Care Home: Broad Acres Residential And Nursing Home

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What the care home does well The people we spoke with and the feedback we received confirmed that the residents were satisfied with the personal care and the daily lifestyle choices provided by the home. One relative said, `Age and disability are the main issues for me. These are dealt with well, as all the residents seem to be given this same care, attention, and consideration`. Two residents` said, `I like the people here, I am well looked after`, and `This is a friendly place and everybody is good to me`. Peoples` medical and nursing care was provided by the home in a way that met their personal healthcare needs. Care plans checked described their care needs and wishes, and which was provided to them in the way that they wanted. Medicines were administered as directed, appropriately recorded and usually accounted for by the nursing staff. The respect for residents at the home was summarised by a relative who said, `I am quite happy as my relative is treated with kindness and respect`, and this comment reflected many of these received. The daily lifestyle activities provided for residents were varied and enjoyed by them. A number of positive comments were received about the good work of the activities coordinator, and the opportunities for day trips outside the home. The meals provided were said to be `good basic meals`, which most residents said there was a choice, and were enjoyable. Complaints and adult safeguarding matters were managed appropriately, and the home ensured that quality assurance was undertaken to receive feedback from the residents, to improve the services offered. The staff group was found appropriately managed, and significant levels of training had been provided within the last year, which would ensure that staff had the skills and training to meet the specialised needs of the residents. The home environment was found to be appropriately maintained, and people said that it was clean, tidy and usually odour free. The management team continued to monitor health and safety issues. What has improved since the last inspection? Since the last key inspection in April 2007, the home has fully addressed the previous 18 requirements. This was also evidenced by a random inspection completed in January 2008. Concerns around moving and handling techniques had been addressed and significant staff training had been provided for most staff members. Record keeping including training records were well organised. Environmental concerns had been addressed including improved security of the laundry room and COSHH cupboard, and the provision of a new cleaners cupboard. The home`s grounds were maintained, including the repair of one of the boundary fences. The doors and narrow hallway walls had been better maintained, and unpleasant odours had mostly been addressed. Systems were now in place to ensure that all medication could be fully audited by the nursing staff. Staff recruitment records were more complete What the care home could do better: The home has largely addressed many of the previous concerns, and has demonstrated improvements to many aspects of its service. One key requirement is that the home must ensure the staff rota provides an accurate record of the staff members` on each duty. The following issues are recommendations for best practice, and the home is invited to consider these in the development of its future service. Care staff numbers, and ratios to residents should be kept under review; to ensure there are always sufficient numbers of staff to meet the residents` specific care needs. A monthly record of fall trends should be kept to evidence ongoing management monitoring of falls. Kitchen staff should ensure rigorous cleaning schedules are adhered to, to ensure that the risk of cross-infection is avoided. CARE HOMES FOR OLDER PEOPLE Broad Acres Residential And Nursing Home Leiston Road Knodishall Saxmundham Suffolk IP17 1UQ Lead Inspector Kevin Dally Unannounced Inspection 25th April 2008 09:00 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 Broad Acres Residential And Nursing Home DS0000024345.V363086.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. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broad Acres Residential And Nursing Home Address Leiston Road Knodishall Saxmundham Suffolk IP17 1UQ 01728 830562 01728 830417 Broadacres@kowlessur.wanadoo.co.uk 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) Mrs N Kowlessur Mr K Kowlessur Care Home 48 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (48) of places Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 20 in the category of Dementia Date of last inspection 31st January 2008 Brief Description of the Service: Situated in a village, within walking distance of the local shop, Post Office and Public House, Broad Acres is a care home with nursing, registered to care for up to 48 older people. This includes 20 places for people with dementia. The home consists of a single storey building, although set in large gardens, there is access to the enclosed gardens, as this is via residents’ bedrooms and an external gate. Mentally frail residents would need to be supervised using the large gardens, at the side of the home. However, there are courtyards, which can be used, which residents can freely walk about. There are 34 single bedrooms and 7 shared bedrooms. All bedrooms have a wash hand basin, 12 of which also have en-suite toilets. There are 4 bathrooms and a shower room, located close to the bedrooms. Communal rooms consist of 2 lounges, 1 dining room and 1 dining room/lounge. Some of the corridors are narrow, and would not be suitable for wheelchair users. Weekly fees range from £415 – £450.00 Residential and/or care of people with dementia, £520.00 to £570.00 Nursing and /or care of people with dementia. Fees include care, nursing (where applicable) accommodation and food. