CARE HOMES FOR OLDER PEOPLE
Broughton Lodge 88 Berrow Road Burnham-on-sea Somerset TA8 2HN Lead Inspector
Stephen Humphreys Key Unannounced Inspection 10th October 2006 09:30 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.V315118.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 Lodge DS0000015971.V315118.R01.S.doc Version 5.2 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.V315118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one named person under the age of 65. Date of last inspection 10/01/06 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. Broughton Lodge is located close to the town centre and the sea front in Burnham –on-Sea. Public transport passes the home for the town centre and on to Weston-super-Mere or to Highbridge. Broughton Lodge Care Home is a large detached house set in its own grounds with a well kept garden to the rear and a tarmaced drive for at least three vehicles set with a small lawn and trees to the front. The front of the home faces Berrow Road. The outlook from the front is clear and bedrooms at the rear of the home look onto the garden. 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 residents. Access to the home is through the main front door. The home is owned by Mr & Mrs Mathews and Mr Michael Mathews is the registered manager. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first key inspection for 2006/2007 carried out by the Commission for Social Care Inspection. The inspector used the Inspecting for Better Lives methodology which is a method of assessing quality outcomes for residents through the service delivery. The inspector collects evidence on how the service meets the social and personal care needs of residents and makes a judgement on the quality of the service delivered. All of the evidence collected for this inspection was gathered from resident survey forms, health professional’s comments and a visit to the home. The outcome of the inspection identifies how well the service has done in meeting or exceeding the national minimum standards for older persons. The format of the inspection involved the inspector carrying out pre-inspection surveys amongst residents and other visiting health professionals. The results of the surveys were discussed with the registered manager. The site visit was carried out on the 9th October 2006 by one inspector. The inspector had an opportunity to talk in detail with the registered providers and residents in the home. Discussions on the service were also held with members of staff. What the service does well:
Broughton Lodge provides comfortable homely accommodation for residents. The accommodation is in single rooms most with en-suite over two floors. All areas seen were clean and well maintained. Individual care is provided to all residents. This person centred approach is supported by detailed care plans developed with the resident and efficient record keeping by the registered manager and staff. The comprehensive care plans enable all staff to access information that details the current state of the resident. This includes people’s personal routines, their likes and dislikes and social histories. The care plans provide recorded evidence that physical and emotional health is monitored and advice sought where appropriate. All medical or hospital attendances are recorded with appropriate outcomes. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 6 There is an extremely relaxed atmosphere in the home, which enables residents to raise any worries and concerns. Comments from residents included “I don’t have any complaints, I don’t think I would need to”. Residents spoken to stated that they continued to feel “in control” of their day to day lives. Organised activities take place in the home with constant interaction between staff and residents 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. The registered manager and staff are complemented on the depth of knowledge they have acquired on each resident. Residents were complimentary about the staff in the home saying that they were kind and always listened to their views and opinions. What has improved since the last inspection? What they could do better:
The registered manager should ensure the window openings in bedrooms on the first floor are restricted to meet health & safety guidelines.
Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 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 Lodge DS0000015971.V315118.R01.S.doc Version 5.2 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 Lodge DS0000015971.V315118.R01.S.doc Version 5.2 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): 1,2,3,5 The quality in this outcome group is good. Prospective residents can be assured that the registered provider will provide sufficient information about the service to enable them to make a choice. EVIDENCE: The registered manager spends a significant amount of time with prospective residents / relatives giving them the opportunity to spend time in the home. The staff are able to provide support and respond to individual needs for information. The statement of purpose is not on display in the home however all the staff are very informed and are able to provide detailed information verbally. The registered manager will provide a copy of the service user guide to prospective residents / relatives. One resident said, “I came here, I chose it myself, I thought it was the best place to be looked after”. Information about the home is displayed on the wall near to the front door along with photographs of activities and a who’s who of the staff. In addition to full personal care the service provides day care and
Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 10 respite care which is an opportunity for prospective residents to spend time at Broughton Lodge before making a decision to move in on a permanent basis. A copy of the home’s terms & conditions was reviewed during the visit. Relatives or residents representatives have a copy that includes the services offered and the fees payable. The current fee ranges from £361 to £450 per week. Not included in the fee are hairdressing, chiropody, newspapers, optician and dental costs. Residents are not accepted into the home until the registered manager has carried out a needs based assessment and identified that the home and resident are compatible. The registered manager will discuss the care needs with the relatives and other health professional’s to enable the skilled staff to maintain a quality service that meets individual needs. One member of staff said that there are no routines in the home, the work is done around meeting the residents needs. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 11 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 The quality in this outcome group is good. Residents can be assured that skilled and experienced staff will meet all their individual health and social care needs. EVIDENCE: The care plans of three residents were reviewed in detail and four other care plans were checked for content. The care plans reviewed in detail were of residents with complex personal care needs. The care plans were very detailed and person centred. The comprehensiveness of the care plan provides staff with all the personal and health care information needed to provide a quality service. The outcomes for residents are the assurance of their well-being. 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 person centred care to each individual. There is excellent liaison between the home and health care professionals in the area. All residents have annual health care checks with the GP and
Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 12 medication is reviewed on a regular basis. All appointments with medical professionals are clearly documented and these records show that residents are accessing GPs, district nurses, chiropodists, opticians and dentists. The registered manager and staff said that none of the residents attend a hospital appointment unaccompanied. The registered manager said that the staff at the home support people in hospital by visiting, assisting with admission and discharge and offering support to residents and their relatives. One resident who is being supported to visit a relative in hospital confirmed this. 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. All residents 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 that assisted them with intimate care. One comment received stated, “I get all I want and I’m happy here, I wouldn’t want to be moved” another said, “They are very kind and thoughtful”. The receipt, storage, administration and disposal of medicines were reviewed at this visit. Controlled drugs were checked and found to be correct. No problems were found with the medicine procedure. All staff that administers medicines have received appropriate training from an accredited trainer. This promotes good practice and resident safety. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 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): 12,13,14,15 The quality in this outcome group is excellent. Residents are able to enjoy a full and stimulating life style. EVIDENCE: There are no set times to get up or go to bed and residents are able to decide how they spend their day. There are organised activities in the home that residents are able to take part in if they choose to. One resident attends a lunch club outside the home and one person stated that they like to go for a short walk each day. One resident attends a social centre twice a week, other residents like to go shopping supported by the staff. The registered manager said that social outings have improved during the summer. Residents are accompanied on walks along the sea front. A hearing loop is fitted in the lounges to enhance the enjoyment of TV and music for those residents who wear hearing aids. The activities programme is displayed. Regular events in the home include a knit-a-thon, cards and bingo. Some people stated that they simply enjoyed the company of staff and other residents. Comments included “I enjoy knitting the
Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 14 most and doing puzzles”, “I enjoy cards the most” and “I love sitting in the garden the most because I love the fresh air”. The registered manager is providing a placement for a work experience student who has developed an exercise programme that the residents enjoy. The programmes are individually tailored to enable the resident to benefit from the exercises. There is a relaxed and informal atmosphere in the home with everyone appearing to enjoy chatting and socialising. Residents 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 resident has a named member of staff who takes a lead role in their care. Residents stated that visitors are always welcome at the home. 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 residents said that they are always able to request an alternative. Residents 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 residents. 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 storeroom. 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.V315118.R01.S.doc Version 5.2 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): 16,17,18 The quality in this outcome group is good. Residents are assured of protection through up to date policies and experienced staff. EVIDENCE: Staff are familiar with the Somerset County Council “Safeguarding Vulnerable Adults” policy which is discussed 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. The complaints procedure is clear and up to date. Residents are aware of how to make any concerns known and who they can inform. Staff spoken to were aware of the whistle blowing and vulnerable adults procedure. The Commission for Social Care Inspection or any other placing authority have not received any complaints about the service in the last twelve months. Residents said they were satisfied with the service and felt very safe. One comment received stated, “I don’t think I would need to make any complaints” A copy of the letter requesting postal voting rights was seen in each care plan reviewed. Information on how to obtain advocacy services was available to residents. No vulnerable adult incidents have been reported to the Commission for Social Care Inspection or social services.
