CARE HOMES FOR OLDER PEOPLE
The Broughtons Care Home 2 Moss Street Great Clowes Street Salford Manchester M7 1NF Lead Inspector
Helen Dempster Unannounced Inspection 10th October 2005 14:45 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 The Broughtons Care Home DS0000062302.V255792.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. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Broughtons Care Home Address 2 Moss Street Great Clowes Street Salford Manchester M7 1NF 0161 708 9033 0161 792 8144 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) Broughton Care Limited Mrs Doris Nordskog Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home provides accommodation for a maximum of 37 service users, who require care by reason of old age (OP) One named service user who is under 65, and requires care by reason of physical disability (PD) is accommodated. Should this be no longer required, this place will revert to the service user category (OP). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The staffing arrangements at the home must be maintained inline with the minimum staffing levels set out in the guidance published by the Residential Forum `Care Staffing in Care Homes for Older People` 14th January 2005 3. 4. Date of last inspection Brief Description of the Service: The Broughtons provides residential accommodation with personal care for up to thirty-seven (37) service users within the category of old age (OP). Accommodation is offered in 36 rooms, 35 single and one double, 31 of which have en-suite facilities. Lounge and dining facilities are located on the ground and first floors. These are arranged in group-living situations accommodating 8 or 9 people. The home is situated in a residential area of Salford close to local amenities and transport systems. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on 11th October 2005 from 14.45pm to 7.15pm. Time was spent talking with the manager, deputy manager, staff and residents. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the running of the home, the management arrangements, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as “residents”. It was felt this best reflected the function and purpose of the service. What the service does well: What has improved since the last inspection?
Since the previous inspection, the home had introduced a residents’ shop. This had been well received by residents.
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 6 Since the previous inspection, all staff had received training in moving and handling and some staff had attended first aid training, updated fire training and COSHH training. This demonstrated a commitment to staff training. What they could do better:
Overall, residents’ needs were assessed and documented. However, the home needed to revise the needs assessment format so that all aspects of residents’ needs were more fully assessed and information from the needs assessment needed to transfer to the care plan in sufficient detail. Residents’ needs were not documented in sufficient detail in the care plans. Risk assessments were in need of development and the review of care plans and risk assessments was not frequent enough to consistently update changing needs on the records. Staff needed training and guidance in care planning. Each resident needed to have a care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given. Residents enjoyed a nutritious and appealing diet. However alternative choices needed to be offered. The home’s complaints policy and procedure needed simplifying and making specific to residents and their relatives/advocates. The complaints record was a communal record and needed to be modified in the context of data protection to maintain the complainants’ confidentiality. The staff needed training in the implementation of Salford Council’s Protection of Adults from Abuse Policy. There was evidence of the availability of a range of staff training, but this needed to be consistently audited and planned so that training, including mandatory training, did not lapse. The home needed to review recruitment practice concerning the taking of references, employment histories and CRB checks. A staffing audit was also needed to identify which staff did not have up to date mandatory training e.g. in basic food hygiene and the home needed to have a documented staff induction process. The home did not have an up to date fire risk assessment readily available and was not consistently undertaking and recording checks of the fire alarm, means of escape and emergency lighting. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 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. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 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 The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Overall, residents’ needs were assessed and documented. However, the home needed to revise the needs assessment format so that all aspects of residents’ needs were more fully assessed and information from the needs assessment needed to transfer to the care plan in sufficient detail. EVIDENCE: The home had a copy of the care manager’s assessment readily available for all residents funded by a local authority. The needs assessments contained basic information, including the details of the G.P and next of kin. Background information about the prospective resident’s life, including place of birth, former occupation and family circumstances, were detailed in the examples viewed. This is good practice as it provides staff with some insight into what is important to each resident. The needs assessments were held with the care plan, but some of the information on the needs assessment was not linked to the care plan. Overall it was felt that the needs assessment format would benefit from review to include all the information required by Standard 3. Advice was given and a requirement was made accordingly. The home does not provide intermediate care.