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced key inspection was undertaken on the 25th April 2008, between 9:00am and 6pm. This was a key inspection that assessed the core standards relating to elderly service users, some who also have dementia. The report has been written using all the information gathered prior to and during the inspection including information from the Annual Quality Assurance Assessment (AQAA), provided by the home. The AQAA gives the service the opportunity of recording what they do well, what they could do better, and what has improved in the previous twelve months, as well as future plans for improving the service. Mrs. Kowlessur, the owner, Mr Christopher Banks, general manager, Mrs Olayinka Bakare, the acting manager, one of the nursing staff, and some of the care assistants provided us with additional relevant information about various aspects of the home. The care and nursing support provided by the home for the residents was inspected to see if this met their personal support needs. Current moving and handling procedures were assessed to check that people are transferred in a safe way, and that the medication practises of the home ensure medicines are administered to residents in a safe and timely way. Daily lifestyle opportunities for residents were observed including whether residents are offered choices, and are included in the decisions that affect their lives. Residents’ records were inspected to assess if these provided an explanation of the care needed, and to confirm if the care delivered, was in the way the resident wanted. The accident and incident book was examined to access the way in which the home monitors falls. Staff recruitment procedures and the staff rota was inspected to access if there were sufficient staff numbers to meet the residents’ care and support needs. The complaints and quality assurance procedures were inspected to assess how the home manages this processes. Residents, relatives and staff members told us what it was like living at the home, and whether the service was meeting their support needs and expectations. Feedback was received from residents (28), relatives/advocates (20), and staff (24) who answered a number of standard questions about life at the home, and a selection of their views and comments are included Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 6 throughout the report. Some residents, relatives and staff were spoken with directly at the inspection. Three staff members’ records were inspected, including staff training and the supervision practises of the home. What the service does well: The people we spoke with and the feedback we received confirmed that the residents were satisfied with the personal care and the daily lifestyle choices provided by the home. One relative said, ‘Age and disability are the main issues for me. These are dealt with well, as all the residents seem to be given this same care, attention, and consideration’. Two residents’ said, ‘I like the people here, I am well looked after’, and ‘This is a friendly place and everybody is good to me’. Peoples’ medical and nursing care was provided by the home in a way that met their personal healthcare needs. Care plans checked described their care needs and wishes, and which was provided to them in the way that they wanted. Medicines were administered as directed, appropriately recorded and usually accounted for by the nursing staff. The respect for residents at the home was summarised by a relative who said, ‘I am quite happy as my relative is treated with kindness and respect’, and this comment reflected many of these received. The daily lifestyle activities provided for residents were varied and enjoyed by them. A number of positive comments were received about the good work of the activities coordinator, and the opportunities for day trips outside the home. The meals provided were said to be ‘good basic meals’, which most residents said there was a choice, and were enjoyable. Complaints and adult safeguarding matters were managed appropriately, and the home ensured that quality assurance was undertaken to receive feedback from the residents, to improve the services offered. The staff group was found appropriately managed, and significant levels of training had been provided within the last year, which would ensure that staff had the skills and training to meet the specialised needs of the residents. The home environment was found to be appropriately maintained, and people said that it was clean, tidy and usually odour free. The management team continued to monitor health and safety issues. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broad Acres Residential And Nursing Home DS0000024345.V363086.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 Broad Acres Residential And Nursing Home DS0000024345.V363086.