CARE HOMES FOR OLDER PEOPLE
High Broom High Broom Road Crowborough East Sussex TN6 3SL Lead Inspector
Elaine Green Announced Inspection 18th October 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 High Broom DS0000021134.V249966.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. High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service High Broom Address High Broom Road Crowborough East Sussex TN6 3SL 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) 01892 654027 01892 665713 The Royal Surgical Aid Society Age Care Mrs Anita Louise Clarke Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. That a maximum of forty two (42) older people be accommodated. A maximum of thirteen (13) older people are accommodated in the close care cottages. That the service users are aged 65 years or over on admission. That one (1) service user can be accommodated aged between 60 and 65 years on admission as long as their individual needs can be met. 23rd June 2005 Date of last inspection Brief Description of the Service: High Broom is a large detached house set in extensive grounds in a quiet country lane on the outskirts of Crowborough. The home is one of a group of four homes run by Age Care, a charity that was formed in 1863 under the Royal Surgical Aid Society. Crowborough town is approximately one mile from the home, with access to local shops, banks and other services. There are rail services to London and bus services to Tonbridge Wells and Brighton. The home is currently registered for 42 older people that includes accomodating a maximum of 13 users in semi- independant cottages located within close proximity to the main house. The service users of the cottages choose how much contact they have with the other service users and staff, with meals and help with bathing in main house. Staff check on service users in the cottages in the morning and there is a call system. If the needs of the service users change over time, they can be admitted to the main house as vacancies occur. High Broom provides a comfortable home for service users. Independance and activities are promoted. A new extension to the lounge, new conservatory and front office were completed last year. A lift is available in the main house. High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection took place on the 18th November 2005 from 10 am to 5pm. As part of the Inspection service users and their relatives were given the opportunity to complete and return to the Inspector comment cards relating to the service received at the home. The Registered Manager completed a Pre Inspection Questionnaire, which provides information re staffing, health and safety and policies of the home. On the day of the Inspection discussions took place with the Registered Manager and the Head of Care re the day-to-day running of the home and the progress made towards meeting the requirements made at the last Inspection. The Inspector joined 4 service users for lunch and had discussions with a group of 8 service users in relation to their experience of living in the home. Other people with whom discussions were held included a health care professional, a relative and the chef. A range of documents and records were also examined including records relating to the assessment and care planning process, staff recruitment and training records and records relating to food. What the service does well: What has improved since the last inspection?
Pre admission assessments and care plans now contain all the information and guidance required by staff. Service users or their representative are involved in these processes and sign and date them. All Care Plans now follow the same format and are reviewed monthly. Recruitment procedures are being followed and all the relevant checks are undertaken prior to staff being deployed in the home.
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 6 A referral has been made for an Occupational Therapist to assess the home in respect of service users health and safety. 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. High Broom DS0000021134.V249966.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 High Broom DS0000021134.V249966.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): These standards were not inspected at this Inspection. EVIDENCE: High Broom DS0000021134.V249966.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. There is a clear and consistent care planning system in place. The health care needs of service users are well met with multi disciplinary working practice taking place on a regular basis. EVIDENCE: Six pre admission assessments and care plans were examined. The quality of the information contained within these documents is commendable and has improved greatly since the last Inspection. Documentation is detailed, relevant, up to date and accurate. Care plans now contain all the information and guidance required by staff in order for them to appropriately support service users in every aspect of their lives. The majority of service users or their representatives have signed their care plans. In one instance the service users’ own words had been used in part of the care plan, this is recognised as being good practice and should be encouraged. Those care plans examined had been reviewed on a regular basis. An examination of the care plans, service users’ daily records, pre admission assessments and discussions with the Head of Care, Registered Manager and a Health Care Professional confirmed that the health care needs of the service users are met. There is evidence of regular multi disciplinary working and that
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 10 referrals are made to the relevant health care professionals as required. The Health Care Professional stressed that they visited the home on a regular basis and that they had no concerns with the standard of care being delivered. They also stated that they felt that staff are well trained and the home is well managed and organised. Some of the feedback from service users’ relatives included a relative stating that that in their opinion “the home is excellent”, another stated, “The standard of care has always been appropriate. She is very well cared for, happy and content – we could not ask for more. The staff are excellent.” Another wrote, “They treat my mother with respect”. A friend of a service user commented, “ We are very impressed by the care provided. High Broom gives an excellent standard in maintaining the residents’ interest in a busy social programme.” A service user wrote, “ On the whole we are looked after very well…” “…things are well organised here and the home and staff do the best for us.” High Broom DS0000021134.V249966.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): 14,15. Service users are supported to exercise control over their lives. Arrangements for mealtimes are poor and need to be reviewed. EVIDENCE: Feed back from discussions with service users and the examination of care plans indicates that service users can exercise control over their lives and are supported to do so. The majority of service users handle their own financial affairs and where this is not the case this is specified in their care plan. Service users can bring their own furniture into the home and most have chosen to do so. Service users receive their own mail and the majority have opted to have a postal vote. All service users or their representatives are involved in the writing of their care plan and this is documented. The Inspector joined service users for lunch in the dining room. On the day of the Inspection the servicing of the main course took ½ hour and consequently some of the food was cold by the time it reached the table. There was no menu on display and staff did not interact with the service users. Feed back from service users and their relatives indicate that service users are not happy with the arrangements for the provision of food at meal times. A requirement is made for these arrangements to be reviewed to include full consultation with the service users as to their views and preferences re the provision of food.
