Inspection on 18/10/07 for Broughton House

This inspection was carried out on 18th October 2007.

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

Broughton House 22/09/08

Broughton House 10/05/06

Broughton House 19/02/06

Broughton House 27/09/05

Broughton House 01/03/05

Broughton House 09/11/04

Broughton House 12/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Broughton House Park Lane Salford Manchester M7 4JD Lead Inspector Elizabeth Holt Unannounced Inspection 10:00 18th and 19 October 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broughton House DS0000006702.V345535.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. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broughton House Address Park Lane Salford Manchester M7 4JD 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) 0161 740 2737 Broughton House, Home for Disabled ExServicemen Mrs Lisa Connolly Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Only ex-servicemen can be accommodated. Up to 50 service users requiring nursing or personal care may be accommodated. Minimum nursing staffing levels as specified in the Notice issued in accordance with Section 25(3) of the Registered Homes Act 1984 shall be maintained for those service users receiving nursing care. Staffing levels in accordance with the Residential Forum Guidance shall be maintained for those service users requiring personal care only in addition to the minimum nurse staffing levels. 10 May 2006 4. Date of last inspection Brief Description of the Service: Broughton House is a large detached Victorian property, which is registered to provide nursing and personal care services for up to fifty ex service men. Accommodation is provided on two floors with eight shared and thirty-four single rooms. All shared rooms have en-suite facilities that include a walk in shower and a large proportion of single rooms also offer the same en-suite facilities. There are several lounge areas around the home including a smoking lounge and a non-smoking lounge. A large dining room with bar facilities is situated on the ground floor, which also doubles as a social area. The home is suitable for wheelchair users and has a lift to assist residents to the first floor. There are a number of assisted bathrooms around the home. There is a physiotherapy room on the ground floor and the home employs its own physiotherapist three days a week. The home employs an activities co-ordinator who provides activities. The weekly fees at Broughton House are currently £364.41 per week. There are additional costs for nursing placements that are between £40-£133 per week, hairdressing, bar and shop, newspapers, toiletries, holidays and activities. Broughton House is located in a residential area within ten minutes drive of Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 5 Manchester and Salford. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection to Broughton House took place on the 18th and the 19th October 2007 and included site visits. Two inspectors were present for part of the inspection on the first day and in total it lasted for fourteen hours. The inspectors looked at records the home holds on residents (care plans) and other records the home has to keep to ensure the home is run properly. The inspector carried out a partial tour of the home to see what the resident’s bedrooms were like and to assess the safety and comfort for the residents living there. Throughout the visit observations were made of care practices. The registered home manager is currently absent from the home and the home has appointed an acting manager to cover her position. On the day of these visits the acting manager was on annual leave. A self-assessment survey information form (Annual Quality Assurance assessment) had been completed and was received before the inspection. Three service user survey forms were completed by residents and their families and returned to the Commission. Two separate concerns/allegations were being investigated under Salford Council’s adult safeguarding procedures at the time of this visit. The outcome of one of these investigations has highlighted that staff need training in the use of risk assessments and risk management and the allegation in relation to the theft of money from a resident was not upheld. Information supplied by the manager of the service prior to the inspection stated that no complaints had been received at the home since the previous inspection. The term preferred by the people consulted during the visit was “residents”. This term therefore, is used throughout the report when referring to the people living at the home. What the service does well: The residents live in a well maintained home that is clean and hygienic. The residents’ bedrooms were well decorated and personalised. A relative of one of the residents spoken to said, “Individual members of staff have impressed me with their efforts, some showing genuine care and kindness.” The staff were heard talking to the resident’s in a kind way and were seen to support them during meal times in a sensitive manner. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 7 The home has flexible visiting arrangements to enable the residents to have regular contact with their families and friends. The home had a number of social and leisure events in place and some residents had attended a live band the night before the inspection and expressed their pleasure at this. What has improved since the last inspection? What they could do better: Improvements to the admission procedure and the information gathered in the pre admission stage are required to ensure the home can meet the health, personal and social care needs of the residents. The Statement of Purpose and the Service User Guide should be reviewed to ensure current and up to date information is there to help residents and their relatives to make a proper choice about the home and what it offers. The manager must ensure the care plans and risk assessments for the residents accommodated accurately reflect the care needs of the residents living at Broughton House. The information gathered at the admission stage should be used to develop the care plan. Shortfalls in the recording of appropriate detailed information may put people at risk of not having their care needs fully met. Shortfalls in accurately filling in forms in relation to diet and nutrition may lead to resident’s needs not being met. A number of residents were seen to have unclean and lengthy fingernails and unclean teeth. Staff must include these care routines and review this as part of the daily care provided to residents. The laundry system must be reviewed to make sure the residents receive their own-labelled clothes. The care plans should include the social needs and wishes of the individual residents to make sure suitable and appropriate activities are provided to meet their needs. The staffing levels and deployment of staff must be reviewed to see if changes are needed to meet the resident’s needs more fully. Shortfalls highlighted in Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 8 the recruitment procedure for staff must be improved to ensure the safety and well being of the residents. Fire safety checks were not up to date at this inspection and a letter for immediate action was left in relation to the need for regular testing of the fire alarm equipment and safety checks of fire equipment. The system in place for recording staff training must be improved and the manager must ensure that all staff undertake the required mandatory training to provide them with the skills to carry out their roles appropriately. An audit of accidents/incidents occurring in the home must be carried out to see if any strategies can be put in place to reduce the risk of accidents to individuals. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are given information about the home, however pre admission assessments are not carried out in such a way to ensure the care needs of the prospective residents can be met in full. EVIDENCE: A Statement of Purpose and a Service User Guide was available that provides new and existing residents with information about the home. Some of the information provided is not in line with the Care Homes Regulations 2001 and the Statement of Purpose should be updated accordingly. Before moving to Broughton House, residents or relatives on their behalf may visit to look around and enjoy a meal with other residents. One relative confirmed she was given a written guide describing the home and its facilities. A review of three pre-admission assessments showed these did not fully assess the prospective resident’s needs. The manager must provide a more detailed, Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 11 specific assessment format with clear information to ensure the staff can meet the individual resident’s needs prior to their admission to the home. The admission procedure does not always appear to involve meeting the resident prior to his admission to the home and there appears to be a lack of involving the relative in the planned care. Two relatives spoken to said they had not been shown the care plan and were not aware of their relatives planned care. One relative stated, “It does not feel as though Broughton House seeks to work in partnership with families. I have not been asked for much information at all”. For a resident transferred from another home there was no evidence of a pre-admission assessment. The home’s management committee have taken steps to review the admissions procedure Copies of care management assessments carried out by a referring agency were available however this information did not appear to be well used to start the care planning process. The home does not provide intermediate care. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning and risk assessments in place lack detail to provide staff with the information they need to satisfactorily meet the needs of the residents. Shortfalls in the care plans may lead to resident’s needs not being met. EVIDENCE: A sample of care plans were reviewed as part of the inspection process which highlighted a number of shortfalls in relation to the information gathered and how this information was used in the risk assessments and care plans. The information gathered at the assessment phase was not adequately used to provide an activities of daily living assessment from which to expand upon to clearly identify the individual needs of the residents. The care assessments and care plans need to be more person centred, individualised and specific to the resident’s individual needs. For one resident there were two care plans in relation to mobility, which made this confusing to read. For another resident the care assessment showed he would like to try dentures, however there is no recorded evidence to show Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 13 whether this was carried through. Another residents care plan contained information about personal hygiene and mobility as the identified need but in the care and intervention section only hygiene and dressing needs were described. The risk assessments in the care plans for moving and handling did not contain enough specific, detailed information. One risk assessment stated, wheelchair to toilet 2 staff, wheelchair to bed 2 staff. The risk assessments must be reviewed to detail the support required