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 The quality in this outcome area is good. People using the service can expect the home to provide relevant information about the service, so that they can decide whether it can meet their needs. They can also expect that staff will have the essential skills to meet residents’ care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service users’ guide was checked and this provided essential information from which potential residents and their relatives could make a decision about whether the home would be suitable for them. Key information included the aims and objectives of the home, the specific services they can offer, contract information, and how to make a complaint to the home, if residents’ expectations are not met. Feedback received from 17 of 20 residents confirmed they had received enough information about the home to help them decide if this was the place for them. Three residents did not say. One relative said, ‘Broad-Acres always keeps me informed and updated with relevant information’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 10 The AQAA said, ‘All prospective service users are visited by a senior member of staff who have been trained in Broad-Acres assessment policies to ensure that their identified needs will be met on admission to the home. All prospective service users and their relatives are always invited to visit the home prior to any admission. Service users are invited to spend a day in the home before deciding whether or not to choose Broad-Acres as their home’. Three residents’ care records checked showed that a care assessment had been completed for each person. This included assessment of their previous medical history, nutritional information, personal care needs, risk assessments, social information, and challenging behaviour needs. This information would help the home in the planning and production of a plan of care to describe the person’s particular care needs. One relative said, ‘We have plenty of contact with the staff. I feel I’m well informed and consulted about my relatives needs’. Broad-Acres provides care for people who are elderly, over the age of 65 years old, with places for residential, nursing, or people with dementia. Care staff included registered nurses, and around 20 care workers, who worked under the nurses’ direction. There was evidence that staff had been trained and/or had some experience in meeting the needs of the residents. For example staff training records showed that nursing staff had received some specialised training, for example, PEG feeding. This is when staff feed a resident liquid food using a tube. Staff had also received training around challenging behaviour training, safeguarding training, code of conduct, continence care training, communication training and dementia care. The building was adequate and entirely on the ground floor, but some areas have narrow corridors that can cause access problems. This is further discussed under the outcome group, ‘environment’. The home continued to provide a range of suitable activities for residents, including some social days out. The new activities co-ordinator was seen moving throughout the home motivating residents and encouraging a range of activities. Comment cards were received from 28 residents, and when asked, ‘Do you receive the care and support you need, 21 said ‘always’, 4 said ‘usually’, 1 said ‘never’, and 2 did not say. Relatives (20), who had completed and returned the comment cards, 15 said that the care home ‘always’ met the needs of their relative, and 5 stated, ‘usually’. The following is a selection of residents and relatives comments around the care provided by the home. ‘ I receive the care when I need it’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 11 ‘I am very well looked after’. ‘I feel the home do a very good job of looking after my relative’. ‘This home is very good compared with the previous care home. Standards are high, staff are friendly and attentive’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The quality in this outcome area is good. People can expect to have their health and personal care needs met in a dignified way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One relative said, ‘We had a very helpful meeting with senior staff to review our relative’s care plan. The discussion was helpful as we were able to get a detailed programme of their care and daily activities. We were also given the opportunity to discuss my suggestions we had on our relative’s care’. The care plans provided for 3 residents were checked, including one with diabetes, one who had dementia, and one with continence care needs. Time was also spent with 2 of these residents to check the level of support written in the care plan, reflected the level of care given. The care plans provided detailed guidance for staff and included a medical history, a care plan map, an assessment of their care needs, and details of how to meet the resident’s personal care needs. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 13 The care plan for the resident with diabetes provided specific nutritional information around their insulin dependence, risk assessment screening, personal hygiene needs, pressure area advice, a bruise chart, mental capacity assessment, and a mobility assessment. The care plan for the resident with dementia included information around their support needs, a holistic care plan, a behavioural assessment, a nutritional assessment, their personal profile, risk assessment, falls assessment, personal information, and an activities programme. These plans showed that the home undertake and provide a detailed assessment of each residents nursing care needs. The care plans seen related to the specific needs of each individual, had been reviewed monthly, and a record had been maintained of any care changes. There was evidence of reviews, which included the resident and their family, and residents had signed each care plan, to confirm their agreement with the plan of care. One resident told me their health had improved since they had moved into the home, and they expressed their satisfaction with the nursing care received. On arrival at the home, the atmosphere