Inspection on 27/09/05 for Broughton House

This inspection was carried out on 27th September 2005.

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 18/10/07

Broughton House 10/05/06

Broughton House 19/02/06

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 Janet Ranson Unannounced Inspection 27th September 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V249929.R01.S.doc Version 5.0 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.V249929.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 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. 1st March 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Broughton House is a large detached Victorian property. The house has been extended and adapted over the years to provide residential and nursing care for up to 50 ex-servicemen over pensionable age. The property with grounds extending to three acres is located in a residential area within ten minutes’ drive of Manchester or Salford. A total restructuring and refurbishment project has recently been completed. The accommodation is provided on two floors with eight shared and 34 single rooms. The majority of rooms have en-suite facilities and are finished to a good standard. There are several lounge areas, including a library, that are located on the ground floor in addition to a large dining room which also doubles as a social area. There is a programme of activities, social stimulation and annual holidays arranged by a dedicated member of staff. The home is managed by a board of trustees and has charitable status. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over nine hours. The manager was present for the majority of this time. Broughton House is registered by the Commission for Social Care Inspection (CSCI) to provide nursing and personal care for up to 50 men over 65 years of age. The home is managed by a board of trustees and is a voluntary body with charitable status. The manager (matron) who was present throughout the inspection is registered with CSCI. In addition to teams of nurses and carers, the organisation employs domestic, catering, laundry, administration and maintenance personnel. Individual case files and care plans of five residents were examined as part of the inspection process. They concerned people who had lived at the home for a long time, were newly admitted and whose needs were changing. Wherever possible, the residents were invited to talk to the inspector of their experiences and expectations. The chief executive spoke with the inspector during the afternoon and three carers were interviewed. The inspector also spoke with the manager and a chef. Observations of staff practice were also made during the day. The residents made wholly positive comments, such as “the staff are wonderful”, “food is excellent” and “almost as good as home” when speaking to the inspector. The carers stated that they enjoyed working at Broughton House as it was “well organised” (when compared to previous experiences) and the staff worked well as a team. What the service does well: What has improved since the last inspection? Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 6 The restructuring and refurbishment project has been completed after almost two years of disruption. The end result being the removal of multi occupied rooms, the provision of en-suite facilities in the majority of rooms and a good standard of décor and furnishings. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Systems are in place to ensure the residents’ needs can be fully identified and met by the home. EVIDENCE: Care needs assessments were contained within the five care files examined as part of the inspection. The home also has a process of assessing potential residents’ needs carried out by a senior member of staff. The assessment is based on the aides to daily living. By completing and documenting such an assessment, the home can ascertain individual needs and ensure they can be met. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 9 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 The residents’ personal care, health and welfare needs are fully documented but it was not always clear that the resident had been involved in the process. Risk assessments were not in place to cover daily living tasks. The residents’ identified health needs are fully met by the various healthcare professionals and by the provision of specialist equipment. The home’s practice concerning the administration of medication is unsafe. EVIDENCE: At the previous inspection there was a requirement that the resident (or their representative) must be involved, wherever possible, in the care planning and reviewing process. It was not possible in every case to identify where involvement had occurred, although documents to this effect were present within each file they were not always completed. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 10 Risk assessments had been carried out concerning moving and handling, nutritional needs, falls and the likelihood of developing pressure sores. It was noted that some residents had electric kettles and, in one case, a small microwave oven in their rooms. This is considered to be good practice but the associated risk had failed to be recognised or documented. In the same way, there were no assessments of risk concerning other aspects of daily living. Where identified, the residents’ health is monitored and addressed by the appropriate health care professionals. Other healthcare professionals are involved on a regular basis, as are the chiropodist, audiologist and optician. A physiotherapist is employed by the home on a part-time basis. Specialist equipment to prevent pressure sores and aid independence was in evidence throughout the home. A local general practitioner (GP) carries out two clinics each week at the home, although the residents can retain their own GP where this is practical. Several residents stated that they were able to come and go as they chose, either independently or with assistance. It was apparent that the residents were encouraged to make independent decisions concerning their daily routines. An inspection of the administration of medications by a CSCI pharmacist inspector was carried out on 14th September at the request of the manager. Several issues of concern were identified and set out in detail in the subsequent report. The manager had devised an action plan, as requested, to meet the requirements. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 11 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): 13 & 15 Visitors are made to feel welcome and remain in contact with their relatives’ care. The residents are able to choose meals from a menu that is nutritious, well balanced and varied. The meals were nicely presented. EVIDENCE: During the inspection several visitors could be seen throughout the home. The residents who spoke with the inspector confirmed they had visitors at all times during the day and evening. One person especially enjoyed visits from members of the local community during the social evenings. The residents have access to their own bar, which is open during the evening, and a small shop. Broughton House has formed many links with local schools, places of worship and other organisations as part of the fund raising activities. As a result, the residents benefit from various social activities held both at the home and further afield. All the residents who spoke with the inspector, without exception, stated that the quality of the food was excellent and they looked forward to their meals. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 12 The staff told the inspector that they could also have a meal at a small cost and confirmed the high standard of cooking. The content of the menu was examined and discussed with the chef who confirmed the use of fresh meat, fish and vegetables. He was aware of the various likes, dislikes and dietary requirements and was obviously accommodating them during the evening meal. A resident who required support during the meal was assisted on a one to one basis, in a sensitive and caring manner. It was noted that meals could be taken in residents’ own rooms, (where some residents could also make their own hot drink), in the lounge areas or a large dining room. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 13 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): 18 The absence of formal training in the protection of vulnerable adults could result in a resident being placed at risk. EVIDENCE: It was apparent during the inspection that the manager was aware of the process to be taken in the event of an accusation of abuse. A discussion took place regarding this issue and the requirement for all staff to now receive formal and specific training in the protection of vulnerable adults. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 14 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, 25 & 26 Broughton House provides a warm, clean, safe and well-maintained environment with a good standard of furnishings and fittings. EVIDENCE: The residents who spoke with the inspector voiced their satisfaction with their accommodation. A resident invited the inspector to his room. He was rightly proud of the accommodation which reflected his interests. The main entrance into the home is accessible to visitors via a secure reception area. All visitors are requested to sign in and out of the building to comply with health and safety requirements. The grounds are fully accessible to the residents. Garden furniture was provided and some bedroom doors opened directly onto a patio area. Maintenance personnel are employed to carry out day-to-day repairs and drive the home’s transport. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 15 A physiotherapist is employed at the home on a part-time basis. Specialist equipment to prevent pressure sores is provided, where identified, by the home. A team of housekeepers is employed at Broughton House which was clean with no apparent offensive odours. The residents stated the home was usually maintained and cleaned to a high standard. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 16 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 The skills and competences of the staff meet with the identified needs of the residents. EVIDENCE: At the time of the inspection there were three first level nurses on duty including the manager (matron). They were supported by numbers of carers to adequately meet the needs of the residents. At interview the carers stated that the staffing levels were better than had been their previous experience. The rotas were drawn up well in advance and were available for inspection. A deputy manager had recently retired and it was reported that there were no plans to replace this person. It is considered that the manager should be supernumerary at all times, in order that she can carry out management tasks in a timely manner. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 36 The matron is appropriately qualified with skills and experience to manage Broughton House. There is no programme of formal supervision for the staff. Systems are in place to protect the residents’ financial interests and to ensure their health and safety at all times. EVIDENCE: The registered manager (matron) has completed her NVQ level 4 Management award. The matron is an RGN with many years’ experience at a senior level and demonstrates a commitment to further development. The carers who spoke with the inspector confirmed she was approachable and considerate. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 18 There is no programme of formal supervision for the staff. Advice was offered to the manager concerning this issue. The home employs a financial officer who is responsible for the residents’ personal allowances and fees. There are procedures to enable residents to maintain their own financial affairs. The home handles money on behalf of the residents. Records are retained to account for individual expenditure. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 19 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X 3 3 X 3 X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 2 X X Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 20 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 risks to daily living are recognised, clearly documented and reviewed. The registered person must ensure they comply with the requirements identified at a recent (14/09/05) inspection carried out by the CSCI pharmacist. The registered person must ensure that all staff receive training in the protection of vulnerable adults. The registered person must ensure that all care staff receive formal supervision at least six times a year. Timescale for action 01/12/05 2 OP7 13(4) 01/12/05 3 OP9 13(2) 01/11/05 4 OP18 13(6) 01/02/06 5 OP36 18(2) 01/02/06 Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 21 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 OP27 Good Practice Recommendations The registered person should consider a review of the management structure, to enable the registered manager to be supernumerary. Broughton House DS0000006702.V249929.R01.S.doc Version 5.0 Page 22 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. 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