Inspection on 10/01/06 for Broughton Lodge

This inspection was carried out on 10th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Broughton Lodge 10/10/06

Broughton Lodge 25/01/05

Broughton Lodge 29/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Broughton Lodge 88 Berrow Road Burnham-on-sea Somerset TA8 2HN Lead Inspector Jane Poole Unannounced Inspection 10th January 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 Lodge DS0000015971.V276837.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 Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Broughton Lodge Address 88 Berrow Road Burnham-on-sea Somerset TA8 2HN 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) 01278 782133 01278 782133 Mr Michael Matthews MRS MANDY MATTHEWS Mr Michael Matthews Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person under the age of 65. Date of last inspection 27th July 2005 Brief Description of the Service: Broughton Lodge is registered with the Commission for Social Care Inspection to provide personal care for 10 people over the age of 65. Nursing care is not provided. The home is a large older style house in Burnham on Sea. It is located within easy distance of the town centre and the sea front. All rooms are for single occupancy and are set over two floors with a stair lift between. All communal areas are on the ground floor and are accessible to all service users. The home is owned by Mr and Mrs Mathews and the Registered Manager is Mr Michael Mathews. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a four-hour period. The inspector was able to meet with staff and service users and observe care practices. The inspector was given unrestricted access to all areas of the home. The manager was available throughout the inspection, all records requested were made available and a sample of records were viewed. All staff and service users were welcoming and co-operative. Some standards have not been assessed on this occasion and this report should be read in conjunction with the inspection report dated 27/07/05. What the service does well: Broughton Lodge provides comfortable homely accommodation for service users. All areas seen were clean and well maintained. The size of the home means that, individual care is provided to all service users. This person centred approach is further enhanced by the excellent care plans and record keeping in the home. The quality of the care plans enables all staff to access very personalized information about service users. This includes people’s personal routines, their likes and dislikes and social histories. The documentation in the home gives evidence that physical and emotional health is monitored and advice sought where appropriate. All medical appointments are recorded. There is an extremely relaxed atmosphere in the home, which enables service users to raise any worries and concerns with staff or the manager. Service users spoken to stated that they continued to feel “in control” of their day to day lives. There are some organised activities in the home and constant interaction between staff and service users providing ongoing social stimulation. The inspector observed that staff were warm and respectful in their interactions and had obvious knowledge of each person as an individual. Service users were complimentary about the staff in the home saying that they were kind and always listened to their views and opinions. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 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 Lodge DS0000015971.V276837.R01.S.doc Version 5.1 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): 1, 3 & 5. The manager sees and assesses all prospective service users to ensure that the home is able to meet their individual needs. Service users have opportunities to spend time at Broughton Lodge before deciding to make it their home. EVIDENCE: There have been no changes to the statement of purpose or the service user guide since the last inspection. These documents continue to reflect the scope of the service offered by the home. Service users spoken to during the inspection stated that they had been able to visit the home prior to making a decision to move in. In addition to full residential care the home also offers day care and respite care which is an opportunity for prospective service users to spend time at Broughton Lodge before making a decision to move in on a permanent basis. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 9 All prospective service users are seen and assessed by the homes manager to ensure that they are able to meet the individual service users needs. The inspector saw copies of these pre admission assessments in personal files. The inspector was able to meet with the newest service user who stated that they had been given information about the home. They also stated that staff had “gone out of their way to make them feel comfortable and at home.” Broughton Lodge DS0000015971.V276837.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, 10 & 11. Care plans in the home give excellent, up to date information on each service user to enable staff to provide person centred care. Service users are treated with dignity and their privacy is respected. EVIDENCE: The inspector viewed the care plans of two service users. Both gave excellent information, which was personal to the individual. The inspector was impressed, as on previous occasions, with the level of personal details contained in the care plans. The plans give clear information about people’s preferred routines including the times that they like to get up, go to bed and small details about how they like their care to be carried out. This enables staff to deliver very person centred care to each individual. There is excellent liaison between the home and health care professionals in the area. All service users have annual health care checks with the GP and medication is reviewed on a regular basis. All appointments with medical professionals are clearly documented and these records show that service Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 11 users are accessing GPs, district nurses, chiropodists, opticians and dentists. Service users spoken to stated that staff assist them to attend appointments outside the home. The inspector has evidence that the staff at the home support people in hospital by visiting, assisting with admission and discharge and offering support to service users and their relatives. Care plans in respect of medical/physical needs are clearly written and give evidence that monitoring systems such as fluid balance charts and tissue viability assessments are put in place where appropriate. Pressure relieving equipment has been put in place in line with assessed needs. Staff spoke compassionately about the care that they offer to anyone that is dying. Families and friends are able to visit at any time of the day or night and additional staff are provided for people who