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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): 19,26 The quality in this outcome group is good. Broughton Lodge provides a comfortable homely environment for residents. EVIDENCE: All residents have single bedrooms, all have wash hand-basins, and four have en suite facilities. There are assisted bathrooms and communal toilets on both floors meaning that residents can access these facilities easily from their personal rooms. The internal environment is warm and cosy. The registered provider has replaced furniture and carpets since the last inspection. Risk assessments are in place and regulatory valves are fitted to all hot water outlets. Comments received included, “oh yes it’s very clean here, if it wasn’t I would run away”.
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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 The quality in this outcome group is good. Residents can be assured of trained and experienced staff to meet their care needs. EVIDENCE: The registered provider is in the home daily and works as part of the team. Residents and staff all said they are one happy team and all work together. The duty rota is based on a four-week cycle. One member of staff lives in and is always available to assist if needed. The registered manager has a highly developed recruitment procedure. The staff turnover is very little in this home with many staff being there for many years. The registered manager places a high priority on training and provides opportunities for all staff. Residents complemented all the staff in the home. Staff have the skills to meet the needs of the residents living at the home. There is constant interaction between staff and residents. Staff files reviewed contained all the required checks and information. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 20 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. Staff spoken to, and observed, appeared committed to providing a high standard of care. They were well motivated and confident in their roles. One comment 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. Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 21 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): 31,32,33,35,36,37,38 The quality in this outcome group is good. The registered manager provides a clear sense of direction to the home and offers ongoing supervision and support to staff. EVIDENCE: The joint proprietor and registered manager is Mike Mathews who has a National Vocational Qualification at level 4 (Registered Managers Award) The registered manager demonstrates excellent knowledge of staff and residents and is very much involved in the day-to-day running of the home. There is a strong ethos of being open in the running of the home. Residents are involved through meetings. The policies and procedures are robust and reflect the working of the home. The registered manager reviews and updates them as required.
Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 22 Staff receive six monthly appraisals but there are no other formal supervision sessions in place. However staff spoken to stated that the registered manager is always available for advice and guidance and provides ongoing supervision. All staff spoken to stated that they felt very well supported. Staff and residents 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 registered manager and interested parties such as visiting professionals and families, and their views on the quality of care are sought. There are regular resident meetings. The inspector viewed the minutes of these recording residents views 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 resident. Resident’s monies kept for safekeeping are recorded and kept separately. The credit / debit records are signed appropriately. Two records were checked and the monies counted. Both were correct. All records requested were made available and all seen were well maintained and up to date. The registered provider has taken reasonable steps to ensure the health and safety of residents 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 residents. 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 viewed the service records for equipment. All accidents and incidents are recorded. All areas of the home are well maintained providing a safe environment for residents. The registered manager does promote safety through good practice however the window openings above ground floor should be restricted to meet health & safety guidelines (health & safety in care homes. P35.col2.195) Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 23 Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 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 3 3 x 3 3 3 3 Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action 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 OP38 Good Practice Recommendations The registered manager should ensure window openings are restricted to Health & Safety guidelines on all windows above ground floor. (197. Any windows that are accessible to vulnerable service users (2m above ground level), can be opened and are large enough to allow people to fall out should be restrained sufficiently to prevent such falls. It is advisable to restrict the opening to 100mm (NHS Guidance). Broughton Lodge DS0000015971.V315118.R01.S.doc Version 5.2 Page 26 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
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