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Inspection on 23/01/06 for Broomhouse Nursing Home

Also see our care home review for Broomhouse Nursing Home for more information

This inspection was carried out on 23rd January 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A good consistency of care was apparent; the staff team enhanced this, as the majority had worked at the home for many years. Residents were observed to be relaxed, and of the residents spoken with all stated they were happy living at the home and many positive comments were made regarding the staff team and care provided. The home was comfortable in appearance and was maintained to a good standard. Residents` care was individualised and promoted independence and choice within their daily lives. The training for staff was up to date and the medication practices of the home were of a good standard, this ensures that residents are supported and cared for by competently trained staff.

What has improved since the last inspection?

The manager has commenced management training in order to achieve the Registered Manager Award. Arrangements for newly appointed staff with regard to direct supervision is now documented Staff at the home receive supervision every two months, this ensures they receive the guidance required to undertake their duties. Staff have received training on ageing and bereavement, to enable them to manage the needs of residents who are terminally ill, and a policy on death and dying has now been devised to ensure that the staff team are aware of residents wishes regarding this. The date of admission to the home is now being recorded on residents` files, including residents that have lived at the home for many years. The correct title for the Commission for Social Care Inspection is now documented within the homes complaints procedure.

What the care home could do better:

Although the content of information in residents` files seen regarding both assessed needs and daily records were detailed, some of documents seen appeared to require information to be duplicated, on to similar documentation. The documentation of information could be reviewed to eliminate this practice, reduce the time spent on unnecessary record keeping and avoid confusion. Regulation 26 visits (monthly unannounced visits by the proprietor/responsible individual of the home) had not been documented at the home since September 2005. The manager stated that the responsible individual had visited the home on many occasions since September 2005, however the relevant documentation needs to be completed to demonstrate this.