was calm and unhurried, with staff working hard attending to the residents’ needs. Some residents were in the day rooms and some remained in their bedrooms. Residents were found well groomed, and looked appropriately cared for. The home was mainly odour free with the exception of one resident’s room, where an unpleasant odour was noted. Staff responded to a request to investigate the cause of this. Domestic staff were seen working their way around the home completing their morning cleaning routines, and rooms seen were found clean and tidy. Day rooms were neat and tidy, clean and odour free. Drink trays with cold drinks were located in each day room, and staff were seen offering residents drinks throughout the day, in addition to morning and afternoon teas. A number of residents were observed being hoisted by staff into their chairs. Two staff were in attendance and good explanations about what was to happen were given, which enabled transfers to be safely completed. Residents appeared calm throughout each transfer. Three residents’ records checked had full moving and handling risk assessments in place that provided detailed staff guidance. The accident records were checked and were found appropriately recorded. During the period from April 2007 to March 2008, 175 accidents had been recorded, an average of around 14 per month, and these were mostly one off incidents. A check looking for any trends of residents’ falls during January to March 2008 showed only two residents with more than 2 falls, and did not exceed more than 5 falls per person. Each fall was documented within each resident’s file, so that the home could observe if there were any particular trends for that individual. There was one notification to the CSCI within the last 12 months where a resident had sustained a serious fracture after a fall. The resident was transferred to hospital for medical care. Fall risk assessments and Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 14 bruise charts were found in place in the residents’ care plans. The management said that they do monitor falls, which was confirmed by individual residents’ records, but there was no summary of overall fall trends within the records. One resident seen with slight bruising on their face, their accident/bruise records were checked, which recorded how this accident had occurred. The home’s system for storing, recording, auditing, dispensing and disposal of medication was checked, which was found adequately maintained. The home continues to receive medicines in weekly dossett boxes directly from the pharmacist; with any medicines unable to be dispensed into the containers, are sent in their original packets. Medication received is entered onto the home’s medication administration records (MAR) charts, and would be signed by the receiving nurse. The nurse was shadowed at the lunchtime medicine round and 3 residents’ records and medicines were randomly chosen to audit. These records checked showed that staff had signed for each medicine in the records. An audit of each of the medicines checked showed that with one exception, the number of medicines in the containers equalled the number recorded during the weekly administration period. The only discrepancy showed that there was one extra tablet within one of the audited medicine bottles. The home needs to ensure that all medicines are able to be accounted for, to ensure that the residents are kept safe and free from medicine errors. The controlled drug (CD) cupboard was found securely maintained, and one CD was checked against the records. This was found to be correct and was appropriately accounted for. The nurse spoken with was able to answer questions around medicine procedures. The fridge in the medicine room was checked and a record of the daily temperature readings was found maintained. Although staff were constantly busy during the morning period, they were observed to provide care, and allow time to meet residents’ individual needs. Staff were seen talking with residents during the morning, and residents were particularly responsive to the home’s activities co-ordinator, who spent quality time working with individual residents. Laughter and fun was had during these activities. Residents were treated with respect, and staff were responsive to requests for assistance. Care was provided in the privacy of their room. Call bells were answered promptly. Feedback received from residents and relatives around the care provided by the home, was as follows. Residents (28) when asked, ‘Do you receive the medical support you need?’ 24 said ‘always’, 2 said ‘usually’, one said ‘sometimes’. One did not say. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 15 Residents when asked ‘do staff listen and act on what I say?’, 26 said ‘yes’, 1 said ‘no’ and 1 did not say. Further, 22 residents said ‘staff are “always” available when they needed them’, 4 said ‘usually’, 1 said ‘sometimes’. One did not say. Relatives (20) when asked, ‘Does the care home meet the needs of your relative?’ 