Inspection on 26/09/06 for Broomhills

This inspection was carried out on 26th September 2006.

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

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

Other inspections for this house

Broomhills 02/04/09

Broomhills 07/04/08

Broomhills 25/04/07

Broomhills 05/01/06

Broomhills 10/08/05

Broomhills 18/03/05

Broomhills 12/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Broomhills Stambridge Road Rochford Essex SS4 2AQ Lead Inspector Ms Vicky Dutton & Ann Davey Unannounced Inspection 26th September 2006 08:00 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 Broomhills DS0000018040.V313542.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. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomhills Address Stambridge Road Rochford Essex SS4 2AQ 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) 01702 542630 01702 542553 www.runwoodhomecare.com Runwood Homes Plc Manager post vacant Care Home 47 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (47) of places Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 47 persons of either sex to be accommodated who are over 65 years of age. Up to 23 persons of either sex to be accommodated who are over 65 years of age and who have dementia. No more than 47 persons to be accommodated at any one time. Date of last inspection 5th January 2006 Brief Description of the Service: Broomhills is registered to provide personal care and accommodation for 47 elderly people, included in this number the home can provide accommodation for up to 23 service users who have dementia. The original house is a 100year-old building of character. There are 37 single and 5 double rooms, most with en suite facilities. The home is currently using 3 of the five shared rooms as single accommodation. There is a choice of lounges and a separate dining room. There is an activities room in part of the basement. Accommodation is provided on 3 floors and all areas can be accessed by the way of 2 passenger lifts. Broomhills is set in 3 acres of grounds. Local facilities are a mile and a half away in the town of Rochford. The home have a statement of purpose and service users guide in place. These are currently being reviewed to reflect changes in local management and to make the service users guide more ‘user friendly’. A copy of the most recent inspection report was available and on display in the home. In a questionnaire completed by the home in May this year, and confirmed at the site visit, fees at the home were quoted as being from £357.00 to £550.00 per week. Additional charges are made for chiropody, newspapers, toiletries and some transport costs. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The inspection was undertaken over a nine hour period. As two inspectors were present this equated to eighteen hours of input. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. A partial tour of the premises took place, care, staff, and other records and documentation were selected at random and various elements of these assessed. A notice was displayed in the home advising all visitors that an inspection site visit was taking place with an open invitation to speak with an inspector. During the site visit residents, relatives, one visiting professional and some of the homes staff were spoken with. As part of this key inspection questionnaires were sent out in the post to relatives and health and social care professionals. Staff and residents surveys were left at the home to be completed by any who wished to do so. The views expressed at the site visit and survey responses have been incorporated into this report. Present at the site visit was the acting manager and a registered manager from another of the group’s homes. Two other managers from Runwood Homes were present in the home during the afternoon of the site visit. A full and detailed feedback from the site visit was provided both during and at the end of the day with opportunity for further discussion and/or clarification. What the service does well: What has improved since the last inspection? Many areas of the home have been re-decorated so the home is bright and cheerful for residents. Although agency staff are used at the home, staffing is more stable. This will benefit resident’s care. When agency staff are used they are told about the home and the residents needs. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 6 The acting manager is involving residents in areas such as the development of service users guide and in choosing colour schemes and fabrics for communal areas. Some new furnishings have been provided for the benefit of residents. More occasional tables, and drawers providing lockable storage in their bedrooms. New industrial washing machine has been installed to improve the homes ability to wash clothes and linen in a way that will help the control of cross infection. Although further development is needed the home are trying to provide a more structured approach to providing residents with activity and occupation. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is provided for prospective residents, and their needs are assessed before they move into the home. Staff at the home have access to appropriate and adequate training to assist them in meeting residents needs. EVIDENCE: The home has a Statement of Purpose and Service Users Guide in place dating from January 2006. These documents are currently being updated to reflect changes in local management. As part of this process the acting manager is taking the opportunity to consult with residents as to what would be useful information to include in the service users guide. From feedback some people felt that they were given sufficient information about the home. One person said that they had been shown round but were given no written information about the home to back this up. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 9 The files of two recently admitted residents were viewed. These showed that the home had completed assessments prior to residents moving into the home. Information was also available from the funding authority. Staff training records showed that most staff at the home have received training in core areas including dementia care. Staff spoken with and observations showed that in general staff, including agency staff at the home had a reasonable understanding of residents needs. Concerns regarding the communication skills/attitude relating to two members of staff were discussed with management. Intermediate care is not provided at Broomhills. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 10 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 poor. This judgement has been made using available evidence including a visit to this service. Care planning at the home does not provide an adequate basis for care to be delivered. This and poor record keeping has the potential to place residents at risk. EVIDENCE: All residents at the home have a care file in place. A number of care plans were sampled as part of this inspection. It is clear that staff at the home spend time and effort on care planning. However most of those viewed showed shortfalls, and did not demonstrate a holistic or joined up approach to providing care for residents. In some cases this had the potential to place residents at risk. Details of shortfalls found were feedback to management at the home. For two residents important medical/care needs were not reflected in care planning. Where care needs were identified and planned for these were not always found to be carried out in practice. For example, walking aids specified to be used by a resident observed not readily available and the resident observed on one occasion walking without any aids. A tour of the building identified one room where there was a strong odour of urine. Staff Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 11 identified that this resident had a history of urinary tract infections. No care plan was in place relating to this to inform staff of preventative actions/recognising possible recurrences. Daily records are kept but were not adequate. When important events such as falls had occurred there was no follow through to show that the resident was monitored or subsequent events linked to previous occurrences. In two cases this could have had serious consequences for the residents concerned. Records showed that residents can access health care checks such as opticians and dentists. Referrals are made to other health care professionals as appropriate to meet their needs. A visiting community nurse was positive about the home, felt that staff at the home were receptive to ideas, and had a good knowledge of residents needs. Pressure relieving equipment was available in the home, and several residents were observed to have air or pressure reliving mattresses on their beds. The use of this equipment was identified in care planning documentation. Development is needed to ensure that resident’s health is not compromised by poor recording practices. Due to a regular weighing programme one resident was identified as having lost a significant amount of weight. The home had been proactive, sought medical advice and identified that their weight and diet needed to be closely monitored. When nutrition records were viewed it was clear that this was not happening with any consistency. Their nutrition record, (along with other residents), was wholly inadequate. This issue has been raised at previous inspections. A tour of the premises identified that management of creams and topical applications at the home was poor. In many rooms there were two or more pots/tubes of the same application in use. Management at the home started to address this situation during the inspection. Issues in relation to the management of creams and topical application were also identified at the previous inspection. Apart from the above medication at the home is generally well managed through the use of a monitored dosage system (blister packs.) When viewed the system was in good order and relevant policies and procedures were available to staff to inform their practice. Some practice issues were identified to management at the home. This included making sure that clear instructions are provided for the use of all medicines. Throughout the day the homes own and agency staff were generally noted to treat residents with courtesy and respect. An incident of a resident being incontinent in a public place was dealt with very sensitively and well by a member of staff. However, another incident was reported to management of the home who undertook to investigate what had happened. A resident had been left in bed covered up, but not wearing any nightclothes. The resident was cold and distressed by this. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 12 Other ‘finishing touches’ that show that residents are treated with respect and care need attention. Items such as dirty hairbrushes and untidy draws were pointed out to local management. Some residents have their own telephones installed in their rooms so that they can make calls in comfort and privacy. The homes pay phone can also be used in private. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 13 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 this service. Insufficient activity and stimulation, based on individually assessed needs, are currently provided at the home. Visitors are encouraged and made welcome at Broomhills. Practices around mealtimes need urgent review to ensure that they meet resident’s needs and preferences. EVIDENCE: The acting manager said that the home has two activity co-ordinators, one of whom also works care assistant hours at the home. No specific activities were observed to take place during the inspection. During the day many residents were left unsupervised and un-stimulated in the homes lounges for significant periods of time. Feedback from some relatives and residents identified lack of activity as an issue. Since the previous inspection some development of activities has taken place at the home, but further work is needed to ensure that all resident’s (including those with dementia) needs in this area are properly assessed and addressed. Care planning does not currently fully address resident’s need for activity/occupation. Activity records are kept separately from care plans. Those records viewed were inadequate, there were few entries and care tasks such as having nails done and hairdressing were identified as activities. A three-week activity programme was seen to be Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 14 in place, a knitting club has started and external entertainers come into the home. Resident’s preferences in terms of daily routines are recorded to some degree on care files. Staff activity was noticed to be quite task orientated, and the flexibility of daily routines was called into question in relation to mealtimes. (See below) Visiting at the home is open and visitors came and went during the inspection. A visitor’s room is available. Visitor’s spoken with said that they were always well received at the home. Broomhills is situated in quite an isolated position so it is difficult for it to become fully part of the local community. A tour of the premises showed that residents are able to bring in personal possessions and personalise their rooms. Information on advocacy services was available in the home, but this was noted to require updating. This inspection showed that the dining space is now better presented for residents with cloths, and tablemats. However attention is needed to ensure that residents are always treated respectfully. Some tablecloths were noted to be very creased and one had holes in. Plastic beakers were noted to be used for all residents, regardless of their needs. At lunchtime some residents wore blue plastic aprons to protect their clothing. A number of residents were left in wheelchairs for meals. It was not clear if this was through their own choice. The kitchen radio was playing loudly, impinging upon the residents dining space and, from comments made, was not to their taste. At teatime plates that were wet/not properly dried were being laid out for residents to use. The acting manager rectified this. Although some good interaction was seen, at lunchtime resident’s plates were cleared quickly as soon as they had finished. They were not asked if they had finished/wanted more. Before service at lunchtime unsupervised residents were left at potential risk due to the open kitchen with lit appliances being left unattended by staff. The registered provider has produced, in consultation with a nutitionalist, a four weekly menu plan for use in the homes. The acting manager was unaware that the home was not adhering to these, but were following their own plan. The food at lunchtime looked appetising and portions were good. Residents spoken with said that the food provided by the home was generally good, and they made positive comments about the lunchtime meal. One resident said that ‘you do not always get what you ordered’. Another area of concern was the spacing of meals. Some residents were still having breakfast at 10.00. Residents were then being assisted to lunch at 11.45. The acting manager thought that lunch was at 12.30, but staff said that it was 12.00. Staff said that everyone had lunch at the same time, even if they had eaten breakfast late. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 15 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 this service. The home could not show that it is currently maintaining their own complaints procedure in a robust and competent manner that will assure residents/others that their concerns will be dealt with properly. To ensure that residents are cared for safely, development is needed to ensure that all staff have an understanding of adult protection issues. EVIDENCE: The home has a complaints procedure. During the site visit this was not readily available or on display for residents or other parties. The acting manager said that it had been taken down for updating. Feedback regarding complaints was varied. Most felt that they would know who to talk to if they had any concerns, another said that they were not aware of the homes complaints process. Complaints records were inadequately maintained. In complaints dating from July and August there was no record of what investigation was taking place, what stage any investigation was at, or what outcomes had been for residents/complainants. Staff training records showed that some staff have yet to attend training in the protection of vulnerable adults. Generally staff knowledge of this area was adequate. Agency staff spoken with were also clear about what actions they would take to protect residents. However one member of the homes staff, Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 16 whose first language was not English appeared to have no understanding of this important area. At the beginning of the year a reported POVA incident was initially handled poorly by the home and left residents at potential risk. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 17 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, 20, 21, 24, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Broomhills generally provides a comfortable environment for residents. A good range of communal spaces are provided. To ensure residents are cared for safely, health and safety issues need addressing and staffs understanding of universal precautions needs to be improved. EVIDENCE: As part of this inspection a tour of the premises was undertaken. Full details of findings were given to local management at the time. A number of maintenance and health and safety issues were identified. Broomhills is situated in a rural area and is some distance from the nearest main road. This could present difficulties for visiting friends or relatives who do not have transport available. The location of the home also has an impact on staffing at the home. Some staff are now accommodated at the home. Arrangements made for this have the potential to impact upon some residents Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 18 and their right to privacy, and to resident’s health and safety. (see below) This is because the access path for the staff accommodation runs directly past resident’s bedrooms and lounge area. Since the previous inspection some redecoration has taken place. In particular the corridor areas of the home are looking bright and cheerful, with tasteful pictures in place. The homes grounds were well maintained. Garden furnishings and a gazebo were available, and some resident’s clearly enjoyed making the most of the outdoor space. Concerns regarding the security and safety of the grounds for residents with dementia were raised with management at the home. On the day of inspection gates had been left unsecured giving resident’s access to the basement area of the home, with many hazards, and via a path (staff access gate) to the car park area of the home and open countryside. Broomhills provides sufficient communal space and there are several lounges and a pleasant conservatory available for residents to use. Appropriate facilities are available in these areas, but residents in the conservatory said that the television in that area had not worked for a while. At this inspection it was noted that more, (though still not enough to benefit all residents) occasional tables were available to assist residents and make it easier for them to safely manage drinks and other items. A separate visitors room and pleasant dining areas are available. The basement area of the home provides a hairdresser’s room and a recreational/activities area for residents, as well as providing staff facilities. The home provides sufficient bathroom and toilet facilities. Some of these areas would benefit from being made more homely. Bedroom doors at the home are fitted with locks so that residents can choose to hold their own keys. Since the previous inspection new cabinets have been provided for most bedrooms providing residents with a lockable drawer for personal items. Many residents have personalised their rooms and made them homely. Those spoken with expressed satisfaction with the accommodation provided. Most bedrooms at the home have en suite facilities, but many of these have no cupboards or shelves fitted. This means that resident’s toiletries are often stored on top of the toilet cistern or in a plastic box. This issue has been raised at previous inspections. The acting manager said that bathroom cabinets were on order. It was noted that many beds were still not supplied with any form of mattress cover, and the bed made with the bottom sheet directly on to the plastic mattress. This does not provide for resident’s comfort. On the day of inspection the home was generally clean and apart from isolated pockets, odour free. There was however no evidence that there were robust deep cleaning schedules in place. Some extractor fans were dirty, and there were cobwebs in high/ceiling areas. The hairdresser’s room and some areas of Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 19 the laundry were also in need of cleaning. Since the previous inspection, and in line with health protection agency advice, the home has installed an industrial style washing machine. This will help to promote effective infection control. Observations during the day showed that staff understanding of infection control/universal precautions needs improvement. Staff were noted to wear the same pair of gloves for multiple tasks in different areas. A training matrix provided by the home did not identify that staff had received training in this area. On the day of inspection the home was experiencing problems with flies. This had the potential to impact on some resident’s comfort and safety. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Established staffing levels have not been maintained at the home on all occasions. The home is still quite reliant on the use of agency staff to provide care for residents. Staff are recruited safely and receive training to carry out their roles. EVIDENCE: Residents and relatives spoke positively about the staff at the home. Feedback via questionnaires/surveys was also generally positive, though some felt that sufficient staffing was not provided at all times. Broomhills previously maintained minimum staffing levels of six care staff plus one senior during the day and three care staff and one senior at night. Rotas viewed at inspection were not fully up to date and accurate. They also showed that the home had failed to provide minimum levels of staff cover on a number of occasions. This could compromise the level of care offered to residents. The acting manager felt that the home was now less reliant on agency staff but estimated that approximately 50 hours a week are still currently being used to cover holidays and sickness. This has the potential to impact on the consistency of care offered to residents. No housekeeping staff are provided during the afternoon/evening at the home. This