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 12 High Broom DS0000021134.V249966.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): 16,17. Albeit the home investigates complaints appropriately, amendments to the complaints procedure are required. Service users legal rights are supported. EVIDENCE: Information gathered through comment cards indicates that a small number of service users’ relatives are not aware of the complaints procedure or of whom to go to if they have a complaint. There have been 15 complaints made in the last 12 months and investigated by the management team, 13 of which were substantiated and 2 partially substantiated. While it is recognised that the home follows their procedures in respect of investigating complaints, it is recommended that steps are taken to ensure that all service users and their representatives are made aware of this policy and procedure. It is also required that the complaints policy and procedures be amended to include the contact details for the Commission for Social Care Inspection (CSCI) this was a requirement made at the last Inspection Arrangements are in place for service users to have a postal vote where required. All service users have an advocate in the form of a friend or relative. Where it is needed arrangements are made for a power of attorney to take responsibility for service users finances and this is specified on their care plan. The requirement made at the last Inspection for the Adult Protection Alerting procedure to be updated remains to be met and a further requirement is made. High Broom DS0000021134.V249966.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): 19,20,25,26. The environment is safe, well maintained, comfortable, homely, clean, pleasant and hygienic. EVIDENCE: The home employs a full time gardener and 2 full time maintenance people. Service users stated that maintenance staff deal promptly with any maintenance required to their rooms. In addition to this the home also employ domestic staff, a laundry person, a chef and kitchen assistants. All the areas of the home Inspected on the day were found to be clean and tidy. The home is decorated and furnished in a comfortable and homely style. Service users commented that they appreciated being able to bring their own furniture with them. Service users have ample communal space enabling service users to have company or sit in quieter areas without having to return to their own rooms. Comprehensive risk assessments of all rooms have been undertake and are reviewed on a regular basis. The requirement for the home to be assessed by
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 15 an Occupational Therapist made at the last Inspection has not been met a further requirement for this to happen is made. High Broom DS0000021134.V249966.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): 27,28,29. The procedures for the recruitment, induction and training of staff are good and consistently followed. The high level of agency staff used by the home is having a detrimental affect on the quality of life of those residing in the home. EVIDENCE: Recruitment induction and training records were examined for 4 members of staff. This documentation showed that staff employed at the home undergo a comprehensive induction programme. Training provided ensures staff are aware of how to promote and protect the health, safety and welfare of service users. This home exceeds the minimum standards for staff to be trained to NVQ Level 2 in Care or above and provides regular training in specialist areas. Examination of staff rotas showed that there are sufficient numbers of staff on duty at all times but that a high number of agency staff are being used on a regular basis. The manager explained that this is due to recent problems in the recruitment and retention of staff and that they are doing everything they can to try to recruit regular permanent staff. In discussions with service users it was stated that while their care needs are still being met, they would prefer to be supported by staff with whom they have formed relationships with and who are more aware of their likes and dislikes. Feedback indicates that agency staff are able to undertake routine tasks but do not instigate activities or communicate with service users and that this is beginning to have a detrimental affect on their quality of life. Service users have been informed about the recruitment problems currently being
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 17 experienced by the home and stated that they understood why the home was using agency staff. High Broom DS0000021134.V249966.R01.S.doc Version 5.0 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): 33,35,38. This home is run in the best interest of the service users. Service users’ financial interests’, health, safety and welfare are protected. EVIDENCE: Documentation relating to quality assurance and quality monitoring systems were examined. Feedback is sought from family and friends of service users and other stakeholders on an annual basis in the form of a questionnaire. Group discussions take place with service users re their views on the running of the home and two have taken place this year. Comment cards received by the Inspector prior to the Inspection indicated that most service users’ relatives had been made aware of the Inspection though a small number had not. It is recommended that steps be taken to keep relatives and representatives aware of forthcoming Inspections and of Inspection reports. The Royal Surgical Aid Society updates policies and procedures every two years. The requirement for two policies and procedures made at the last
High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 19 Inspection had not been met. Other requirements made at the last Inspection have been met within the given timescales with the exception of the home being assessed by an Occupational Therapist. Documentation confirmed that referrals had been made and that they were still waiting for an appointment. Records relating to health and safety were examined and were found to be in order with the exception of records pertaining to fridge temperatures. It is required that advice be sought from the local Environmental Health Office re the safe storage temperatures of refrigerated food and that this advice is followed. A detailed risk assessment is undertaken for each room in the house on a regular basis and any hazards that are identified minimised. All staff receive statutory training in health and safety. High Broom DS0000021134.V249966.R01.S.doc Version 5.0 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 x x x x 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X x 3 X 3 X X 3 High Broom DS0000021134.V249966.R01.S.doc Version 5.0 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 OP15 Regulation 16 2i4 14 1a 15 1 16 2i 22(7) Sch 4(11) 17(2) Requirement Arrangements for the provision of food at meal times must be reviewed and include full consultation with service users. The complaints policy must be reviewed to include the correct contact details for the CSCI. Service users’ representatives should be made aware of the complaints policy and procedure. This is a requirement made at the last Inspection. Adult Protection alerting Procedures must be updated to be in line with local guidance. This was a requirement at the last Inspection. Steps must be taken to address the issues raised within the report in regard to the use of agency staff. Timescale for action 30/12/05 2 OP16 30/11/05 3 OP18 12(1a) 30/11/05 4 OP27 18(1,a) 30/11/05 High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 22 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 Refer to Standard OP33 OP38 Good Practice Recommendations Service users relatives or representatives should be kept informed of forthcoming Inspections and Inspection reports. Advice to be sought from the local Environmental Health Department re the safe storage temperature of refrigerated food. High Broom DS0000021134.V249966.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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