15 said ‘always’, and 5 said ‘usually’. All relatives with one exception said they were ‘always’, kept up to date with important issues that affected their relative, and that their relative ‘always or usually’ received ‘the support or care that they expected or had agreed’. Nineteen of 20 relatives said the support or care staff ‘always’ have the right skills and experience to look after people properly. A selection of views received from residents and relatives about the care provided by the home included the following comments. ‘I receive the care and support, when I need it’. ‘I am well looked after’. ‘The person I see appears to be happy and settled, and usually “sings the praises” of the staff. Their appearance is clean and their hair is washed and set on a regular basis’. ‘My relative has aged and prefers to be on their own. When placed near to some residents in the dayroom, who are sometime noisy (a condition they cannot help) this irritates my relative’. ‘My relative requires full nursing care and health issues are dealt with by their doctor. They are assisted with eating and drinking’. ‘Staff are always aware of the needs of my relative who has dementia. Staff respond appropriately and in a friendly way, even when my relative is rather demanding’. ‘There is a strong emphasis on caring for the individual and understanding their needs. Residents are kept warm, well fed and there is a genuine concern for them’ ‘All residents are treated with dignity. There are no restrictions on visiting and staff are friendly to visitors’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. People using the service can expect staff to support them with a choice of lifestyle activities including leisure pursuits, social opportunities, and contact with families and friends. They can also expect to be offered a choice of meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives made the following comments about the lifestyle opportunities provided by the home. ‘I have always been very impressed by the outings, which I knew my relative enjoys. We were delighted to be able to share a Christmas dinner with them, at Sutton Hoo. Visitors are always made very welcome, and the staff are friendly and helpful. We also enjoyed the fireworks party, and the summer fate’. ‘The staff treat residents with the respect they deserve, and try to keep them active in mind and body. They provide a variety of games and music and trips out for the more independent’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 17 During the morning, time was spent speaking with some of the residents and relatives, who were visiting at the home. The daily routines and activities were also observed. The home had a calm and unhurried atmosphere, and staff were seen talking with the residents. The residents I spoke with said the home was a good home, the staff were friendly, and that their rooms were kept neat and tidy. Some relatives told me that they frequently visited and were always made to feel welcome by the staff. One resident had a view over the garden area, and kept a group of garden plants and flowers by their door. They also enjoyed reading. They said that while there was no set ‘rising time’, they preferred to start the day at around 7am. The resident said if they wanted to sleep in, staff would respect their wishes, and return to help them at a later time. The resident said they liked to be independent, so preferred to manage their own care in the morning, but staff would assist them, if this was requested. During the morning the activities coordinator was seen initially working with a group of more vulnerable residents, in one of the home’s lounges. A variety of exercises and stimulatory activities were being encouraged, for example, hand stretching exercises, ball catching etc. These residents were clearly happy to join in, while also enjoying a lively chat with the people around. Another resident was provided with a bible reading, and later someone was assisted to read a newspaper. Staff told me that the home ensured that residents had access to leisure activities and these included piano playing, quizzes, monthly trips outside the home, for example Eastern Farm Park, newspapers, books, and mini games. Feedback received from 28 residents when asked, ‘Are there activities arranged by the home that they could participate in’, 17, replied ‘yes, always’, 8 said ‘usually’, 1 said ‘sometimes’, and 2 did not say. The home runs a rotating menu, copies of which were seen, and pictures of most menus choices were available on the tables within the dining room. Menu ‘choice sheets’, which gives information on the menu choices, are completed for/by each resident on a daily basis, and recorded. The advertised lunch menu on the day of the inspection was a choice of fried or poached fish, or sausages and gravy, served with mushy peas and chips. A small sample of the fish provided to me was tasty and appropriately cooked. Dessert was crème caramel or ice cream. Supper (tea time) was soup of the day, beans on toast or assorted sandwiches, cheese and biscuits, and cake and fruit. The range of hot menu choices over the previous week included mince pie, gammon steak or omelettes, chicken pie or sausages, cottage pie or ham and cheese salad, toad in the hole or corned beef, and vegetable and cheese bake. Drinks were available and seen throughout the home, with residents being encouraged by staff to take drinks during the day. The kitchen staff maintained Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 18 a ‘food likes and dislikes’ record with key information around peoples’ food preferences and choices. This was found not to be up to date for some of the new residents. The food trolley in the dining room was checked, and was noted to have some stains on the lids, which looked slightly unsightly. The management said that the home’s washing processes had caused these. There were signs of small amounts of crumbs in the hot trays, which requiring further cleaning by the kitchen staff. Some concerns were raised about the kitchen staff placing hot food in the hot containers too early, which may lead to food drying out. However, management confirmed that environmental guidelines were being followed, so they considered that this was not a concern. Kitchen staff must ensure rigorous cleaning schedules