Inspection on 17/02/06 for The Broughtons Care Home

This inspection was carried out on 17th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Broughtons Care Home 16/10/07

The Broughtons Care Home 28/07/06

The Broughtons Care Home 10/10/05

The Broughtons Care Home 14/01/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

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 17th February 2006 11:20 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.V279863.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. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 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.V279863.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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` 10th October 2005 Date of last inspection Brief Description of the Service: The Broughton’s 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.V279863.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection for the year. It was carried out on 17th February 2006 from 11.20 am to 3.30pm. Time was spent talking with the manager, deputy manager, staff, residents and two residents’ relatives. 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 that this best reflected the function and purpose of the service. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how the home is meeting the needs of the residents. What the service does well: What has improved since the last inspection? Lots of things had improved since the previous inspection. The home had addressed most of the requirements made within the set time scale. The Improvements included: Residents’ needs assessments had improved and were detailed and person centred so that residents’ needs could be met in the way they preferred. Residents’ care plans had improved. The manager had provided staff with inhouse training on care planning and the revised care plans were found to be clear, detailed and reflected each person’s views and wishes about their care. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 6 The complaints procedure was improved and was more user friendly. Since the previous inspection, alcohol gel was in use to improve infection control. Recruitment practice, planning of staff training and staff induction had improved and residents benefited from being cared for by staff who were appropriately supported and trained. Since the previous inspection, most the staff had attended food hygiene training and this was planned for the remaining staff. Residents were protected by improved and robust fire safety procedures, including regularly completing fire safety checks. 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. The Broughtons Care Home DS0000062302.V279863.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 The Broughtons Care Home DS0000062302.V279863.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): 3 Prospective residents’ needs were assessed and assessments were person centred so that residents’ needs could be met. EVIDENCE: The home had worked hard to meet a requirement made at the previous inspection concerning improving needs assessments. The manager had used the National Minimum Standards to form headings of all the areas of needs which required assessing. The needs assessments sampled were person centred and gave a good reflection of how each resident’s needs could be met in the way that they preferred. This is good practice. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The residents’ care and health needs were well documented by the home in a person centred approach. However, some aspects of the care of medication and monitoring of residents nutritional needs/weight compromised the good practice. EVIDENCE: Five care plans were sampled. Requirements were made at the previous inspection concerning the need to develop and review existing care plans. It was evident that the managers and staff had worked hard to meet these requirements. The manager had provided keyworkers with in-house training on care planning through group work and individual one to one supervision. The revised care plans were found to be clear, detailed and person centred. Each care plan had a pen picture and the main care plan was divided into the main areas of need covered in the National Minimum Standards. The care plan monthly review sheet was an example of good practice. This was the case as it was based on the headings of the main care plan, so keyworkers were reviewing each aspect of needs and care every month. This is commendable. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 10 This good practice could be enhanced by archiving out of date documents when new care plans had been put in place, to reduce the risk of confusion. The need for each resident to have a nutritional assessment and for control measures to be identified when a resident is at risk through low body weight was discussed. One example was a resident who weighed 5 stone 7lb. This resident was said to eat a “good diet” but no further details were noted. Risk assessments were in place but they needed further development son that all risks applicable to an individual resident were assessed, including the risk of falls. These must be subject to consistent review to take account of any changes. A requirement was made accordingly. Medication was held in 2 medication trolleys, which were stored in a locked room. Good stock control measures were in place and controlled drug balances and records were accurate. However, some areas of practice in the administration of medication did have the potential to place residents at risk. Examples to support this concern included the staff who administered medication did not record on the MAR sheet the date, which had resulted in staff signing on the wrong column in one case. Some prescribed medication did not have full administration instructions for example a record stated, “to be used as directed”. The MAR sheet for one resident detailed that a prescribed medication should be taken twice daily. However, a hand written note had been added to the sheet which stated, “only takes at night”. For another resident, medication prescribed twice daily was been taken at teatime only, and a hand written staff message on the MAR sheet stated “prefers 20mls at teatime”. It was stressed that medication must be administered as prescribed and any prescribing changes must be made by the GP. The need to ensure that a care plan for the administration of “when required” medication, including Paracetamol was in place which confirmed why medication is prescribed and in what circumstances and for what conditions, PRN medication is given was discussed. A requirement was made accordingly. Residents spoken to said that they were treated with respect and that their rights were respected. Relatives spoken to confirmed that this was the case and care plans also reflected residents’ rights and choices. This is good practice. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 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): 15 Residents enjoyed a nutritious and appealing diet with alternative choices offered. This is a strength of the home. EVIDENCE: The chef was interviewed, menus were viewed and a number of residents were asked about food. At the time of inspection, a lunch of chicken curry and rice or Thai fishcakes with chips and peas was being served. The curry was sampled and found to be tasty and well seasoned so that it was not too spicy. Residents said that it was “lovely”. A record of food served was held. This included bacon and egg for one resident at lunchtime, who had always eaten bacon and egg on Friday and this had been accommodated by the home in addition to planned alternative choices. This is commendable. The chef said that he enjoys talking to the residents and making sure that he knows their likes and dislikes which helped him to meet their needs. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 12 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. Residents benefited from having a clear complaints and adult protection procedure. However, this would be enhanced by managers and staff having training in implementing the adult protection procedure. EVIDENCE: The home had revised the complaints policy and procedure in response to a requirement made at the previous inspection. The new procedure was user friendly. In response to a requirement made at the previous inspection, the complaints record had also been modified in the context of data protection to maintain the complainants’ confidentiality. Salford Council’s Protection of Adults from Abuse Policy was readily available at the time of inspection. A requirement to the effect that staff had training in its implementation had not been fully addressed and was repeated. The manager made a call to Salford Council to try to arrange this training at the time of inspection. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 13 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): 26 The residents benefited from a clean home, with good infection control measures. This good practice would be enhanced by the home meeting the requirements recently made by the environmental health officer concerning kitchen hygiene. EVIDENCE: The home was clean and tidy. Since the previous inspection, alcohol gel was in use to improve infection control. The home had been visited by the environmental health officer on 3rd November 2005 and requirements were made concerning kitchen hygiene practice. A requirement was made to the effect that these requirements were actioned. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 14 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): 28, 29 and 30. Residents were supported and protected by the home’s recruitment practices and by having caring staff who were themselves appropriately supported and trained. EVIDENCE: At the previous inspection, a requirement was made to the effect that the recruitment process must be reviewed so that appropriate references, employment histories and CRB checks are consistently taken. The file of a recently recruited member of staff was viewed and the manager was interviewed about staff recruitment to check whether this requirement had been met. The staff file contained all appropriate documents including 2 references and the POVA First and CRB check had been done. Recruitment practice had been reviewed in response to this requirement. At the previous inspection, 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 training e.g. in basic food hygiene. This had been addressed. Staff were receiving one to one supervision regularly and in response to a requirement made at the previous inspection, a documented staff induction process had been put in place. Since the previous inspection, most the staff had attended food hygiene training and this was planned for the remaining staff. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 15 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 and 38. Residents were protected by improved and robust fire safety procedures. However, the outcomes of quality assurance surveys and reviewing arrangements for holding and recording money held on behalf of residents did require a better audit trail. EVIDENCE: The home had a quality assurance process, which included the use of satisfaction surveys. These were kept in the hallway for people to take and complete. The results of these surveys had not been collated, analysed and put into a report. A requirement was made accordingly. The records of money held on behalf of residents were viewed. The home was not acting as an agent for benefit purposes and they received residents’ fees and personal allowances from the placing authority, Salford Council. It was evident from records that residents were receiving their personal allowance. The manager explained that when residents’ money builds up it is placed in The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 16 their individual savings accounts held with social services or in another bank account. Some residents had built up large sums of money held at the home which needed to be banked, the signatures of 2 members of staff needed to be used for all financial transactions made on behalf of a resident and individual receipts needed to be held consistently leaving a clear audit trail for all purchases made on behalf of residents. A requirement was made accordingly. At the previous inspection, requirements were made to the effect that the home needed an up to date fire risk assessment to be readily available and to consistently undertake and record checks of the fire alarm, means of escape and emergency lighting. These requirements had been fully met and a letter from the fire authority, dated 29/11/05, confirmed that the home was meeting fire safety standards. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 3 The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 and 15 Requirement 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. Timescale for action 22/03/06 2. OP9 13 Residents’ nutritional assessments must be detailed and clear and the home must also have recorded strategies where any concerns/risk about a resident’s weight exist. 22/03/06 The home must ensure that the management for the recording and administration of medication are carried out safely to maintain the health of residents. This includes:Administering medication as prescribed and ensuring that any prescribing changes are made by the GP or consultant. Ensuring that medication is signed for when given on the correct date on the MAR sheet. The care plan for the The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 19 3. OP18 13 4. OP26 16 5. OP33 24 6. OP35 16 administration of “when required” medication, including Paracetamol, must confirm why medication is prescribed and in what circumstances and for what conditions, PRN medication is given. The managers and staff must have training/guidance in the implementation of Salford Council’s Protection of Adults from Abuse Policy. The requirements contained within the Environmental Health Officer’s report of 3rd November 2005 must be actioned. The home must review and develop their quality assurance system to provide a verifiable method, which involves residents, to audit the service and report on the findings. Arrangements for managing the money of residents must be reviewed so that large sums of money held at the home are banked, the signatures of 2 members of staff are used for all financial transactions made on behalf of a resident and individual receipts are held consistently leaving a clear audit trail for all purchases made on behalf of residents. 22/07/06 22/03/06 22/07/06 22/03/06 The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 20 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 OP7 Good Practice Recommendations It is recommended that out of date documents are archived when new care plans are put in place, to reduce the risk of confusion. The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Broughtons Care Home DS0000062302.V279863.R01.S.doc Version 5.1 Page 22 - 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. 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