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 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 and 8 Residents’ health, personal and social care needs were not sufficiently detailed in the care plans and risk assessments were not frequently reviewed. The limited detail in the care plan and reviews of the risk assessments had the potential to compromise the resident’s having their needs fully met by the home. EVIDENCE: The care plans included basic information, next of kin details and details of personal care. Records of medical treatment and visiting professional visits, including optical and chiropody were included in day-to-day records, but were difficult to locate. The manager said that she planned to record medical details on a separate record to allow ease of access to this information. Overall, it was evident that staff needed training and guidance in care planning. In particular, care plans included vague terms including “good diet” rather than specific information about nutritional needs. While general risk assessments were in place concerning the premises, the use of wheelchairs etc, these needed review to include all risks applicable to an individual resident, including the risk of falls. Advice was given concerning this
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 11 and a requirement was made accordingly. Care plans had not been consistently reviewed. One example was records of occasions where a resident displayed some aggression towards staff, yet this issue was not addressed in a care plan or risk assessment. A requirement was therefore made concerning the need to review care plans and risk assessments on a monthly basis. Medication practice was not fully assessed during this inspection and will be assessed at the next inspection. However, the need for each resident to have a care plan for the administration of medication, including ‘when required’ (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given was discussed and a requirement was made accordingly. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 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 and 15 Visiting arrangements were appropriate and residents’ recreational interests were accommodated where possible. A particular strength of the home was providing additional staff, at peak times, who spent one to one time with residents. Residents enjoyed a nutritious and appealing diet. However alternative choices needed to be offered. EVIDENCE: The home has an open visiting policy and residents confirmed that the home welcomes visitors. Local churches visit the home on either a weekly or monthly basis. Residents talked about an entertainer that they enjoyed. The manager said that he visits the home every 2 months. A range of in house activities including bingo, jigsaws etc are available. One of the strengths of the home is their use of students on work experience, who the inspector observed spending one to one time just chatting with residents. As these students are not involved in the delivery of personal care, and are in addition to the staff provided, they do have time to spend with residents and residents benefited from this. Staffing rotas were designed to allow an overlap of staffing between the hours of 12.30 pm and 3pm. This enabled staff to take individual residents out to the shops, or one case to a weekly visit to a hairdresser in the community. The home also provides a hairdresser who visits the home on a weekly basis.
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 13 Since the previous inspection, the home had introduced a resident’s shop. This had been well received by residents. The home has a 4-weekly rotating menu which offers a varied and wholesome diet. The manager stated that alternative choices are offered, but this was not documented on the menu and there was no record to document choices being offered. A requirement was made accordingly. Residents said that the food is good. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 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 and 18 The complaints procedure needed amending to make it more user friendly and the complaints record needed modifying so that the confidentiality of the complainant was maintained. Staffs’ lack of training in the implementation of the ‘Protection of Adults from Abuse Policy’ had the potential to compromise residents’ safety. EVIDENCE: The home had a complaints policy and procedure. However, this was complex and not user friendly and referred to staff grievance issues. It needed simplifying and making specific to residents and their relatives/advocates. A requirement was made accordingly. A complaints record was held, but this was a communal record and needed to be modified in the context of data protection to maintain the complainants confidentiality. A requirement was made accordingly. Salford Council’s Protection of Adults from Abuse Policy was readily available at the time of inspection. The manager said that staff had not had training in its implementation and a requirement was made accordingly. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 15 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 and 26 At the time of the inspection, the environment was clean, comfortable and homely, with no unpleasant smells. EVIDENCE: A partial tour of the premises was conducted and the home was found to be clean, comfortable and homely. The residents said that they were happy with their rooms and lounges. The home is maintained by the employment of a handy man on a full time basis. Accommodation is offered in 36 rooms, 35 single and one double, 31 of which have en-suite facilities. Lounge and dining facilities are located on the ground and first floors. Bedrooms were personalised and residents are encouraged to bring in their personal effects. The Broughtons Care Home DS0000062302.V255792.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 and 30 Adequate numbers of staff were deployed appropriately to meet residents’ needs and residents benefited from the use of students on work experience at the home. There was evidence of the availability of a range of staff training, but this needed to be consistently audited and planned so that training, including mandatory training, did not lapse. Some aspects of the recruitment process had the potential to put residents at risk. EVIDENCE: Staffing rotas for week ending 09/10/05 were viewed. Minimum staffing levels to meet the needs of the 37 residents were 3 carers plus a senior member of staff at all times during the day. However, staffing rotas were designed to allow an overlap of staffing between the hours of 12.30 pm and 3pm, which meant that 6 carers plus a senior member of staff were available between these hours. As noted earlier, a strength of the home is their use of students on work experience, who the inspector observed spending one to one time just chatting with residents. As these students are not involved in the delivery of personal care, and are in addition to the staff provided, they do have time to spend with residents and residents benefited from this. A number of staff files were viewed. Good practice included holding a photograph of the staff members on their file and holding copies of the confidentiality, health and safety and equal opportunities policies on each staff file, which had been signed by each individual to note their understanding. However, some staff did not have 2 references, references were often accepted from friends and the last employer was not approached for a reference in all