are adhered to, to ensure that the risk of infection is avoided. One of the dining tables we sat at required further cleaning, due to a sticky tabletop surface. Twenty of 28 residents said they ‘always’ liked the meals at the home, 4 said ‘usually’ and 2 said ‘sometimes. Two did not say. Residents and relatives provided additional comments about the home and a selection of their views are included as follows. ‘I go on outings to Aldeborough, as I like the sea’. ‘Yes, I am able to do activities in the home. They are very nice’. ‘I love the meals, and never have any problem’. ‘I do not like the kippers, stew and dumplings’. ‘My relative has poor vision, so the home provides stories, news and music on a disc. The newspaper is read to them and they enjoy a “sing-a-long”, when played on the piano’. ‘We have been pleased since our relative was admitted, but the employment of the activities organiser, Bernard, has been an excellent appointment’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The quality in this outcome area is good. People living in the home can expect that their concerns and complaints would be listened to, investigated and action taken as necessary and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints policy is contained in the home’s statement of purpose and user guide. The policy explains that complaints will be processed within 10 working days or a shorter period. The guide informs the reader, that they can speak to a staff member, their Social Worker, or the owners to make a complaint. Since the previous inspection the home had not received any complaints. Relatives made the following comments about making a complaint to the home. ‘I have had to only make a few verbal comments in the past 5 years’. ‘I have not had to make any complaints, but the home checks regularly that all is OK, and if we have any problems’. ‘If I am worried, then they always try to sort the problem out’. Feedback received from 16 of 20 relatives said that the home had responded appropriately if they or the person using the service, had raised concerns about the care. One said ‘usually’, and 3 did not say. All residents said they Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 20 knew who to speak to, if they were not happy. Seventeen of 20 relatives confirmed they were aware of the how to make a complaint to the home. The home had an adult safeguarding policy to ensure staff knew what to do if they suspected any abuse of a resident. This included how to report their concerns to the management team. Staff records checked confirmed they had received adult safeguarding training. Since the previous inspection there had been one referral to adult safeguarding around the moving and handling of a resident. At the time of the incident, the home had investigated the concerns, and concluded that staff had used incorrect moving and handling techniques. The home reported that the staff members were given additional training and supervision, to ensure they understood the correct procedures. The safeguarding alert was therefore closed. Staff members’ recruitment records checked showed that the home had obtained a criminal records bureau checks (CRB), and protection of vulnerable adult check (POVA) for each staff member. Reference and identity checks had also been undertaken. This ensured that the home would only employ staff with suitable police clearance, and an acceptable employment history. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,26 The quality in this outcome area is adequate. People could expect a home that would be clean, hygienic and usually odour free. Some parts of the home may not be easily accessible for some residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives made the following comments about the home environment for the residents. ‘The overall care, cleanliness and maintenance of the property and gardens are all done well’. ‘The home could improve by providing wider corridors in the older parts of the building (health and safety)’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 22 ‘They could improve by providing ensuite facilities and easier access for wheelchairs in some areas, but this is a 1960/70’s home, so it would take a major makeover’. The home consists of a single storey building set in large gardens, with access to the enclosed gardens, via some residents’ bedrooms, and an external gate. There are 34 single and 7-shared bedrooms. All bedrooms have a wash hand basin, 12 of which also have en-suite toilets. There are 4 bathrooms and a shower room, located close to the bedrooms. Communal rooms consist of 2 lounges, 1 dining room and 1 dining room/lounge, and these were appropriately maintained, and kept. Some of the corridors near the kitchen end are narrow, and would not be suitable for wheelchair users. This is in contrast to other areas, which provide wide corridors, and easy access to the residents’ rooms. The home continues to maintain residents’ rooms and many were seen to be appropriately decorated, light and airy. The rooms were found clean and tidy, with adequate furnishings, although in a few rooms, some of the bedroom furniture looked outdated. Some furniture sets, did not always match. The concerns about the narrow corridors were discussed with the owner, who said that plans had been drawn up to improve this part of the environment. The plans included widening the corridors, and reducing the residents’ rooms by one, so enabling new ensuites to be developed. However, this plan remains on hold at present. Residents and relatives feedback and observation of the home confirmed that the cleanliness of the home was good. The domestic staff were seen working