Inspection on 20/12/06 for Broomhill Lodge

This inspection was carried out on 20th December 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broomhill Lodge 23/02/06

Broomhill Lodge 03/11/05

Broomhill Lodge 10/03/05

Broomhill Lodge 27/01/05

Broomhill Lodge 04/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Broomhill Lodge 1 Broomhill Road Goodmayes Ilford Essex IG3 9SH Lead Inspector Stanley Phipps Key Unannounced Inspection 20th December 2006 to 29th January 2007 04:00 Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 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 Lodge DS0000025889.V325077.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 Adults 18-65. 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 Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomhill Lodge Address 1 Broomhill Road Goodmayes Ilford Essex IG3 9SH 0208 590 3427 0208 590 4308 Jon@roselock.com 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) Mrs Pamela Philp Mr. Alan Philp Mr John McGillick Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Moderate to high level of disability. Date of last inspection 23rd February 2006 Brief Description of the Service: Broomhill Lodge is a residential care home for eight younger adults, both male and female with a learning disability. The home is run by Alpam Homes, an organisation with a number of other similar schemes in which the service users may exhibit various forms of challenging behaviour. The building is situated in a residential street close to public transport and other local amenities. All bedrooms are single with all other facilities - shared. There is a large garden to the rear of the property and the premises are furnished in a way that values homely living. There are parking spaces to the front of the building as well as street parking to the front, which is not currently a controlled parking zone. The organisation also runs a day centre (Highview House) that is regularly attended by service users from the homes in the group. Broomhill Lodge is staffed on a twenty-four hour basis to ensure that service users needs are met as and when required. A statement of purpose is made available to all service users in the home and is kept in the main office. This document is also made available to relatives and stakeholders, as they may be important in referring service users to the home. A service user guide is also given to each service user upon admission to the home. Fees start from £1,100.00 per week and may vary dependent on individual levels of need. Fees are charged extra for personal effects, which are variable. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning at 16.00 p.m. on the 20/12/06 and ended on the 29/01/07, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff, service users and relatives, where possible. The inspection found that the service was generally managed with service users at the heart of its operations. Both the management and staff worked closely with individuals to ensure that they enjoyed good quality living at Broomhill Lodge. All service users were happy throughout the course of the inspection and were observed positively engaging with staff. It must be stated service users do have a real presence in the home and their community, and there was always a buzz of excitement in the home. While some improvement was noted since the last inspection, there were a few areas that had not been complied with, and they are repeated in this report. The registered persons are required to ensure that all requirements are complied with, as failing to meet requirements may adversely impact upon the health, safety and well being of service users. In this respect the Commission would pursue enforcement action to achieve compliance. Further areas for improvement are also outlined later in this report. As part of the inspection a number of records were assessed and they included; up to four service users files, two staff files, health and safety records, menus, risk assessments, the accident/incidents log, complaints, the staffing roster and the policy and procedures file. The inspection also considered verbal feedback received from external professionals, relatives, service users and individual members of the staff team. A tour of the environment was undertaken during the course of the inspection. What the service does well: Broomhill Lodge continues to provide a homely environment for service users living there. Their choice, independence, and interests are promoted to full capacity. This is empowering given their disabilities and in this respect their social, personal and healthcare needs are safely provided for in the community. The staff continued to show commitment in working closely with individuals in enabling to maximise their full potential. Despite leading a structured life service users enjoy flexibility in what they do. Staff also work positively on Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 6 developing service user’s strengths which has a positive impact on outcomes for service users. As a consequence service users develop confidence, which helps them to improve their weaknesses. Positive links are maintained with families and friends to ensure that service users maintain a positive outlook on life. The staff team is particularly good at showcasing the creative work of service users in the dining lounge in units designed for this purpose. This gives service users a true sense of ownership with regards to their home and creates a buzz in the environment. The registered persons continue to regularly monitor the home as required by regulation – on a monthly basis. Advice has been given to improve on the detail contained in the reports arising from these visits so that they could become a more effective monitoring tool. What has improved since the last inspection? What they could do better: Ensure that an accurate record of drugs coming into the home – is maintained at all times. Use an alternative area other that the service users’ lounge for sleeping-in duties. Ensure that the recruitment practices are robust at all times. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 7 Carry out an internal audit and have in place an annual development plan for the service. Undertake risk assessments for safe working practice topics as outlined by standard 42.6 of the National Minimum Standards for Younger Adults. Provide formal supervision for the registered manager as well as carry out an annual appraisal as required by NMS 43 (3)(iii) for Younger Adults. 