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 17 cases. In addition, the employment history taken was not consistently dated and was incomplete and was not always checked for unexplained gaps. The home was not making clear notes of the candidates’ answers at interview. A requirement was made to the effect that the recruitment process must be reviewed accordingly to ensure residents safety. Overall, CRB checks were appropriately made. However, in one case a staff member had been employed without a new check, as she had bought a copy of a fairly recent check made by a former employer with her. This practice must cease and a requirement was made accordingly. Since the previous inspection, all staff had been trained in moving and handling, some staff had attended first aid training and updated fire training and COSHH training had been provided for some staff. This demonstrated a commitment to staff training. The manager was advised of the need to complete a staffing audit so that she was able to identify which staff did not have up to date mandatory training e.g. in basic food hygiene. A requirement made at the previous inspection about staff training was repeated and a further requirement was made to the effect that a full audit of training, including mandatory training was undertaken to facilitate planning of training so it did not lapse and advice was given on this auditing process. Staff were receiving one to one supervision on a 2 monthly basis but the home did not have a documented staff induction process. A requirement was made accordingly. The Broughtons Care Home DS0000062302.V255792.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): 31 and 38 The manager behaved in a competent and professional manner during the inspection. The safety of residents and staff could be compromised by not undertaking the full range of fire safety tests and the fire risk assessment not being readily available as a working tool for staff. EVIDENCE: At the time of inspection, the manager had an open and professional approach to advising staff and demonstrated a commitment to staff training. She had almost completed her NVQ 4 Management Qualification. She said that she was well supported by Mr Scott, the managing director of Broughton Care Ltd. At the time of the visit, the home did not have an up to date fire risk assessment readily available and was not consistently undertaking and recording checks of the fire alarm, means of escape and emergency lighting. Immediate requirements were made to the effect that the advice of the fire
The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 19 department was sought on the completion of a fire risk assessment for the home and fire safety checks must be consistently undertaken of the fire alarm, means of escape and emergency lighting and the outcomes recorded in the fire log book within 36 hours of the inspection. The Broughtons Care Home DS0000062302.V255792.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 The Broughtons Care Home DS0000062302.V255792.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 OP3 14 Standard Regulation Requirement The needs assessment format must be reviewed so that it includes all the information required by Standard 3. Timescale for action 30/11/05 2 OP7 13 Care plans must be reviewed and 30/11/05 developed to include specific details of individual resident’s needs and the plans must be reviewed on a monthly basis. 3 OP7 15 and 18 Staff must receive training and guidance in completing care plans. 30/01/06 4 OP7 13 and 15 Risk assessments must be in place to assess all risks applicable to an individual resident, including the risk of falls. These must be subject to consistent review to take account of any changes. 30/11/05 The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 22 5 OP9 13 A care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given must be in place for each resident. Alternative menu choices must be offered and documented. The complaints procedure must be clear and user friendly to enable people to make complaints and the complaints record must be modified in the context of data protection to maintain the complainants’ confidentiality. The managers and staff must have training/guidance in the implementation of Salford Council’s Protection of Adults from Abuse Policy. A documented staff induction process must be in place. 30/11/05 6 7 OP15 16 30/11/05 30/11/05 OP16 22 8 OP18 13 30/01/06 9 10 OP28 18 30/11/05 OP29 18 11 OP30 18 The recruitment process must be 30/11/05 reviewed so that appropriate references, employment histories and CRB checks are consistently taken. 30/11/05 A full audit of training, including mandatory training must be undertaken to facilitate planning of training so it did not lapse The registered person must ensure that all staff receives mandatory training, including basic food hygiene and that copies of up to date certificates are kept on staff files.
DS0000062302.V255792.R01.S.doc 12 OP30 18 and 13 30/12/05 The Broughtons Care Home Version 5.0 Page 23 13 OP38 23 The home must obtain the advice of the fire service concerning the completion of a fire risk assessment for the home. Fire safety checks must be undertaken and the outcome recorded consistently. This includes weekly checks of the fire alarm and means of escape and monthly checks of the emergency lighting. 13/10/05 14 13/10/05 OP38 23 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 31 Good Practice Recommendations The registered manager must obtain NVQ level IV. The Broughtons Care Home DS0000062302.V255792.R01.S.doc Version 5.0 Page 24 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
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