their way through the home during the morning. With only one exception, there were no noticeable unpleasant odours. Residents told us that the cleaning staff cleaned their rooms every day. Call bells are situated throughout the home in bedrooms and communal rooms, and these were seen in operation with staff answering these. The carpet from the entrance door to the main lounge was noted to be quite worn in several places and could be a potential tripping hazard. In discussion with the general manager, a replacement carpet had already been ordered, and it was planned that this would be replaced in May 2008. Residents (28) completing the feedback card, all said that the home was kept fresh and clean. A selection of residents and relatives’ comments included the following views. “The home is very nice and clean’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 23 ‘My relative said that the home is always clean’ ‘The rooms are very clean’. ‘The atmosphere is welcoming and my friend appears well cared for. They are content and their room is comfortable and have not raised any complaints with me’. ‘They could improve by providing more space and possibly more equipment’. ‘It can take quite a while to get used to some of the décor and soft furnishings but at the end of the day the place is kept clean and tidy’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome area is good. People using the service can expect adequate levels of staff on duty, and staff would be trained to meet their care needs. The home’s staff recruitment procedures would ensure that only suitably checked staff are employed to care for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A selection of comments received from residents and relatives about the staff outcome group included the following views ‘It would be nice if they had extra staff sometimes, so that on a nice day my relative could be wheeled out side for some fresh air’. ‘I think staff do a very good job’. ‘I think more staff are needed especially in the lounge and at meal times, to help feed residents and just talk to them’. ‘We like the care service they provide. Staff turnover does not seem to affect the quality of the care’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 25 Copies of the staff rota for the 2-week period the 14th to 27th April 2008 were viewed. This showed that planned staffing levels in the morning were maintained at around 1 registered nurse, 1 senior carer, and 5 or 6 carers, This provided a ratio of 1 care staff to 7 residents. The average staffing levels in the afternoon (2pm – 6pm) was 1 registered nurse (RN), 1 senior carer (SC) and 4 care assistants, giving a ratio of 1 member of care staff to 9 residents. Staffing levels on night were, 1 registered nurse with 3 care staff. This represented a slight reduction in the staff to resident ratio found at the last key inspection. However, the night shift does overlap with the morning shift for a period of 1 hour, so provides 4 additional staff during the busy morning period, and would improve the overall ratio for the morning shift. There had been some alterations to the rota owing to staff sickness or providing for annual leave cover, however, staff levels had been maintained at these levels, during the 2-week period. The care staff levels on the morning of the inspection were 1 RN, 1 SC, and 5 carers, and the care staff listed was slightly different to those actually within the home, so the rota was not accurate, for the morning shift. The staff rota must therefore always provide an accurate record of the staff on duty. Staff were seen to be constantly busy during the morning period, and most time was spent providing direct care, and promptly answering the residents’ call bells. The manager and general manager work alternate weekends to ensure management cover at weekends. Feedback received from 20 relatives /visitors felt that staff “always or usually” provide the support and care their relative needed. Information supplied by the home showed that 5 of 20 carers currently hold a National Vocational Qualification (NVQ) level 2 award, with 2 holding an NVQ 3, a total of 7 of 20 care staff with a care qualification. There are also 7 further carers working towards either an NVQ 2 or 3 in care. Two staff members’ employment records were checked and these showed that the home continued to undertake recruitment checks, to access new staff members suitability for the role. This included criminal records bureau checks (CRB) and protection of vulnerable adults (POVA) checks, 2 written references for each staff member and identity checks. Staff members had been provided with a copy of their job description. Staff training included the provision of induction training, core, and specific training for care staff at the home. With the last year, significant training had been undertaken, which should ensure that staff had the skills and training to meet the particular needs of the residents. New care staff complete the home’s ‘in-house’ induction training around ‘understanding the principles of care’. The induction programme is based on the Skills for Care consortium and takes staff through 6 foundation standards Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 26 within the first 12 weeks of employment. The general manager, who holds an NVQ 3 care qualification, undertakes the induction training. Training objectives include personal care, health & safety and adult safeguarding issues. One staff member spoken with confirmed that the induction training had been helpful, and that the self-learning package had enabled them to ‘go at their own pace’. Within the last year, the home has completed significant