have no family or friends to support them. Advice and guidance is sought from GPs and the district nursing team. Running records are maintained which highlight any significant events or changes in mood or physical health. On the day of the inspection a key-worker had arranged a meeting for a service user and their care manager to discuss changes in mood that had been observed by the care staff team. All service users spoken to were happy with the way that they were assisted with personal care. Everyone asked, stated that their privacy was respected and that they were comfortable with the staff who assisted them with intimate care. All service users have single bedrooms, all have wash hand-basins, four have en suite facilities. There are assisted bathrooms and communal toilets on both floors meaning that service users can access these facilities easily from their personal rooms. The home uses the Boots Monitored Dosage System for the administration of medication. There are appropriate storage facilities. The inspector viewed the Medication Administration Records and highlighted to the manager some minor errors in recording. Controlled drugs were viewed and records kept correlated to stocks held. At the time of this inspection no service users administered their own medication. Service users asked stated that they wished the home to be in control of their medication. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 12 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 & 15. The menu in the home is flexible and is determined by the wishes of service users. There is ample social stimulation in the home and opportunities for service users to take part in organised activities. Service users living at Broughton Lodge are able to determine their own routines. EVIDENCE: There are no set times to get up or go to bed and service users are able to decide how they spend their day. Service users spoken to stated that they still felt “in control” of their day to day lives. There are some organised activities in the home that service users are able to take part in if they choose to. Some service users continue to attend social clubs outside the home and one person stated that they like to go for a short walk each day. Individual interests are recorded in care plans. The home are in the process of building an additional communal lounge, which will give service users additional living space. A hearing loop is fitted in the Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 13 main lounge, and will be installed in the new area, to enhance the enjoyment of TV and music for those service users who wear hearing aids. Service users spoken to were generally happy with the level of activity in the home. Some people stated that they simply enjoyed the company of staff and other service users. The inspector was able to spend time observing care practices and noted that there is good interaction between staff and service users. There is a relaxed and informal atmosphere in the home with everyone appearing to enjoy chatting and socialising. Service users assist staff with the weekly shop and many stated that they very much enjoyed this outing and the personal time with staff. There is a key-worker system in the home, meaning that each service user has a named member of staff who takes a lead role in their care. Many service users stated that they had been assisted to go Christmas shopping by their key worker. On the afternoon of the inspection the weekly knitting session took place. This is organised by volunteers who come to the home and appeared to be another social occasion. Service users spoken to in a group were aware of local facilities and stated that they often attended events outside the home. Service users stated that visitors are always welcome at the home. Photographs seen showed that some regular visitors had been invited to have Christmas dinner with service users. All food in the home is prepared and cooked by the care staff, taking account of people’s individual likes and dislikes. There is a four week menu but service users said that they are always able to request an alternative. Service users who assist with the weekly shop stated that one of the pleasures of this was the ability to choose food which they liked. There is a dining room that is able to accommodate all service users. The inspector saw the main meal of the day. The food was well presented and appeared nutritious. Good stocks of fresh fruit and vegetables were seen in the store-room. All staff have completed training in food hygiene and those observed appeared competent in the kitchen. The main meal was relaxed and unhurried and again was a sociable activity for all. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 14 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 & 18. The relaxed and open atmosphere in the home means that service users are able to discuss any worries or concerns with the manager or a member of staff. Appropriate measures are in place to minimise the risk of abuse to service users. EVIDENCE: The home has policies on making a complaint, recognising and reporting abuse and whistle blowing. No formal complaints have been made since the last inspection. Service users stated that if they had any concerns or worries they would be comfortable to approach a member of staff or the manager. The home is familiar with the Somerset County Council “Safeguarding Vulnerable Adults” policy and this is discussed with all staff during their induction period. All staff are checked against the Protection Of Vulnerable Adults register and have an enhanced Criminal Records Bureau check before commencing work at the home. Because of the size and nature of the home any changes in behaviour, which may be indicative of a problem, would be quickly noticed and sensitively discussed with the service user. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 15 Service users have unrestricted access to their personal rooms and all communal areas. Service users appeared comfortable in their surroundings and were happy to talk with the inspector on a variety of subjects. Broughton Lodge DS0000015971.V276837.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, 20, 21, 22, 24, 25 & 26 Broughton Lodge provides a comfortable homely environment for service users. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 17 EVIDENCE: Broughton Lodge is a large Victorian house situated in Burnham on Sea. It is within easy reach of the town centre and the sea front. All areas seen by the inspector appeared well maintained and domestic in style. A fire detection and call bell system is fitted throughout the home. Service user accommodation is set over two floors with a stair lift between. Communal seating areas consist of a lounge and a dining room, these are both located on the ground floor and can be accessed by service users throughout the day and night. Since the last inspection a new lounge area has been built which will shortly be ready for use by service users. On the day of the inspection new furniture was being ordered for the lounge areas. Four of the ten bedrooms have en suite facilities consisting of a toilet and wash hand basin. All rooms have wash hand basins. There is a communal bathroom on each floor with appropriate assisted bathing facilities. Various aids and adaptations have been put in place to assist service users to maintain their independence, these include grab rails and clear signage. Baths are fitted with thermostatic controls to prevent the risk of scolding. Radiators are guarded and risk assessments have been carried out on upstairs windows and appropriate action taken to minimise risks to service users. Planning permission has been granted to extend the home to create a further 6 rooms. The inspector was given unrestricted access to all areas of the home. All areas are domestic in style and homely in appearance. Bedrooms have been personalised to reflect individual tastes and needs. There is a small laundry area, which is appropriate to the needs of the service users. This was seen to clean and well organised. There are no hand washing facilities in the laundry and this should be considered if the home chooses to extend. Appropriate hand washing facilities are in place where staff assist with personal care. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 18 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, 29 & 30. Staff have the skills to meet the needs of the service users living at the home. There is constant interaction between staff and service users, which is very much valued by service users living at the home. EVIDENCE: Care staff are responsible for all duties in the home including cooking, cleaning and laundry. Throughout the day there are two staff on duty. Overnight there is one member of staff on duty and a member of staff who lives on the premises provides sleep in cover. The managers’ hours are in addition to this. There is a set rota, which is displayed in the office. Staff spoken to, and observed, appeared committed to providing a high standard of care. They were well motivated and confident in their roles. Service users stated that staff were kind and always had time to chat. One person stated that the best thing about staff was that they “listen and don’t boss you around.” Staff commented that all staff work as a team and that there is good communication between staff. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 19 The high quality of the care plans gives staff the information to provide very person centred care and this was demonstrated on the day of the inspection. Staff stated that they have access to statutory training such as first aid, moving and handling, food hygiene and other health and safety subjects. Over 50 of the staff have an NVQ in care at level 2 or above and the home is currently looking for a provider to facilitate further NVQ training. Only one member of staff has been employed since the last inspection and the inspector saw evidence of a thorough recruitment process, which included written references and checks by the Criminal Records Bureau. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 20 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, 32, 33, 36 & 38. The manager provides a clear sense of direction to the home and offers ongoing supervision and support to staff. All areas of the home are well maintained providing a safe environment for service users. This safety would be further enhanced by the completion of risk assessments in respect of equipment being used by specific individuals. EVIDENCE: The joint proprietor and registered manager is Mike Mathews who has a National Vocational Qualification at level 4 (Registered Managers Award) The manager demonstrates excellent knowledge of staff and service users and is very much involved in the day to day running of the home. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 21 Staff receive six monthly appraisals but there are no other formal supervision sessions in place. However staff spoken to stated that the manager is always available for advice and guidance and provides ongoing supervision. All staff spoken to stated that they felt very well supported by the manager. Staff and service users described the management style in the home as very relaxed and open. All those asked felt that their opinions were sought and listened to. There are clear lines of communication between the manager and interested parties such as visiting professionals and families, and their views on the quality of care are sought. There are regular service user meetings. The inspector viewed the minutes of these which showed that service users views are sought on a variety of issues and that they have formal input into some aspects of the running of the home such as menu and activity planning. There is clear leadership in the home with a commitment to provide individual care to each service user. All records requested were made available and all seen were well maintained and up to date. The home has taken reasonable steps to ensure the health and safety of service users whilst maintaining a homely environment and ethos. There are regular safety checks of the environment and risk assessments are in place to minimise risks to staff and service users. One service user is currently using bedrails but no risk assessment was in place in respect of this. This was discussed with the manager who agreed without hesitation to carry out this assessment and put monitoring systems in place. All staff receive regular training in fire safety and clear records of this are maintained. There are weekly in house checks on fire detection equipment and the system is serviced 3 monthly by outside contractors. The inspector did not view the servicing records for equipment on this occasion. All accidents and incidents are recorded. All areas of the home viewed by the inspector were clean and well maintained. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X X 2 3 2 Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 23 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 OP38 Regulation 13 (40 [a][c] Requirement The manager must carry out a risk assessment on the bedrails used in the home. If the risk assessment confirms the use of bedrails, monitoring systems must be put in place to ensure their ongoing safety. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP26 OP36 Good Practice Recommendations The manager should regularly audit the Medication Administration Records to ensure that they are correctly signed. The manager should consider the improvement of hand washing facilities in the laundry if the home is extended. All staff should receive formal supervision sessions 6 times a year. Broughton Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Lodge DS0000015971.V276837.R01.S.doc Version 5.1 Page 25 - 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!