33 13(6) 15/03/07 6. OP29 19(1)(b) (The manager must take action to report any suspicion of abuse of a resident or any event that shows abuse has taken place, to the relevant authority) The registered person shall not 31/03/07 employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule DS0000035843.V300395.R01.S.doc Version 5.2 Page 32 Broomhill 2. (Criminal Records Bureau clearance must be obtained for any staff member before they start work at the home, in either a casual or permanent capacity.) (References must be followed up properly where there is doubt about a person’s fitness for the post) The registered person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users: Ensure that the persons employed by the registered person to work at the home receive training appropriate to the work they are to perform. 7. OP30 18(1)(c)(i) 31/03/07 8. OP36 18(2) 1. Casual staff must have the same induction and basic training as permanent staff as soon as possible on starting work 2. All staff must have safeguarding adults training following recruitment and at regular intervals following. 3. Training in dementia awareness and care must be given to staff by a recognised training organisation The registered person shall 31/03/07 ensure that persons working at the care home are appropriately supervised. (Supervision of all care staff must take place at the frequency as set out in the home’s own policy) Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 33 9. OP38 13(4)(a) The registered person shall 31/03/07 ensure that all parts of the home to which service users have access are so far as reasonably practicable, free from hazards to their safety. (Advice must be sought from the appropriate health and safety agency on ways to make the staircases in the home safe particularly for people with dementia) 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. 2. Refer to Standard OP7 OP12 Good Practice Recommendations Where teeth care is identified as part of the care plan, staff should record what actions they take to ensure that this need is properly met. Consideration should be given to doing suitable activities for people with dementia so that they have the same opportunities as other residents. This should be included in individual care plans. Where residents have requested religious services staff should make every effort to ensure this need is met at the home. Where residents are vegetarian cooks should be made aware of this and their needs should be met by preparation of a clear and properly prepared vegetarian choice at each meal. Menus should also regularly show a vegetarian choice. The manager or a member of the management team should regularly check daily records particularly where residents are most vulnerable and at risk of abuse 3. 4. OP13 OP15 5. OP18 Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broomhill DS0000035843.V300395.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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