CARE HOME ADULTS 18-65
Broomhouse Nursing Home Broomhill Road Old Whittington Chesterfield Derbyshire S41 9EB Lead Inspector
Janet Morrow Unannounced Inspection 17th October 2005 10:15 Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 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 Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 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. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Broomhouse Nursing Home Address Broomhill Road Old Whittington Chesterfield Derbyshire S41 9EB 01246 260697 01246 268065 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) Intacare Limited Jill Askew Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (0) of places Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st February 2005 Brief Description of the Service: Broomhouse home provides accommodation and personal care with nursing for up to 40 people with learning disabilities. The home is located in the village of Whittington close to the town of Chesterfield. There are shops, pubs and other amenities within walking distance. The home is divided into four named houses on two floors. Service users are accommodated in each house in accordance with assessed needs and compatibilities. There are well-maintained grounds with mature trees overlooking fields to the rear of the home. Car parking space is provided. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day for a period of 4.5 hours. A tour of the building was undertaken. Care records, maintenance records and staff records were examined. Three staff were interviewed and six residents were spoken with. Two visiting professionals were contacted by telephone after the inspection visit. The manager was out of the building escorting residents on an outing during the inspection. The serving of the lunchtime meal was observed and sampled. What the service does well: What has improved since the last inspection?
Information provided at the time of admission had improved and provided more detail to ensure that the home was able to meet residents’ needs. The information held on staff files had improved and met legal requirements. The manager was due to start management training to achieve a National Vocational Qualification (NVQ) at level 4.
Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 6 Record keeping was generally accurate although there were one or two areas in residents’ files that needed further information. 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. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 7 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 Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3and 4 Sufficient information was available to ensure that the home was suitable and could meet the needs of the individual at the time of the admission, which ensured that placements were appropriate. EVIDENCE: The home had developed a statement of purpose and residents’ guide that contained comprehensive information about the home. All the information required by Schedule 1 of the Care Homes Regulations 2001 was in place. There were some visual images available in the document to aid understanding. However, there was no reference made to previous inspection reports and there were no residents’ views of the home included. Three residents’ care files were examined and these contained assessment information. One file had this information provided by the assessment and care management process and the others had been completed by the home. However, the home’s own documentation was not fully completed on two files and the nurse in charge explained that this was because the residents concerned had been at the home a long time. There were some gaps in the information on newer residents, such as information on wishes regarding death and dying, but overall the information was sufficient to ensure that the home could meet individual needs. There was documentation in files on trial visits and the nurse in charge stated that residents were offered day visits for meals and respite care, where appropriate, prior to a permanent placement.
Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 and 10 Systems were in place to encourage residents’ participation and respect their confidences, which ensured they maintained control over their lives. Risks were generally well managed, but there was a lack of information in a specified area on care plans, which had the potential to put residents health needs at risk. EVIDENCE: There were posters and notes of residents’ meetings on display in the corridor, which contained pictorial images to aid understanding. This showed that residents had the opportunity to participate in the activities in the home. Those residents spoken with confirmed that they were able to make choices about their daily lives. There was a policy available on confidentiality and staff interviewed were aware of this and demonstrated in discussion that they knew how to deal with sensitive information. The three residents’ files examined all had a care plan in place that covered all aspects of daily life. Risk assessments were available in a range of areas such as bathing, falls, moving and handling and outings. However, one file
Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 10 examined did not have a care plan for pressure sore prevention where this had been assessed as a high risk. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 14 and 17 The home offered a range of activities and choice in daily routines that enabled residents to maximise their independence. Meals were nutritious, which enhanced residents’ daily lives. EVIDENCE: Five residents spoken with during lunchtime were able to discuss their daily routines and activities. All pursued their own activities within the home such as watching television or videos/DVDs and listening to music and playing games. A variety of leisure and community resources were used such as local shopping facilities and local pubs and there was also choice about attending educational and leisure activities in the community. On the day of the inspection a group of residents had gone on an outing to a safari park and other residents stated that they had also been to the park on a previous trip out. The serving of the lunchtime meal was observed. All residents spoken with enjoyed the food, which was wholesome and nutritious. An alternative was available for those who did not like the option available. The meal was unhurried and gave residents plenty of time for eating.
Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 21 Residents’ health and personal care requirements were well managed, which ensured that needs in these areas were met. However, greater attention to terminal illness would further enhance the care offered. EVIDENCE: The three residents’ files examined all had records to show that access to health care was available with visits such as opticians and General Practitioners being recorded. There was comprehensive information available in specialist areas such as speech and language therapy. Observation showed that personal support was offered sensitively and residents spoken with said that they found staff helpful. A friendly and relaxed rapport was observed between staff and residents. The home did not have a comprehensive policy on ageing and death and did not have information available on how to deal with terminal illness. Care staff interviewed stated that trained nurses would take the lead responsibility if a resident was terminally ill. It was unclear from the discussion with staff what role unqualified staff would have in dealing with terminal illness. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Complaints were handled objectively, which ensured residents concerns were listened to. EVIDENCE: The home had a clear complaints procedure that was included in residents’ care files. It contained pictorial images to aid understanding. However, the title of the Commission for Social Care Inspection included in the procedure was incorrect. The record of complaints was seen and this showed that concerns were listened to, appropriate action was taken and the outcome was recorded. There had been no complaints received at the office of the Commission for Social Care Inspection since the last inspection in February 2005. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The home is equipped, furnished and maintained to a good standard, which offers homely and spacious facilities for service users to safely enjoy. EVIDENCE: A tour of the building showed that the home was well maintained, furnishings and fittings were of good quality and bedrooms were personalised. Not all bedrooms had all the items detailed in Standard 26 such as two comfortable chairs and TV aerial point. However, one visiting professional commented on the poor state of the sign at the entrance to the home and felt it gave a negative first impression. The home was clean, tidy and odour free. The laundry and kitchen areas were clean and tidy. There were sluice facilities on the washing machine in the laundry. A sluicing disinfector was installed. There was sufficient equipment to assist those with disabilities including hoists, handrails, bath hoist and pressure relieving mattresses. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 36 Robust recruitment procedures and staff supervision ensured residents were safeguarded. EVIDENCE: Two staff files were examined and showed that recruitment procedures were thorough. All the information required by Schedule 2 of the Care Homes Regulations 2001was in place. This included identity information and Criminal Record Bureau checks. Staff interviewed stated that supervision occurred and was linked to an appraisal and performance monitoring form. They were unclear about how often supervision occurred but stated that they found it useful and that the manager was approachable at any time for discussion. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41 and 42 Record keeping and maintenance procedures were up to date, which safeguarded residents’ interests and ensured the health and safety of all in the home. EVIDENCE: A range of records were examined that included residents’ care files, staff files and maintenance records. These showed that record keeping was up to date and accurate. Most of the information required by Schedules 1 – 4 of the Care Homes Regulations 2001 was in place although there was some missing information such as date of admission and a specific care plan missing from one resident’s care file. The maintenance records examined showed that there were regular checks being undertaken on equipment used by the home; for example, hoists were checked in February 2005, portable electrical appliances in January 2005 and water safety in September 2005. Fire records showed that a practice drill had taken place in July 2005, fire appliances were serviced in January 2005 and the emergency lighting in January 2005. The Fire Service had visited the premises in July 2005 and staff had undertaken fire training in May 2005.
Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 17 Staff interviewed also confirmed that training in health and safety issues occurred. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 X X 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Broomhouse Nursing Home Score 3 3 X 2 Standard No 37 38 39 40 41 42 43 Score X X X X 2 3 X DS0000002047.V261448.R01.S.doc Version 5.0 Page 19 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 Standard YA39 Regulation 26 (2) (3) Requirement The registered person must ensure that Regulation 26 visits are completed on a monthly basis. This requirement was not assessed on this occasion. The home must promote and make proper provision for the health and welfare of residents. Residents’ rooms must have adequate furniture. Residents’ records must include the information specified in Schedule 3 of the Care Homes Regulations 2001 Timescale for action 01/01/06 2 3 4 YA6 YA26 YA41 12(1) (a) 16 (2) (c) 17(1)(a)& Schedule 3 01/01/06 01/01/06 01/01/06 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 YA20 Good Practice Recommendations Storage in the medication trolleys should continue to be reviewed and additional capacity provided where possible. This recommendation was not assessed on this occasion.
DS0000002047.V261448.R01.S.doc Version 5.0 Page 20 Broomhouse Nursing Home 2 3 4 5 6 7 8 9 10 11 12 YA35 YA1 YA2 YA6 YA21 YA21 YA22 YA24 YA26 YA36 YA41 The registered person should record the arrangements that are in place for newly appointed workers. This recommendation was not assessed on this occasion. The residents’ guide should include residents’ views of the home and make reference to the most recent inspection report. Assessment documentation should contain information about residents’ wishes on death and dying such as funeral arrangements. There should be a care plan in place for all identified risks. Staff should receive training on ageing and bereavement.. There should be a policy on death and dying that includes how to deal with terminal illness. The correct title of the Commission for Social Care Inspection should be detailed in the complaints procedure. The sign at the entrance to the home should be repaired or replaced. Reasons not to provide some items of furniture such as a table and two armchairs should be recorded. Staff supervision should take place at least six times per year. Residents’ records should include date of admission and care plans for all assessed needs, such as pressure sore prevention. Broomhouse Nursing Home DS0000002047.V261448.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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