including the use of any equipment to safely transfer a resident from chair to toilet. One of the relatives in the service user surveys responded by stating, “It doesn’t feel as though work is being done to improve his mobility. I am concerned it will decline without better input.” The weight chart for a resident showed a continual weight loss over a period of months. Despite the weight loss and the individual’s poor appetite, the nutritional risk assessment remains assessed as “minimal risk”. The actual care plan states to “weigh weekly”, however there is no evidence to support this was done. The records must be in line with action planned and show the appropriate intervention and support from other healthcare professionals. Observations during the inspection showed that the personal care needs of the residents were not always being met. Some resident’s fingernails and teeth were unclean. One resident said, “I don’t like my nails this long and they are not clean”. In the relatives/resident’s survey one relative said,” Sometimes his hair smells and is untidy. I have also shaved him late in the day and I would like him fresh from the morning”. The ongoing monitoring and care practices in relation to pressure area care require attention to detail and highlight an area for staff training. A resident’s care plan showed deterioration in his pressure areas and a referral to the District Nursing services was made. The evaluation did not then show the outcome following this or an updated care plan to reflect the changing health care needs. Another resident’s care plan showed he now has “a sheepskin under his heels and between his feet at night”. This would not be in line with current good practice. One resident said on the inspection that his foot was hurting and it was clearly distressing him; this was reported to the nurse in charge and it was evident his heel was sore and required attention. The following day this resident had a dressing on his heel and calf. Some of the daily reports are detailed however they are not always linked back to the planned care. A discussion highlighted that providing separate professionals visits records would show what decisions have been made and any health action planned. In relation to wound care and the ongoing review of residents a requirement was made for the home to provide a body mapping tool to show clearly any markings or changes on a residents’ skin. It was pleasing to see that on the second visit the nurse in charge of the home had taken steps to provide a detailed wound care chart for a resident, had Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 14 made a referral to the tissue viability nurse and requested a body mapping chart to be provided. There was evidence of monthly evaluations of the care plans however the information was sometimes misleading and the care plans were not updated to reflect the changing health care needs. A discussion with three of the registered nurses highlighted that they had recently discussed with the manager plans to review the nursing care planning documentation. There was no evidence to show that the plans of care had been drawn up with the involvement of the resident/relative. One resident’s wife was not aware of this record and felt her husband should be changed more often and would like to know when he was bathed and how regularly. “I have been with him four hours and he has not been changed, I have called the staff because his pants are wet”. Concerns raised in two of the relative’s surveys highlighted issues about the loss of clothing, even when labelled and concerns their relatives are seen in other resident’s clothes. One relative said,” I do not like seeing him in other people’s clothes”. Some of the fluid and diet intake charts were not well recorded; one showed that at 17.30 a resident had taken a cup of tea and then nothing until 21.00 hours when he received 50mls of juice. If a resident requires this level of monitoring there must be evidence to show that drinks are at least offered at regular intervals. Overall it appears the current care planning system requires reviewing to ensure the documentation clearly reflects the ongoing and changing health, personal and social care needs of the residents accommodated. Even though risk assessments and care plans are in place it does not appear these are assessed and reassessed with the ongoing and changing needs of the residents in mind. Medication was appropriately stored in a clinical room. A sample of medication records was looked at and these showed some shortfalls that had the potential to put residents at risk of not receiving their medication appropriately. Some medications had been handwritten onto the record sheet and a staff member and a witness did not sign these. A recommendation was made for a variable dose medication to show clearly on the medication administration chart the accurate dose being given. The nurse in charge addressed these on the day of the inspection. Controlled drugs were appropriately stored and a check of the records showed these were accurate. From observations made during the inspection and discussions with some staff members it appeared the staff were respectful to the residents in the way they spoke with them. Some staff clearly has a good rapport with the residents and although some of the conversation with individual residents may not be Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 15 considered appropriate, a resident confirmed he enjoyed the chitchat he had with the particular care worker. Attention needs to be paid to communication care plans and risk assessments to protect both the residents and the staff. One communication sheet recorded a resident as being “touchy feely” and a discussion highlighted the need to make sure this assessment clearly showed the support or strategies the staff could do to support the resident in order to protect him and themselves. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given support and opportunities to exercise some choice and control over their lives. Residents are supported to maintain contacts with relatives and friends and to pursue leisure and social activities. A wholesome balanced diet is provided for residents. EVIDENCE: There were some shortfalls in identifying and recording the individuals’ preferences in relation to their social, cultural, recreational or religious wishes. This lack of written assessment information makes it difficult to establish if the resident’s experienced lifestyle matches their expectations. For a resident who was admitted to the home last month the assessment for his profile and life experiences had not been completed. There is an activity organiser in place who usually coordinates social and leisure activities. The night previous to this inspection a number of residents commented on how they had enjoyed the entertainment of a live band. Whilst the home encourages all the residents to participate in activities the residents choose whether to do so or not. Some in house entertainment is provided which included bingo and dominoes on a weekly basis. Exercising to music Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 17 was organised on a monthly basis. One resident said how he had enjoyed a visit to Blackpool. There is a bar and a shop at the home for the residents to enjoy and some of the residents visit the local pubs. Some residents received communion as they wished and visits were made from a local vicar and priest. The home has an open visiting policy that allows the relatives and friends of the residents to visit at anytime during the day. The residents are able to receive their visitors in private. There were visitors at the home during the inspection visit and they said that they are made welcome at all times. The home ensures that those residents who do not have relatives have access to advocacy support. They also use the social services to ensure that residents’ interests are safeguarded. Residents who could express a view said they were aware of the menu and choice of food on offer, however this was displayed on a sheet only in small print. It is recommended this be displayed more clearly for residents who could not read the small print version. The home provides wholesome and appetizing meals. There was a menu in place that offered choice. Specialist diets were also catered for such as low fat diets and sugar free diets. The meal on the day of the inspection was a roast chicken dinner and ice cream for desert. The inspector joined three residents for lunch, they enjoyed the food and said there was always plenty and it was well cooked. Residents who required assistance were supported in an appropriate manner. One relative commented, “Individual members of staff have impressed me with their efforts, some showing genuine care and kindness”. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures in place to protect residents from harm are not as robust as they should be and not all staff would be competent to refer on potential abuse to protect residents. EVIDENCE: The home had a complaints procedure, which is available in the Service User’s Guide. The manager of the home had received no complaints since the previous inspection and the Commission for Social Care Inspection had received none directly. Two of the three representatives of relatives who responded to the service user surveys said that they knew how to make a complaint. One of the relatives responded by saying, “if I am not happy I would see if the matron is in and have a word with her. I need to speak to her because my husband should be getting weekly money but he has dementia.” It is clear from this that the home’s manager is considered approachable and relatives feel they could discuss areas of concern with her. The home’s management must ensure that serious concerns/allegations are appropriately referred to Salford Council’s Safeguarding Adults team for investigation. Shortfalls in the reporting of concerns/allegations potentially place the safety and welfare of the residents at risk. From a review of the training records some of the staff had undertaken training in the protection of vulnerable adults, however this had not applied to all staff Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 19 currently employed. Discussions to arrange dates for abuse awareness training in adult protection had been made with Salford’s Adult protection Unit. Some staff were aware of the types of abuse however they were not clear about the appropriate course of action to take in the event of an allegation of abuse. Staff must receive updates in the policies and practices in relation to abuse awareness and whistle blowing. At the time of writing this report an allegation in relation to care practices and an allegation of theft of money were under investigation by other agencies. The outcome of these investigations has highlighted a need for staff to be trained in risk management and the recording of risk assessments. The allegation in relation to the theft of money was not upheld. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, comfortable and well-maintained environment for the residents to live in. EVIDENCE: The home was clean, tidy and odour free upon entering on both visits. There is a programme in place to refurbish and redecorate the home and this is on going. A record of maintenance to record repairs was available however there was no record to show if the repairs had been carried out. A partial tour of the premises took place, which showed bedrooms, bathrooms and communal areas to be adequately decorated. Residents who could express a view were very pleased with their bedrooms and it was evident that some residents had personal effects in their rooms. One resident said, “I like to spend my time in my room, I go down for meals and social events if I fancy them. The staff look after me here”. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 21 There is a large dining room with some comfortable seating by the entrance of this room and a further two lounge areas for residents to socialise. One of these lounges is a designated smoking area for the residents. An area of plasterwork required addressing in a bedroom on the ground floor, which was raised during the visit, and two fire extinguishers needed to be attached to the wall. Procedures are in place for infection control practices and staff were aware of the importance of good hand washing practice. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff should be reviewed to ensure the needs of the residents are being met in full and the recruitment policies and procedures did not fully protect the safety and wellbeing of residents. EVIDENCE: On the day of the visit there were 19 residents in receipt of nursing care and 24 in receipt of personal care only. From observations made during the visit there were no staff available in the dining areas and lounges to meet the care needs of the residents. There was also no evidence of staff visiting residents who were using their own bedrooms for what some residents said was, “lengthy periods of time”. The numbers and deployment of staff require reviewing to ensure the needs of the residents are met in full. Comments made from a relative in the service user survey highlighted a lack of attention to detail in her husband’s personal care. She said she felt the care home could improve by, “getting a few more regular staff, because they do seem to be very busy at meal times and bed times.” Another relative wrote, “There are not enough staff to look after the men. They would be able to take it in turns to be able to sit and talk to residents and it will make them feel happier.” There were two registered nurses and six care workers on the morning shift, who usually work in teams of two. From 2pm the number of care workers reduced to four with the two registered nurses and on night duty it is one Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 23 Registered nurse and 4 care workers. A discussion highlighted the possibility of introducing a key worker and team nursing system to enable staff to have specific accountability for a number of residents. The staff were supported by a care worker who focuses on light duties particularly in relation to supporting residents at mealtimes. Other staff included domestic, laundry, catering, maintenance and administration. For the week commencing 14th October 2007 there was a number of shifts covered by bank and agency staff. This has the potential to lead to a lack of continuity of care, however it was stated that they use a number of regular bank staff and had introduced short-term contracts for some new employees during the past twelve months. A discussion highlighted that a number of new staff were in the process of being recruited including an acting deputy manager. The staff files for five staff were looked at and were all found to contain a written application form, three files had two written references, and the fourth and fifth files had only one written reference each. There were comments to state “good verbal reference” for both these applicants. One staff file did not have evidence of a Criminal Records Bureau check (CRB) or a POVA (protection of vulnerable adults) check. This person had a CRB check from another employer however they had commenced employment at the home without being properly vetted. There was not a clear employment history or the space on the application form to adequately fill this in with specific dates and no evidence to show this was explored at interview. A requirement was made for appropriate recruitment procedures including Criminal Records Bureau checks to be carried out. A staff-training file was available, which indicated some shortfalls in the training provided for staff. The induction carried out for newly recruited staff involved only a one or two hour in-house session. A requirement was made for the induction programme to be reviewed in line with the national guidance from “Skills for Care”. It is advisable for the manager to keep a training matrix for all staff to be able to see at a glance what training staff had been done and what they were planning to do. There were shortfalls in training for Moving and Handling and First Aid seen for a number of staff and little evidence of professional study days/updates for Registered nurses in areas such as PEG feeding, diabetes, wound care, nutrition continence and falls. The manager reported two staff members are due to undertake manual handling training so this can be then carried out in-house. This needs addressing as a matter of urgency to ensure the safety of the residents and staff. Pre inspection information supplied by the manager stated that 90 of care staff had completed or were currently undertaking NVQ Level2. Care staff spoken to say they enjoyed undertaking the courses as it helped them in their daily work. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not currently being managed with sufficient oversight and skill to fully promote and safeguard the health, safety and welfare of the residents. EVIDENCE: At the time of the inspection the registered manager was absent from the home and the company has put in interim management arrangements. The acting manager was on annual leave during this inspection visit. Comments from the staff were positive in terms of the guidance and direction the manager is giving the home, however some of the shortfalls identified in this report highlight the need for more guidance and support to effectively manage the home on a daily basis. Relatives spoken to said the manager was approachable and felt she would listen to suggestions and comments. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 25 Standard 33 of the National Minimum Standards is that the home must use a quality assurance system largely based on seeking the views of relatives, residents and visiting health care workers to gain measure the home’s success in meeting the home’s aims and objectives. The home’s self audit questionnaire states this questionnaire is in place. The home has a policy and procedure for the management of resident’s finances. A sample of residents records were looked at and these records appeared accurate with staff signatures to support these. An immediate requirement letter was left at the home for the regular testing of the weekly fire alarm tests, emergency lighting and fire equipment tests. The records showed the last weekly alarm check had been carried out on the 5/09/07 and the extinguishers had not been checked for over twelve months. Some staff members were still awaiting fire safety training and a fire drill had highlighted some training needs for staff. Arrangements were being put in place for some further fire training to be carried out. The home acted immediately following these shortfalls and reinstated the contract with the extinguisher company on the second day of this inspection. In relation to shortfalls in the fire detection equipment tests, fire drills and training the Chief Executive explained there had been changes in the maintenance persons employed which had contributed to these shortfalls and training had been arranged for staff and to train two staff as fire marshal courses. A look at the maintenance records showed that a record of the electrical periodic inspection had been carried out on the 25.05.07. The Commission appear to be notified under Regulation 37 of the Care Homes Regulations 2001 of some notifiable incidents/accidents that have taken place in the home. A review of the accident records showed one resident had 17 incidents recorded for July and August 2007 and another resident 8 recorded incidents. There appears to be no audit of these records to show if any strategies could be put in place to minimise the risk to the residents or referrals to a falls clinic. A discussion highlighted these issues would be raised at the home’s monthly Health and Safety Committee meeting, however the minutes do not reflect any action to be taken or further review of these planned. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 26 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement Timescale for action 30/11/07 2. OP7 15(2)(b) 3. OP8 12(1)(a) (b) 4. OP10 12(3) Pre admission assessments must be undertaken and the outcomes of these must be clearly recorded to ensure the service can clearly meet the needs of the prospective residents. An audit of the care plans must 30/11/07 be carried out to ensure these accurately detail the actions required by staff to ensure that all aspects of the health, personal and social care needs of the residents are met. Daily entries must be linked to the care planned. These documents must be reviewed on a regular basis. 12/11/07 Nutritional and pressure care assessments must be clearly recorded and staff must action the strategies to be put in place where any concerns/risks about a resident’s weight or pressure areas are highlighted. Fluid and dietary records must be accurately recorded. Staff must ensure the personal 12/11/07 care needs of residents are paid attention to so the dignity of the DS0000006702.V345535.R01.S.doc Version 5.2 Broughton House Page 28 5. OP18 13 6. OP27 18 7. OP29 19(1)b Schedule 2 18 10. OP30 11. OP38 23 (4) resident is maintained. All staff must have training/guidance in the implementation of the Protection of Adults from abuse. The numbers and the skill mix of staff on duty must be sufficient to make sure that the residents accommodated receive the appropriate care to meet their needs. Appropriate recruitment procedures must be followed to demonstrate that appropriate action has been taken to minimise the risk to residents. Evidence must be provided that staff have undertaken the necessary training to ensure that it provides suitably qualified, competent and experienced staff to ensure the health and welfare needs of the residents are met. Training must include risk assessments and risk management. Fire alarm and fire safety checks must be carried out on a regular basis. 31/12/07 23/11/07 23/11/07 31/12/07 19/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Sufficient information must be provided to prospective residents for them to make an informed choice about admission to the home. This includes updating the Statement of Purpose and Service User Guide. It is recommended that relatives and their representatives DS0000006702.V345535.R01.S.doc Version 5.2 Page 29 2. OP7 Broughton House 3. OP7 are consulted as to how the resident’s needs are met. It is recommended that a separate form is used to record visits from health professionals to ensure the appropriate health support is provided. Broughton House DS0000006702.V345535.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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