means that care staff must carry out any of these duties required during this time, reducing further the care staff cover at the home. The acting manager said that they were trying to Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 21 recruit an evening cleaner. A previous requirement that that the registered provider conduct a full review of staffing levels at the home has not yet been met in an adequate manner. The homes pre-inspection questionnaire identified that three have completed NVQ at level 2, and a further five staff are currently undertaking this qualification. The records of two recently recruited staff were viewed. These showed that residents are protected by staff being properly recruited, with all checks and procedures being carried out before staff commence their duties. The acting manager described the induction procedure followed by staff at the home. This included a basic first day induction, then moving onto a four week induction process. During the first three days staff are supervised by a full time member of staff. It was said that staff will soon be working to a Skills for Care programme. Unfortunately the induction records for the two recently recruited members of staff could not be located so these records were not viewed/assessed by the inspector. The home has a good process in place to ensure that agency staff receive an induction into the home. Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Broomhills provides opportunities for residents to influence and express their views on the service they receive. Regular residents meetings are held. Periodic family forums are held. Management at the home has not been effective in addressing issues that have been outstanding for some time. Health and safety issues have been identified that have the potential to put residents at risk. EVIDENCE: An acting manager has been in post at the home since March 2006. The acting manager is currently undertaking the Registered Managers Award and anticipates completing this award in February 2007. One resident said that although the staff at the home were very nice it ‘felt like there was no one in Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 23 charge.’ However feedback from a relative said that the home ‘seemed more organised since new management took over’. Issues identified at this inspection show that local management at the home needs strengthening in order that residents live in a safe and well managed home. Many issues previously identified by both CSCI and the registered providers own auditing system have been outstanding for some time and have not addressed and managed at the home. Notices around the home and discussions with the acting manager show that opportunities are provided for residents and relatives to voice their opinions. The acting manager gave examples of how residents are consulted about things like fixtures and furnishings. Regular residents meetings are held and the acting manager makes herself available on one evening a week for a ‘surgery’, where relatives can come and discuss any issues they may have. Regular staff meetings are also held. Although the above shows a commitment to hearing resident’s views, on the day of the site visit the home lacked a sense of clear leadership and direction. The registered provider has strategies in place to monitor the quality of the service provided. An annual audit (undertaken over two days) of the service is conducted. For Broomhills this exercise was recently completed in July 2006. The process is very detailed and includes the use of questionnaires to gauge levels of satisfaction. Regulations require that the report of this audit be made available to interested parties. The providers own audit identified an overall deterioration in the service since the last audit of March 2005. This inspection by CSCI identified many of the same issues identified by the registered provider. Some of these shortfalls have been outstanding for some time and not yet successfully addressed by the registered provider. The registered provider nominates an operations manager to conduct a monthly visit to the home to seek the views of people using the service, and make sure that the home is being managed correctly. Records of resident’s finances managed by the home were sampled. These were satisfactory. However, as pointed out at the last inspection, currently residents can only access their monies, or other items that the home might hold for safekeeping, during office hours Monday to Friday. This is not satisfactory or stipulated in the Homes Service User Guide. A recent incident has highlighted the need for this situation to be better managed. A number of health and safety issues that have the potential to put residents at risk were identified during this inspection. Some have been highlighted through the report. Others, such as ‘keep locked’ and sluice room doors being left open were detailed to management at the home. The pre-inspection questionnaire sent in by the home, and records sampled at inspection indicated that equipment and systems in the home are regularly serviced and maintained. Records relating to the regular testing and observation of fire equipment had however not been maintained according to Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 24 the homes own specified timescales. It was stated that this was due to the handyperson not being available. Training records indicated that staff training in core areas such as moving and handling is generally up to date. Risk assessments relating to safe working practices have been recently reviewed. However COSHH data maintained by the home has not been reviewed since 2003. As pointed out at the last inspection development is needed to ensure that safe working practices and COSHH information is on display in relevant areas such as the sluice rooms. An accident record is maintained by the home. The format in use had not been fully completed, checked and ‘signed off’ by a manager since the middle of August. This means that any follow up actions necessary to safeguard residents may not be recognised or followed up. Broomhills DS0000018040.V313542.