Inspection on 19/02/06 for Broughton House

This inspection was carried out on 19th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 18/10/07

Broughton House 10/05/06

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 Kathleen Mcall Unannounced Inspection 19th February 2006 11:30 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.V278413.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 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.V278413.R01.S.doc Version 5.1 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.V278413.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. 27th September 2005 Date of last inspection Brief Description of the Service: Broughton House is a large detached Victorian property, which is registered to provide residential and nursing care services for up to fifty ex service men. The registered manager is Mrs Lisa Connolly. The home is managed by a board of trustees and has charitable status. Broughton House was first established in 1916, the home has recently completed a major refurbishment programme. 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. There is a library on the ground floor and there are plans to install a computer with internet access for residents use. 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. Broughton House is situated is located in a residential area within ten minutes’ drive of Manchester or Salford. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over the course of a Sunday afternoon. The lead nurse on duty accompanied the inspector throughout the inspection process. Care plans, assessment documentation, medicines and their storage were examined. The inspector spoke with several residents who were in the home at the time of the inspection and spoke with members of staff. The registered manager was not on duty at the time of the inspection. Consequently staff on duty did not have access to all the required documentation. Residents told the inspector that they were very happy with the care they received. One resident told the inspector ‘I’m very well cared for’ and said that care staff were helpful and very approachable. Other residents told the inspector that they felt comfortable living at Broughton House because it was for service men and that they felt there was a common bond amongst the residents. Several residents told the inspector that they were very pleased with the food provided. The inspector had a discussion with a relative who was visiting the home at the time of the inspection. The relative told the inspector that she was very satisfied with the way in which the home was meeting her relatives care needs and described care staff as being polite and helpful. The inspector spoke with several members of staff who were on duty and observed that staffs approach towards service users was sensitive and caring at all times. What the service does well: Broughton House is a large home. Despite this it has a relaxed and friendly atmosphere and offers a flexible routine based around the needs of the residents. It provides a good standard of care in a pleasant, well-maintained and clean environment. Residents appeared to be well cared for and supported by a trained and competent workforce. Residents spoke positively about their time at the home and spoke highly about care staff at the home. Care staff had a relaxed and friendly approach towards residents and good banter between staff and residents was evident. Assessment and care planning arrangements were good. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 6 Residents spoke positively about the food and were pleased with the choice and variety on offer. What has improved since the last inspection? What they could do better: The registered manager must ensure that residents or their relatives are consulted when drawing up a care plan. Presently nursing staff have overall responsibility for care plans and did not consult with the resident to confirm their agreement and satisfaction with the way in which their care needs were being met. Similarly with risk assessments the registered manager where possible must consult with residents when drawing up risk assessments. At the time of the inspection it was identified that there was a small number of residents who did not have a relative or a representative who was acting independently on their behalf. Many residents were placed at the home from areas outside of Salford and Manchester and social services departments were no longer involved. These residents need to be provided with advice and information on local advocacy group and agencies. Car staff at the home still did not receive formal supervision. This had been a requirement at the last inspection and the registered manager had failed to address it. Since the last inspection a small number of care staff had completed training in the protection of vulnerable adults. Further training was planned for the remaining staff group. The staff must have training in the protection of vulnerable adults. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 7 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. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 8 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.V278413.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Service users care needs were fully assessed before admission. EVIDENCE: Several new service users had been admitted to the home since the last inspection. As part of the inspection a selection of service user files were examined. These contained a sufficient amount of assessment information in respect of each service user. It was the practice of the home that service users were assessed prior to their admission. Assessments were obtained from social workers and health professionals if they had been involved in the admission and no service users were admitted to the home without their care needs having been assessed. The home also completed its own assessment, which was very detailed and formed the basis of the service users care plan. Service users told the inspector that they were quite satisfied with the way in which the home met their care needs. The needs and preferences of service users were recognised and met by care staff. Care staff demonstrated a good understanding of service users care needs. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Service users health and personal care needs were identified through care planning and met by care staff. EVIDENCE: All service users had a care plan. Care plans seen were individualised to each service users’ care needs with information held in one accessible document. Care plans included health needs, personal care needs, mobility, social interests, and risk assessments. Care plans and risk assessments were reviewed on a monthly basis or more frequently if needed and any changes were included. It had been a requirement at the previous inspection that service users and or their representative must be involved, wherever possible, in drawing up a care plan and involved in the reviewing process. Whilst the home had put in place a form for relatives to sign that confirmed they had been involved in the assessment and care planning process and confirming their agreement with the care plan provided, in all files sampled none of the forms had been completed. No such form existed for service users. Care plans seen at the time of the inspection had not been signed by service users. Staff confirmed Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 11 that this did not happen and that nursing staff completed care plans based on information obtained during assessment process. Daily records were detailed and gave a full picture of how the home was meeting service users care needs and how service users had spent the day. Since the last inspection risk assessments had greatly improved and were now in place in respect of those service users who had electrical equipment in their bedrooms. Other risk assessments were in place that addressed the risks presented by service users who smoked in their bedrooms and for those service users who went out alone despite being at risk of falls. None of the risk assessments had been signed or dated by the service users. service users should sign their risk assessment to confirm their involvement in discussions and their understanding of the risks and concerns identified. Broughton House had specialist equipment in place to meet the needs of service users living there. The home had its own General Practioner who visited the home twice per week. Service Users’ could still retain or find their own GP if they wished. The home employed a physiotherapist. Medication practice at the home was assessed in response to requirements made by a pharmacist inspector following the previous inspection. Service users medication was supplied in their original bottles by the supplying pharmacy, this was stored appropriately. Medication records were in the main accurately maintained with the exception of handwritten medications, which must be verified by a second member of staff. Two service users managed their own medication. Risk assessments were in place to support this practice and were reviewed on a monthly basis. Service users medication was supplied in a Vena link system however this was not appropriately labelled and staff could not identify individual medications. Three service users were on a controlled drug. The storage and recording of this was appropriate. The home had a secure dedicated refrigerator for the storage of medication requiring refrigeration. Several service users had been prescribed creams, which care staff applied, and nursing staff then ticked the MAR chart to confirm that the cream had been applied. It is not appropriate for nursing staff to tick MAR charts as confirmation that creams had been applied. The use of cream charts in service users rooms may be an alternative to consider but must be referenced on the MAR chart. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 12 Service users told the inspector that staff treated them well and they were very satisfied with the care they received. Care staffs approach towards service users was observed to be respectful, sensitive and caring at all times. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The day-to-day routine of the home including mealtime arrangements was relaxed and informal and met service users needs. EVIDENCE: The day-to-day routine of the home was relaxed and flexible with some service users preferring to spend time in their rooms and others using the lounge areas. Service users said they could get up and go to bed at times that suited them and that the day was theirs to spend how they choose too. The home employed an activities coordinator Monday to Friday. Throughout the week there was an extensive programme of activities on offer at the home. Service users confirmed that they could choose whether to join in or not. No formal activities were organised at the weekend, as the home was very busy with visitors. Visitors were made welcome at the home and service users kept in touch with family and friends. There was a small number of service users who did not have a relative or a representative. Many service users had moved to Broughton House from areas outside of Salford and Manchester and social services departments were no Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 14 longer involved. The home must provide for those service users who do not have a relative or a representative, information on advocacy services. The home employed a financial officer who was responsible for residents’ personal allowances and fees. Meals were served at regular intervals and were usually taken in the dining room areas, though service users did have the choice of having their meals in their bedrooms. Several service users told the inspector that they had enjoyed their lunch. Other said the food was ‘very good’ and that a good choice and selection was provided. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users felt confident that their complaints would be taken seriously and acted upon. Staff had begun to undertake appropriate training in adult protection, which ensured the protection of service users. EVIDENCE: Service users with whom the inspector spoke said that they knew who to complain to if they had a problem and all felt confident that the problem would be resolved in a satisfactory manner. Complaints records were not available at the time of the inspection. The home had a procedure for responding to allegations of abuse. It was a requirement at the last inspection that all care staff completed training in the Protection of Vulnerable Adults. At the time of this inspection ten members of staff had completed such training. Further training on the Protection of Vulnerable Adults was scheduled to take place in spring. Care staff with whom the inspector spoke demonstrated a good understanding of the issues around adult protection and were clear about their responsibility with regard to reporting abuse and poor practice. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 The home was well maintained and provided comfortable living accommodation for service users. EVIDENCE: The home was well maintained throughout and provided comfortable accommodation. A number of service users rooms were seen, these were also furnished and equipped to a comfortable standard, many had been personalised by the occupants. The home was clean, tidy, bright and airy throughout and was free from any unpleasant odours. The grounds are fully accessible to the residents. Garden furniture was provided and some bedroom doors opened directly onto a patio area. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. The home was sufficiently staffed with a staff group that was trained to undertake their duties. EVIDENCE: At the time of the inspection the home was sufficiently staffed with a staff that was trained to meet the assessed needs of service users. A staff rota showing, which staff were on duty and in what capacity, was kept at the home. At a previous inspection it was recommended that the registered manager should be supernumerary at all times, in order that she could carry out management responsibilities. Since the last inspection the registered manager had addressed this. Care staff on duty at the time of the inspection confirmed that they had undertaken training to assist them in their role as carers including POVA training, incontinence care, first aid, moving and handling and fire safety. Care staff confirmed that they had completed induction training at the commencement of their employment. An NVQ assessor was visiting the home at the time of the inspection. Several members of staff were completing training in health and safety and the safe handling and administration of medicines in care homes. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36, 38 Care staff were not adequately supervised. The health and safety of staff and service users was safeguarded through regular training. EVIDENCE: Staff had updated their training in safe handling and moving procedures, fire safety, food hygiene and health and safety. The home recorded information in respect of falls and accidents by service users. This information was regularly reviewed and monitored to see if patterns were evident and measures to address emerging patterns were put in place. It had been a requirement at the previous inspection that all care staff must receive formal supervision at least six times a year. At the time of this inspection it was observed that the registered manager had not addressed this requirement and care staff were still not receiving formal supervision. Staff Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 19 told the inspector that informal supervision took place on a daily basis at handover between staff and that annual appraisals had begun to take place for nursing staff. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 20 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 3 Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The registered person must ensure the residents and/or their relatives are fully involved in the development and review of their care plans. (Previous timescale of 01/05/05 not met). The registered person must ensure that all risk assessments are signed and dated by the service user, or their relative and a member of staff and are reviewed on a regular basis. Policies and procedures must be updated to reflect the updated safer medication handling procedures. The registered person must ensure that handwritten recordings on MAR charts are checked and signed by a second member of staff. The registered person must ensure that monitored dosage systems received by the home for service users who manage their medication are appropriately labelled with a description of medication contained. DS0000006702.V278413.R01.S.doc Timescale for action 01/05/06 2. OP7 13(4) 01/05/06 3. OP9 13(2) 01/05/06 4. OP9 13 19/02/06 5. OP9 13 19/03/06 Broughton House Version 5.1 Page 22 6 OP14 12(2) 4. OP18 13(6) 5. OP36 18(2) The registered person must 19/05/06 ensure that those service users who do not have a relative or a representative are provided with information on advocacy services and how to access them. The registered person must 01/05/06 ensure that all staff receive training in the protection of vulnerable adults. (Timescale of 01/02/06 not met) The registered person must 01/05/06 ensure that all care staff receive formal supervision at least six times a year. (Timescale of 01/02/06 not met.) 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 OP9 Good Practice Recommendations The registered person should consider the use of cream charts for care staff to complete following the administration of creams. Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broughton House DS0000006702.V278413.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!