CARE HOME ADULTS 18-65 Broomhouse Nursing Home Broomhill Road Old Whittington Chesterfield Derbyshire S41 9EB Lead Inspector Angela Kennedy Unannounced Inspection 23rd January 2006 10:30 Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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.V280629.R01.S.doc Version 5.1 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.V280629.R01.S.doc Version 5.1 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.V280629.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 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.V280629.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took approximately three and a half hours. During the inspection a tour of the building was undertaken. 39 residents were living at the home on the day of inspection; six of the residents were spoken with. Discussions also took place with the homes activity co-ordinator and two of the qualified nurses employed at the home. Four residents files were examined (as part of the case tracking process which helps determine that residents individual needs are being met). Other records examined include; staff files, residents’ finances, and medication, some of the homes policies and procedures, and the homes quality assurance systems. The manager of the home was very helpful and available throughout the inspection. What the service does well: A good consistency of care was apparent; the staff team enhanced this, as the majority had worked at the home for many years. Residents were observed to be relaxed, and of the residents spoken with all stated they were happy living at the home and many positive comments were made regarding the staff team and care provided. The home was comfortable in appearance and was maintained to a good standard. Residents’ care was individualised and promoted independence and choice within their daily lives. The training for staff was up to date and the medication practices of the home were of a good standard, this ensures that residents are supported and cared for by competently trained staff. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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 Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards 1 – 5 were not assessed at this inspection. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 The homes practices enabled residents to make informed choices regarding their lives. Individualised care that met the changing needs and wishes of residents was provided through appropriate assessment practices. EVIDENCE: 4 residents files were examined and risk assessments and care plans seen. Risk assessments were detailed and reviewed appropriately enabling robust care plans to be developed. This demonstrates the home aims to meet the assessed needs and wishes of the residents. A ‘My Wish List’ document was seen within the residents files examined. This had been completed by the individual resident with staff assistance and included: how the resident wished to be treated, how they liked to look, the type of holidays they enjoyed and would like to try and the type of food they preferred. Evidence that this information was acted upon was seen within the resident’s files. Similar documents such as ‘My Nightmares’ and ‘What’s Important to Me’ where also seen and were detailed in content. Residents had access to advocacy services and information was available within the home for residents and relatives regarding this service. An advocate Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 11 chaired the monthly residents meetings and then fed back any issues or concerns to the manager. (Further details regarding this can be found in Standard 39 of this report.) Residents’ monies were kept by the home in small amounts, to which residents had access, as they required. Some residents kept small amounts of money themselves, according to their assessed ability to do so. (Further details regarding this can be found in Standard 23 of this report.) The residents spoken with confirmed that they were able to make choices and decisions regarding their lives. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 Residents independence and individual choices were promoted by the activities organised by the home. The practices within the home demonstrated that residents privacy and freedom of movement was respected and maintained whenever possible. EVIDENCE: Discussions took place during the inspection with the homes activity coordinator regarding the activities that were available both within the home and outside of the home. The activities provided within the home included tabletop activities such as board games and jigsaws and activities such as basketball, cooking, embroidery, seasonal crafts and karaoke. Residents were seen participating in a variety of indoor games on the day of inspection. On the day of inspection the hairdresser was at the home and many residents had chosen to have their hair cut and styled. The activities co-ordinator also talked about the activities undertaken outside of the home by residents, these included; shopping, ten pin bowling, swimming and visiting the cinema. Day trips were also organised such as an annual boat Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 13 trip in Nottingham where a three-course meal was provided during the trip, this appeared to be a favourite with the residents. The home provided transport for the residents by means of a minibus and a car. Local transport was also used such a taxi or the local bus service. The manager stated that some residents had a bus pass (according to risk assessment). Residents spoken with confirmed they were happy with and enjoyed the activities on offer both within the home and outside of the home, including the holidays organised by the home. The activities co-ordinator confirmed that holidays are provided for the residents in small groups of 6 residents or less, and the holiday accommodation varies from group to group, which can be hotels that have wheelchair access to 8 berth caravans. The type of holiday for individuals depended on their assessed needs and wishes. Some of the residents at the home vote, this is dependent on choice and ability and staff support residents in this activity as required. The home has an open visiting policy and many of the residents received visitors. One of the residents spoken with received regular visits from her husband who was also welcomed to spend the day with his wife during seasonal holiday periods. There were also a number of residents who visited their families and friends. Residents were able to see their visitors within their bedrooms if they wished to do so. The residents preferred form of address/name was not recorded in the residents files seen. This should be documented to ensure the residents chosen name is used. Residents had access to all communal areas of the home as well as their private facilities. Residents were also able to access the grounds of the home, however some residents did require staff support or supervision to do this. Staff were seen to be respectful within their interaction with residents. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 14 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): 20,21 The residents at the home are protected by the homes policies and procedures for dealing with medicines. The staff team can appropriately support the wishes of residents with a terminal illness. EVIDENCE: On the day of inspection there were no residents at the home who were assessed as able to self-administer their medication. Medication was administered to residents by the qualified nursing staff. The medication trolleys and cabinets were examined and all the medication seen was satisfactory. The medication administration records were examined and all recordings seen were accurately documented. Records were kept of medicines received, administered and disposed of and the controlled drugs register was also examined and all documentation seen was found to be in order. The homes medication policy included the requirement that; following the death of a resident medication must be retained in the home for a period of seven days in case there is a coroner’s inquest. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 15 Staff had received training on ageing and bereavement, which is undertaken by local funeral directors. Staff commented that the quality of this training was very good, and following the death of service users the undertakers are very comforting to both residents and staff providing a remembrance service as required for residents and staff who are unable or do not wish to attend the funeral. A palliative care procedure has now been produced for the home. This looks at death and dying and how to deal with terminal illness. This procedure was seen and was robust in detail. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 16 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): 23 The policies and procedures within the home protect residents from neglect, self harm and abuse, however more stringent practices would enhance the protection of residents. EVIDENCE: Some of the residents’ monies are kept by the home, which residents have access to as required. Some residents kept small amounts of money with them if assessed that they were able to do so. Some of the residents had lockable cabinets within their bedrooms, the manager stated that few residents used these but if a resident required a lockable cabinet and didn’t have one it would be provided. The money kept within the home was stored separately for each resident and locked within a safe. All transactions were recorded and signed for. The transaction sheets had columns for two signatures; many transaction sheets only had one signature for each transaction and not the two staff signatures as required. Each resident had their own bank account, and had bank statements were provided for each resident. The administrator of the home is responsible for all the records regarding the transaction of residents’ monies and was the appointee for withdrawing the residents’ monies as required by the residents. All records regarding residents monies was seen and appeared to be in order. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 17 Staff received training in physical intervention; the manager confirmed that this training was de-escalation training, used to calm areas of potential conflict if and when required. The home had procedures for the protection of vulnerable adults such as; the vulnerable adults procedure, whistle blowing and No Secrets. These were seen and found to be satisfactory. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Residents’ bedrooms meet their assessed needs and lifestyle EVIDENCE: Of the residents’ rooms seen, all were tastefully decorated and demonstrated the resident’s own personality and choice. Wash hand basins were provided in each bedroom and sufficient electrical sockets were available for the residents many electrical appliances. All bedding, carpet curtains and curtains were of a good standard and storage space was satisfactory. Within the bedrooms seen only one comfortable chair was provided. The manager stated that this was due to the size of the rooms but if or when residents wished to receive visitors within their room additional seating is provided. Of the residents spoken with all confirmed that they were happy with their bedrooms and two of the residents eagerly gave a guided tour of their rooms upon request. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 19 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): 32,35 Residents are supported by a competent staff team and the training, policies and practices of the home demonstrate that residents’ needs are met by appropriately trained staff. EVIDENCE: 75 of the care staff at the home have acquired a National Vocational Qualification (NVQ) in Care at level 2. This demonstrates that the home aspires to meet the residents needs by ensuring the staff have the required training to enable them to undertake their roles to the best of their ability. Staff employed within the last six months have not yet commenced their NVQ2 in care, but the manager confirmed that she is awaiting a start date. Staff training files were examined and found to be up to date; training at the home was linked to the residents needs. One of the staff nurses at the home had delegated as the person responsible for the training and development programme. The manager stated her intention to appoint a nurse on night duty to also cover this role; this will be useful in assessing the training required for night staff. The home had a structured induction package; this included providing a named member of staff to work with new employees through their induction period. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 20 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): 37,39,41 The home is managed well and residents’ views regarding the development of the home are sought. EVIDENCE: The manager of the home has twenty five years experience within the learning disabilities field and has worked as a manager for the last five years. She has recently commenced her registered managers training in order to achieve the Registered Managers Award. Residents and staff spoke highly of the manager, and she appeared professional, approachable and friendly towards staff and residents on the day of inspection. The policies and procedures examined were found to be satisfactory and certificates and licences were displayed within the home. Residents meetings are held at the home on a monthly basis and all residents who wished to attend were able to do so. The meeting is chaired by an Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 21 advocate and none of the staff team are present at the meeting. This allows residents to speak openly about any issues or concerns they have. The advocate then feeds any issues back to the manager who draws up an action plan. The actions to be taken are then fed back to the residents via the residents meetings. This gives assurance that the home endeavours to seek the views of the residents in reviewing and developing their home and the care and support given. Regulation 26 visits (monthly unannounced visits by the proprietor/responsible individual of the home) had not been documented at the home since September 2005. The manager stated that the responsible individual had visited the home on many occasions since September 2005, however the relevant documentation needs to be completed to demonstrate this. Activities undertaken by residents were documented. However it was noted that both the activities and other records were often duplicated on similar formats, an example of this was ‘Records of Outings and Day Trips’ and ‘Timetable of Activities’ which resulted in information either being duplicated or only recorded on one form, leaving the other form blank, which at a glance looked as if information had not been recorded. This method of recording information requires reviewing to eliminate duplication of records and avoid confusion. The date of admission was not recorded on all residents files seen. The manager stated that since this recommendation had been left at the last inspection staff have begun to record the date of admission on residents’ files along with pre-admission history, this was ongoing at the time of inspection. Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 22 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 2 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 3 3 X 2 X 2 X X Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 23 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 YA26 Regulation 16 (2) © Requirement Residents’ rooms must have adequate furniture and if items of furniture are not provided as stated in standard 26, then the reasons why and the residents agreement regarding must be documented in individual files The registered person must ensure that Regulation 26 visits are completed on a monthly basis. outstanding requirement previous timescale 01/01/06 3. YA41 17(1)(a) & Sched 3 . Residents’ records must include the information specified in Schedule 3 of the Care Homes Regulations 2001 Outstanding requirement previous timescale 01/01/01 01/04/06 Timescale for action 01/04/06 2 YA39 26 (2) (3) 01/03/06 Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 24 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 YA1 Good Practice Recommendations The residents’ guide should include residents’ views of the home and make reference to the most recent inspection report. (Not assessed at this inspection) Residents preferred form of address should be included within their plan of care. Resident finance sheets should have two signatures at each transaction The sign at the entrance to the home should be repaired or replaced 5. YA26 Reasons not to provide some items of furniture such as a table and two armchairs should be recorded. 6. 7. YA36 Staff supervision should take place at least six times per year YA41 Residents’ records should include date of admission and care plans for all assessed needs, such as pressure sore prevention Methods of record keeping in residents files should be reviewed to avoid duplication. 2. 3. 4. YA16 YA23 YA24 8. YA41 Broomhouse Nursing Home DS0000002047.V280629.R01.S.doc Version 5.1 Page 25 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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