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 2 X X 1 Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person/s must ensure that residents care plans reflect their current needs and show how these are to be met. Previous requirements of 01/09/05 and 01/03/06 not met. 2. OP8 16, 17 Schedule 4 The registered person/s must ensure that an adequate record of resident’s nutrition is maintained to show that residents receive adequate, wholesome and nutritious food. Previous requirements of 30/04/05, 14/09/05 and 01/03/06 not met. 3. OP9 13 The registered person/s must make arrangement for the safe recording, handling and safekeeping of medicines in the care home. This refers specifically to the management of creams and topical applications at the home. The registered person/s must DS0000018040.V313542.R01.S.doc Timescale for action 01/12/06 14/11/06 14/11/06 4. OP12 16 01/12/06 Page 27 Broomhills Version 5.2 make arrangements to consult with residents and provide social occupation and activities suitable to their individually assessed needs. Previous requirements of 01/11/05 and 01/04/06 not met. 5. OP15 12 The registered person/s must ensure routines and practices relating to residents mealtimes are urgently reviewed to ensure that they meet with resident’s needs and expectations and have regard for their dignity. This refers to the issues raised in the body of the report. The registered person/s must maintain a robust complaints procedure. This refers to the issues raised in the body of the report relating to the need to show that proper investigation and recording practices are in place. 01/12/06 6. OP16 22 01/12/06 7. OP19 23, 12 01/12/06 The registered person must maintain the premises in a way that is suitable for achieving the aims and objectives of the home. The registered person/s must review the arrangements for staff/visitors accessing accommodation in the basement area of the home. This to ensure that: Residents right to privacy is respected and protected. Residents are kept safe through the homes grounds being safe and secure. Previous requirements of 01/10/05 and 01/03/06 not met. 8. OP26 13 The registered person/s must DS0000018040.V313542.R01.S.doc 14/12/06 Page 28 Broomhills Version 5.2 make suitable arrangements to prevent the spread of infection at the home. This refers to the issues raided in the body of the report. The need for staff to receive adequate training/instruction/supervision in infection control/universal precautions and for robust deep cleaning practices to be in place. 9. OP27 17 Schedule 4 18 The registered person/s must ensure that an up to date and accurate staffing rota is maintained at the home. The registered person must demonstrate that a full review of staffing levels has taken place. This must also include a review of the seniors role at weekends and the consistent use of agency staff to maintain minimum staffing levels and their deployment. The home must able to demonstrate that sufficient levels of staff are on duty at all times to meet the needs of service users. It is not sufficient for the home to state that a review has taken place; it must demonstrate how outcomes are achieved. Previous requirement dates of 30/04/05,01/11/05 and 01/03/06 not met. The registered person/s must undertake a review of the management arrangements at the home of the home and ensure effective management practice that: Meets the health, social and welfare needs of residents. Has a robust approach to addressing outstanding issues. 01/12/06 10. OP27 14/12/06 11. OP31 12, 18 14/12/06 Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 29 12. OP38 12 The registered person/s must 14/12/06 ensure that the health and safety issues raised in the body of the report are addressed. 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 OP4 Good Practice Recommendations The registered person/s should ensure that all staff have sufficient communication skills to care properly for residents and understand the homes policies and procedures. The registered person/s should ensure that areas of care identified in the report such as care of resident’s draws/wardrobes/hairbrushes are managed properly at the home. Current information on advocacy services should be available to residents/families. The registered person/s should ensure that all staff receive training and have a clear understanding of POVA procedures and are able to communicate that understanding. Resident’s should be provided with adequate storage facilities in the en suite areas of their private accommodation. Consideration should be given to the provision of mattress covers for the comfort of residents. 50 of care staff should be trained to NVQ level two or above by 2005. Repeated recommendation. 2 OP10 3. 4. OP14 OP18 5. OP24 6. 7. OP24 OP28 Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 30 8. OP32 See requirement no. 11. Management practice at the home should provide a clear sense of leadership and direction. See requirement no. 11. The registered person/s should be able to demonstrate the effectiveness of their own quality monitoring processes and audit tools. Current practice relating to residents access to their monies should be reviewed. Repeated recommendation. 9. OP33 10. OP35 Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Broomhills DS0000018040.V313542.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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