levels of training for staff members. Some of the topics included challenging behaviour, safeguarding adults training, induction training, code of conduct, complaints training, continence care training, communication training, PEG feeds, dementia and care mapping training, death of a resident, and equal opportunities. The training book provided good evidence of this training. Staff members’ records checked provided additional evidence of training. Feedback received from staff members said they had received training, which enabled them to meet the care needs of the residents at the home. Feedback received from 20 relatives said they thought that care staff had the right skills and experience to look after the residents properly. A selection of comments received from relatives about the staff included the following views. ‘I probably visit more than most relatives, and have only ever seen a professional and cheerful approach in dealing with the residents’. ‘I know the nursing staff are very experienced, but I am not sure about the carers’. ‘I understand that all staff attend various training courses, and supervision is offered on a regular basis’. ‘Staff appear to possess adequate skills’. ‘Everyone behaves in a professional manner’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36, and 38. The quality in this outcome area is good. People using the service can expect an appropriately managed service, with quality assurance systems in place to receive feedback from the residents. They can also expect to be kept safe from unnecessary risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A selection of comments received from residents and relatives about the management of the home were as follows. ‘Broad-Acres are very prompt in informing me about my relative. For example, if they are ill or need to see a Doctor’. ‘The home checks with me regularly to see if all is OK and if we have any problems etc’. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 28 ‘We are very pleased with this care home as the standard of care to its patients is exceptional’. ‘The home is warm and clean, and staff are sensitive to the residents’ needs.. They provide good basic food in a homely atmosphere. Managers and staff are all very approachable’. Mrs Olayinke Bakare, the acting manager, is an experienced registered nurse (RN) and is currently applying to the CSCI to become the registered manager of the home. Mr Chris Banks, the General Manager, and Mrs Kowlessur, one of the home’s owners, are available to support the acting manager, when this is required. Feedback received from relatives said that the home responded positively to them if there were any concerns. Residents spoken with and feedback received from relatives confirmed they thought the home met the different needs of the people, and helped them to live the life they choose. The home also kept people informed about the latest events and news from the home by providing them a copy of the ‘Broad Acres news bulletin’. Quality assurance monitoring was undertaken by the home during October to December 2007, and the results were published in the home’s news bulletin. The survey comprised of 27 questions for relatives, professionals and visitors to answer, around various aspects of life at the home. Where concerns were raised, the home would investigate these and try to provide solutions. Some of the feedback recorded said the following. ‘Thank you for a good evening on Friday. We all enjoyed and welcomed the chance to hear more about the home, and your plans for it, and the residents’, and ‘I would like to thank you all very much for all the care and efforts you have made into making my relative as comfortable as possible. We have been overwhelmed by your kindness and thoughtfulness’. The home can hold small amounts of residents’ personal money in safekeeping, which would be secured and accounted for. A check was undertaken of 2 residents’ personal money, and the money held balanced with the records. Feedback received from staff members confirmed they received supervision from the home, and supervision records were maintained. Two of 2 staff members records checked had a record of their supervision session. One new employee had a monthly probation report, for their first 3 months. Staff records checked showed that staff had received health and safety training, including moving and handling training, fire, infection control, basic first aid, food hygiene, and control of substances hazardous to health (COSHH). Most of these topics are now also covered within the induction programme. A check of the home’s COSHH cupboard showed that this was Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 29 kept locked, and the cleaner’s cupboard had now been moved away from the inside of the fire exit. Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 X X 3 X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 31 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. 2. 3. Refer to Standard DO8 Good Practice Recommendations A monthly record of fall trends should be kept to evidence ongoing management monitoring of falls within the home. Kitchen staff should ensure that the residents’ food preference book is kept up to date, to ensure that they are aware of the different food needs of each resident. The home should consider how they will maintain the recommended standard of 50 workers having achieved an NVQ in care. OP15 OP28 Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Broad Acres Residential And Nursing Home DS0000024345.V363086.R01.S.doc Version 5.2 Page 33 - 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. 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