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 Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (2,3) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process assures service users that their needs would be identified to determine their suitability for living at Broomhill Lodge. This is enhanced by the proactive involvement of the registered manager in this process. EVIDENCE: There were no admissions to the home since the last inspection. However, assessments were being carried out involving the registered manager and this would ensure that service users needs are closely assessed in relation to the home’s statement of purpose. It would also ensure greater compatibility of service users living there. Most of the current service users are quite established and stable in the home and it is particularly important that admissions to the home are thoroughly screened by someone with a good understanding of both the needs service user group and that of prospective service users. Detailed assessments remained on the files of all service users currently living in the home. They were carried out in conjunction with service users and the placement authorities and remains key to determining the suitability of the home for meeting the needs and aspirations of service users. The home’s admissions procedure generally, remains sound. It was positive to see that the manager had followed up on information that was not provided previously for one individual. This meant that the home now had a better understanding of the individual’s needs and was in a better position to provide for them. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6,7,9) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and choices are now fully documented in their service user plans. This improves the opportunities for them to be met. They are encouraged to make decisions about their life, within a risk management framework. In doing so, service users live at Broomhill Lodge are supported to enjoy an independent lifestyle, within their individual capabilities. EVIDENCE: All service user plans assessed, detailed the needs of the service users concerned, and this included their changing needs. They also reflected the choices made by service users, which demonstrated their involvement in it. There was an improvement in one case in which the medical needs of an individual were obtained as requested and this was integrated into his service user’s plan. Staff were better able to support this individual and there was evidence that he had made good progress in the home. In speaking with a social care professional she indicated that staff had ‘a good grasp of the service users needs’. Service user’s needs would be even more identified and provided for in the near future, as the registered persons were embarking upon person–centred planning. This would be a positive outcome for them. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 11 A key worker system is in place at the home and service users spoken to knew their key workers by name. The key workers conduct a six-monthly review of their individual cases and this is quite detailed, monitoring the progress and objectives for each individual. Some of the areas covered included social, medical and medical appointments, leisure, behaviour and incidents. It was noted that most of these reviews were of a good standard. Annual reviews were also carried out involving external professionals and the day care staff were involved through either reporting on day care activity or by attending in some cases. It was noted that a few of the annual reviews were outstanding and this was due to getting the involvement of social workers. The registered manager was however working on this. All service users spoken to reported that they enjoyed making decisions about their lives. One individual informed that he gets to choose what he wants to eat and what he does at day care. He then went on to show a piece of his pottery work that was on display in the home, of which he was quite proud. Another attends the Eastway Care Ltd, independently up to five days per week and in discussion with him he was happy to be doing that. Service users are given information in several forums to enable them to choose how they live. They included; monthly service user meetings where holidays, activities and issues like day care are discussed, individual reviews, letters and leaflets placed on their notice board. Key workers were instrumental in providing information to service users to support them in decision-making in the home. Although information is widely available, service users did not take up advocacy services at the time of the inspection. However, relatives acted as advocates in most cases, on matters affecting the welfare of service users and this included, their finances. As part of promoting a safe environment and service user independence, risk assessments were in place for the seven service users living in the home. They were updated and developed within the risk management framework of the home. Risk assessments were individually undertaken, taking into consideration the aspirations, skills and abilities of each service user. They are used in a positive manner in minimising risks and it was clear from the low level of accidents and/or incidents occurring in the home, that they served the best interests of the individuals living there. It was also evident that service users get out and about quite regularly and are encouraged to maintain their independence in all aspects of their lives. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,15,16,17) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from being well engaged in activities they choose and generally enjoy. They are actively involved with their community and this is complimented by strong links that are maintained with their relatives. The management and staff promote both the individuality and, rights of service users living at Broomhill Lodge. Meals are generally of a good standard and meet the nutritional requirements of individuals in the home. EVIDENCE: There was evidence that the management and staff worked with service users in supporting them to take part in activities on an individual basis. Each service user has a programme of activity and this is based on choice, ability, interest and cultural preferences. A good example of the choice provided, is where one service user has been supported to continue with the activities at a day centre in Leytonstone, which he attended prior to moving into Broomhill Lodge. He informed that he plays five-a–side football - that he is passionate about, computers and does swimming. Staff work well in keeping him motivated to keep up with his programme and this is positive. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 13 Other service users also have a programme that they participate in, and this involves a mixture of social, leisure and skill development e.g. arts and craft. Most service users spoken to, informed that they are pleased with their activities and this could be evidenced by the confidence and pride they placed in their individual achievements, most of which are displayed in the home. During a staff interview it was noted that one individual had the experience of ice-skating on two occasions in 2006, which he enjoyed. Activities like music and movement provided in day care, also create a sense of relaxation and leisure for individuals choosing to have that experience. Service users were observed enjoying a game of pool in the home and it was clear that some individuals were very passionate about the sport. One service user has his personal cue for example and is always up for a challenge. Another was participating in a Drama play – ‘The Wizard of Oz’ and had his script for rehearsal. He was quite proud with his involvement and this is positive. It was noted at the time of the inspection that none of the service users were actively pursuing a religious pathway and this was determined through individual choice. They are however given opportunities to pursue their religion, regardless of faith. This is a strong area of the homes operations. Service users get out quite frequently at Broomhill Lodge and up to three individuals go to the local shops independently. Others go out with support and they are all, well established in the community in which they live. They go out for magazines, snacks and indeed their personal shopping. At the time of the visit one individual went shopping for a pair of trainers and another for clothing with staffing support. In total, five were out shopping on the day. They also use the leisure facilities, the bank, and get out to evening clubs quite regularly. In fact they lead quite a packed lifestyle and in many respects, when indoors tend to relax or engage with a game of pool or watch television. This is a strong area of the homes operations and this was also confirmed in feedback received from relatives and external professionals. There was good evidence to confirm that the service users’ relatives were an integral part of their individual lifestyles. This included involvement in planning outcomes for them with regard to their health, personal, spiritual, physical and social development. Service users get to meet with their relatives either at the home or they may go away and spend time with loved ones either on a regular basis or on special occasions. Service uses go away at Christmas, weekends for birthdays and various, but for individual reasons. In one case the relationship between a service user and his mother has been noted as improving and work is ongoing between the staff and the individuals concerned. The value placed on maintaining family relationships is quite high and service users are assured that the management and staff would work in their best interests to preserve valuable relationships. An example of this is Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 14 where staff took service users out over the Christmas to buy gifts for their relatives. Another example is where a service user is supported to make telephone contact with his sister in Australia, and it is known that they exchange gifts, which is really positive. Staff also support service users to maintain friendships that they enjoy. One service user enjoys meeting his friend at an evening club and this is viewed as a positive experience for that individual. All service users spoken to, enjoy the links that are made with their relatives and friends, which is positive. Relatives spoken to informed that they are always made to feel welcome at the home. This is a strong area of the home’s operations. One member of staff was interviewed and in discussions held with others, they were aware of the General Social Care Council’s code of conduct in promoting the rights of service users. Staff were observed addressing service users by preferred names, knocking on their doors before entering their private spaces and generally providing individualised care. In most cases service users’ relatives advocate on their behalf, but the registered manager has identified ‘Daffodils’ to provide advocacy services to those that might need it. At the time of the inspection service users were not accessing advocacy services. Service users expressed a high level of satisfaction with the facilities were confident about using both the private and communal spaces in the home. Meals and menus were assessed over a four-week period and were nutritionally balanced, taking into consideration the individual and cultural preferences of service users. In conversation with one service user he commented; “I like fish and chips and it is usually on the menu”. Another commented; “the food is great and we get to choose what we want”. Choices were determined at service user meetings, but there was evidence of a flexible approach being used – should a service wish for something else, other than what was on the menu. On the first day of the inspection, the evening meal (pasta &cheese with mixed vegetables) was provided in a relaxed atmosphere with some light background music. All service users looked pleased with proceedings on the day. It was noted that healthier eating options were available to service users e.g. low fat milk, brown bread and a fresh supply of fruit was available to service users. From examining service user’s records there was evidence that staff were monitoring service users healthcare in relation to their dietary requirements. This involved monitoring individual weights, providing guidance on food where required and, liaising with external professionals if the need arises. A good supply of food was available, which was found appropriately stored to preserve its nutritional value. Staff handling food, were aware of the cultural needs of service users and as such provided meals that was consistent with the nutritional needs of service users. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy personal support in accordance with their needs and wishes and the staff team is proactive in ensuring that both their physical and emotional needs are met. Generally, medication practices in the home ensure the safety of service users requiring support with medication. However, improvement is required in recording drugs used in the home. EVIDENCE: Service users follow their individual plan and are encouraged to work with staff in providing personal support to them. This is important as the range of special needs of the service user group is quite varied and as such, would be best provided in line with the preferences of each individual. The staffing deployment continued to take full account of this and every effort is made while providing support to promote and maintain service user’s independence. Service users wear their own clothes and have their individual and distinct way of dressing. It must be stated that service users are always well presented regardless of the event or occasion. Discussions held with service users and staff indicated that they (service users) were pleased with the how personal support was provided in the home. Feedback from relatives and external professionals indicated that the staff were flexible and preserved the dignity of individuals living in the home. The Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 16 key-worker system is used to ensure the monitoring and coordination of outcomes for service users. Despite the varying levels of service users’ abilities, levels of confidence and self-esteem were quite high across the board and this is positive. All service users were registered with a GP and detailed records were held on visits made to, and by, health professionals. This included the use of dentists, the psychiatrist, opticians and the chiropodist. Records viewed outlined the actions taken by staff following an epileptic fit and from the actions taken; the individual’s safety was promoted. There was also evidence that a psychologist is involved in supporting an individual, and ongoing work is required. The registered manager is instrumental in ensuring that this is followed through, as there was recognition that this type of specialist input is required. Staff interviewed showed a good understanding of the needs of service users, and were also quite knowledgeable about the needs of individuals that they were key working. They are therefore able to identify when service users’ health is deteriorating and are able to make appropriate interventions. In so doing they work well with the GP, the psychiatrist and at times the community learning disability nurse. The registered manager confirmed that the psychiatrist is usually responsive, when staff are in need of direction and advice regarding the specialist needs of service users. Records on health interventions were very detailed, accurate and updated. This is positive. Medication practice was observed and an assessment of the drug storage and record – undertaken. The staff responsible for medication referred to the drug charts and discharged their responsibilities in a satisfactory manner. None of the service users were capable of self-medicating and so they rely upon the staff to carry out this responsibility in a safe manner. This is important as it ensures that their health and welfare is promoted and protected. A satisfactory medication policy and procedure was in place in the home and staff were aware of it. From assessing the training records it was observed that all staff with the responsibility for administering drugs have been provided with training in medication. As such, the recording and storage of drugs was in the main- satisfactory. However, there was some difficulty in determining what quantities of drugs were in stock, when assessing what had been used. It was observed that the quantities of drugs coming into the home were not always recorded. This must improve to ensure that a clear an accurate audit trail can be carried of all drugs used in the home. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints policy and procedure is available for the benefit of service users and their relatives. Sound procedures were also in place at the home to ensure the protection of service users living at Broomhill Lodge. EVIDENCE: The complaints procedure was updated and remains available on the notice board. Most of the service users are able to voice their unhappiness with their experience of the service, while others may rely upon their relatives or significant others to assist them. For those who are able to, they stated that they would complain, if they were unhappy with something in the home. From interviews with staff, they viewed complaints as a positive feature in promoting the rights of service users. Relatives spoken to informed that they are happy to raise any concerns they had with the manager. At the time of the inspection there were no complaints on record. A satisfactory adult protection procedure remained in place at the home and this includes clear guidance on ‘whistle-blowing’. The local authority’s adult protection protocol was in place at the home for the benefit of staff. Most of the staff team had training on adult protection and from interviews held with a random sample- they understood their responsibility in protecting vulnerable adults. There were no adult protection issues in the home. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24,26,28,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally enjoy living in a comfortable and safe environment, one that is homely and fit for its purpose. This includes; the communal and private spaces as well as the toilets and bathing facilities. More appropriate arrangements are required for staff doing sleeping in duties at the home. EVIDENCE: During the course of the inspection the home was clean, bright and airy with furnishings and fittings that were homely and maintained in a good state of repair. Its location is ideal to local amenities and all service users were observed accessing the building with great ease. Each of the service users spoken to expressed their happiness with living there. Feedback received from relatives and external professionals was quite positive with regard to the quality of the accommodation. Pictures including those from service users’ holidays adorned the hallways to add to the warmth and homeliness of the environment. The lighting, heating and ventilation was satisfactory and there was evidence that the home was maintained in line with the requirements of the local fire, public protection and, health and safety agencies. There is a good system in Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 19 place for reporting repairs and a dedicated member of staff carries out routine maintenance in the home. Adequate arrangements were also in place for the refurbishment and redecoration of the home. At Broomhill Lodge service users are very excited about their bedrooms, which were personalised to individual choice and interests. As such they are very forthcoming in showing off their rooms and on this visit, up to four rooms were examined. They were of a very good standard including the furnishings, although plans were in place to deep clean the carpets in one of the rooms. One of the bedrooms viewed, had an amazing collection of warplanes that were beautifully displayed in a cabinet and around the room. The service user concerned had an interest in that area and was encouraged to develop it. All service users confirmed that they were allowed a choice in decorating their rooms and each of the rooms was well coordinated. This is a strong area of the home’s operations. There are adequate communal spaces throughout the home and this includes, a separate dining and longing facility, which also contains a pool table for recreational purposes. Service users also have access to a beautifully landscaped garden that is designed to safely undertake outdoor activities. The kitchen and laundry is domestic in scale and well maintained. Service users can receive visitors in their private spaces, in one of the lounges or in the office if required. The home also has the capacity to facilitate sleeping-in staff. At the moment however, this is done in the communal lounge in the area of the pool table and this practice fails to comply with National Minimum Standard 28.3 and Regulation 23(3)(b) of the Care Homes Regulations 2001. This was discussed with the registered manager and it was reported that staff felt safer and closer to service users, should they need support at night. Whilst this is acknowledged the inspector pointed out other risks e.g. staff expecting service users to go to bed at a particular time, staff sleeping in the lounge may seen as something normal even when on the day duty, a lack of privacy and safety for the staff – most of whom are females. There is no doubt that the staff are generally creative and flexible in meeting the needs of service users. Apart from using the service users lounge as their sleep-in facility, the risks outlined combined with the regulatory requirement outweighs the benefits and as such, alternative arrangements must be made for sleep-in duties. The laundry area is situated outside to the rear of the building and it was generally satisfactory and in a good condition. The floor surfaces were also satisfactory and the equipment is suitable for ensuring infection control in the home. Hand washing facilities were placed throughout the home and this is useful in promoting hygienic practices. Policies and procedures are in place to Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 20 ensure the safe management of spillages, dealing with soiled laundry and generally guiding staff in relation to infection control. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (32,34,35,36) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. At Broomhill Lodge service users receive care and support from a dedicated and effective staff team. Improvement in the recruitment procedures would ensure that service users are safer. A focussed approach is in place to improve the skills and expertise of staff. Improved supervision for staff provides sound direction and this would be enhanced once the staffing appraisals are completed. EVIDENCE: At the time of the inspection sixty per cent of the staff team had achieved their NVQ level 2 Award in Care. One had started the NVQ level 3 with at one other recently starting their level 2. Service users were therefore benefiting from being supported by staff that had a good understanding of basic care. What was promising is that staff were keen to improve their skills and knowledge and service users were observed positively engaging with the staff at all times. From interviews and discussions held with staff – they demonstrated a sound knowledge of the service users’ needs and the service aims. They were creative in communicating with service users and worked positively with service users strengths, while developing their weaknesses. An assessment of the service users’ records indicated that staff were capable of working with the multiple and individual needs of service users. They also worked well with external professionals in providing care and support to the service user group. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 22 The recruitment files were examined for two staff and it was clear that some aspects of the process were better than others. Criminal Reference Bureau Checks were carried out for both individuals as required by regulation. However, gaps in employment for one individual were not explored and this suggests that the process was not robust, as it needs to be. References taken up in this case were non-employment references and again the rationale for this is unclear. A passport photograph was not held on file as required by regulation. The registered persons need to ensure that the recruitment of staff is robust to ensure that staff working with vulnerable adults, are fit to so do. A training plan was in place for the staff team and there was evidence that staff were receiving training in line with the service aims. All staff were in receipt of a structured induction that was in line with current guidance. One of the areas discussed with the manager is that of equality and diversity, and he advised that this is being looked into. He also advised that they have started with person centred planning following training, and were in the process of doing the assessments on service users. From assessing the service users, speaking with them and their relatives, as well as external professionals, staff were capable of providing good quality care to the service user group. The support systems for staff were improved as formal supervision had been more frequently carried out. Staff interviewed felt that the supervision sessions were effective in helping to promote personal and professional development and in providing guidance. Service users benefit from this, as staff performance is monitored in line with the philosophy of the service. Although appraisals were not completed, the process had started, as staff were given their evaluation forms to fill out and return to the registered manager. Plans were in place to get them started imminently. This would be monitored at the next inspection along with the impact on the service as a whole. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39,42,43) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good management systems are in place at Broomhill Lodge to promote welfare and best interests of service users. This includes the regular monthly monitoring of the service. The quality of the service could be enhanced by; carrying out an internal audit of the service, providing formal supervision for the registered manager and carrying risk assessments in line with standard 42.6 of the National Minimum Standards for Younger Adults. EVIDENCE: The registered manager continued to work closely with service users, their relatives, the staff team and external professionals in providing good quality care at Broomhill Lodge. He has kept up his interest in the service and has started his NVQ Level 4 in Management training in September 2006. This would further consolidate previous learning and experience that would go towards improving the service. He continues to attend the quarterly management forum that is chaired by his manager and this is useful in maintaining good standards of care in the home. Staff were of the view that he Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 24 provided a clear sense of leadership as part of his responsibility. This is positive. It was noted that a service user survey had been carried and the results were made available to the inspector. Monthly providers visits were also taking place regularly and the registered persons were following up issues as they were identified. Service user’s development is monitored six-monthly at internal reviews and at annual reviews. The views of stakeholders are also elicited in a similar forum. In speaking with one professional she stated; “it is a very good service. Service users are stable, they access lots of activities and the staffing are at the right levels”. Policies and procedures were reviewed and available to staff. However, the registered persons need to carry out an internal audit of the service at least annually (Standard 39.3) and have in place an annual development plan for the home (Standard 39.2). Health and safety in the home has been generally satisfactory with updated records in place. Staff were in receipt of health and safety training and demonstrated an understanding of the principles in maintaining a safe environment at Broomhill Lodge. Portable appliance and Legionalla tests were carried out. Risk assessments regarding health and safety were reviewed and appropriate certificates for the gas, electric and fire equipment were in place. However, there was one area requiring improvement and it was in relation to carrying out risk assessments on safe working practice topics i.e. manual handling, fire safety, first aid, food hygiene and infection control. This is to ensure that any action required to promote safety is identified and acted upon. At the previous inspection a requirement was made for the registered manager to have formal supervision and an annual appraisal. This has not been complied with on the evidence provided at this inspection. As such, it would be repeated with a revised timescale. It is imperative that this is carried out to ensure that support, development and guidance is provided to the individual concerned. It was observed that insurance for the service, meets the minimum requirements set by this standard. A business and financial plan was not requested at this inspection, but would be looked at in the next inspection. In concluding the registered persons need to ensure that every effort is made to comply with requirements made previously, as the Commission may pursue enforcement action to achieve compliance. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 2 2 Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 26 YES Are there any outstanding requirements from the last inspection? 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. 2. Standard YA20 YA28 Regulation 13 & 17(1)(a) 23(3)(b) Requirement Timescale for action 15/04/07 3. YA34 19(4) 4. YA39 24(1) 5. YA42 13 The registered manager must keep an accurate record of all drugs used in the home. The registered persons are to 30/04/07 ensure the current practice of using the service users lounge for sleeping–in staff - ceases and; that appropriate and alternative arrangements are made for sleeping duties. The registered persons are 30/04/07 required to ensure that robust recruitment practices are carried out at all times in relation to; exploring gaps in employment, taking up references in line with Schedule 2(3) of the Care Homes regulations 2001 and having proof of identity – i.e. a recent photograph on file for staff. The registered persons are 30/04/07 required to; carry an internal audit of the service and, have an annual development plan for the home. The registered persons are 30/04/07 required to carry out risk assessments on the safe working practice topics in standard 42.2 of the National Minimum DS0000025889.V325077.R01.S.doc Version 5.2 Page 27 Broomhill Lodge Standards for younger Adults. 6. YA43 18(2)(b) The registered persons are required to provide regular formal supervision and an annual appraisal for the registered manager in line with standard 43.3 of the National Minimum Standards for Younger Adults. This requirement was previously made with the timescale – 31/07/06. 30/04/07 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 YA37 Good Practice Recommendations The registered persons should provide an action plan to the Commission indicating the steps planned for the registered manager to achieve his NVQ Level $ in care Award. Broomhill Lodge DS0000025889.V325077.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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