Care Home: Broad Oak Manor Nursing Home

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What the care home does well Broad Oak Manor provides high quality nursing and personal care to its residents. Feedback from residents and relatives about the care provided was excellent. One resident said `it`s very nice here and I am very well looked after, the nurses and care staff are very good and the food is excellent.` A relative said `we are very happy with the care provided, the home has a happy, caring atmosphere.` Another said `all the staff are friendly have time to talk about any problems. The home is always clean and fresh and the food is a very good standard.` Care plans contain comprehensive information about residents individual needs and each resident is allocated a primary nurse and key worker.` The service has employed two activity co-ordinators who have arranged a regular programme of activities. Visitors are welcome at any time and a restaurant on site enables residents to enjoy a meal with family or friends. There is also an extensive outside area with a seating area outside the restaurant where residents can enjoy a drink and snack outdoors. Feedback about the food was excellent and the new chef manager has introduced new menu`s, which combine ideas from the residents. The chef is very involved in the running of the home and has previous experience of working as a care worker with older people. The home has undergone a major refurbishment and provides a homely, safe environment. The home was very clean and tidy throughout. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Staff receive regular training and the service has a thorough recruitment procedure. No complaints have been received. What has improved since the last inspection? The manager has registered with the Commission for Social Care Inspection. The service has employed two activity co-ordinators who have arranged a regular programme of activities. A lot of work has been done to improve the environment and previous requirements in relation to maintenance issues have been resolved. All equipment such as commodes are clean and hygienic and all procedures relating to health and safety are adequately maintained. What the care home could do better: Procedures relating to medication must be improved. One resident was not given his medication for three consecutive days, as it was not available. The matter was investigated and it appeared that communication between nurses had broken down when one nurse went on leave. Handwritten instructions on medication administration records had not always been signed by the GP or by two nurses and bottles of medication had not been dated on opening. One resident had to wait several days whilst experiencing discomfort, as his pressure-relieving mattress was faulty. Some residents said that they would like regular meetings, which will enable them to be more involved in the running of the home. CARE HOMES FOR OLDER PEOPLE Broad Oak Manor Nursing Home Broad Oak Manor Broad Oak End Bramfield Road Hertford Herts SG14 2JA Lead Inspector Alison Jessop Unannounced Inspection 8th August 2007 10:00 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 Oak Manor Nursing Home DS0000061180.V348351.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 Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broad Oak Manor Nursing Home Address Broad Oak Manor Broad Oak End Bramfield Road Hertford Herts SG14 2JA 01992 551900 01992 507950 kim@broadoak.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) Lance Adams Jill Adams Jessica Rose Dobson Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Terminally ill over 65 years of age (3) of places Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 27 older people who require convalescent or nursing care. 10th May 2006 Date of last inspection Brief Description of the Service: Broad Oak Manor is a period house set in 7 acres of grounds on the outskirts of Hertford. Accommodation is arranged on three floors and comprises both single and double rooms. There is currently a library and dining room on the ground floor as well as the reception area. The kitchen and laundry are sited in the basement. The grounds are attractively laid out with trees, shrubs, flowerbeds and lawns and there is a patio with garden seating for service users to enjoy. There is also a sensory garden. The complex includes a development of close care units, a converted barn offering a large lounge, a la carte restaurant with two dining areas and health and fitness facilities. There is a rail station a short drive away and Hertford town centre further distant. The home is served by public transport - service users use private cars, taxis, Dial-a-Ride services or the homes mini bus service when they go out. A copy of the Service User Guide, Statement of Purpose can be obtained from the manager or from the company’s website at www.broadoakmanor.co.uk. A copy of the previous inspection report can be obtained from the manager or by visiting the CSCI website at www.csci.org.uk. The range of fees varies, and this information can be obtained from the manager of the home. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day by one regulatory inspector. Time was spent talking to service users who gave feedback about what it is like to live at the home. Records were scrutinised, the environment was inspected and feedback was also gained from staff. Time was also spent with the manager who provided information about developments to the service. Surveys were sent out to a number of relatives and eight were returned. Very positive feedback was received about their relatives care. Feedback was also gained from the visiting GP, which was also very positive. The overall outcome was positive, three statutory requirements have been made and all previous statutory requirements were met. What the service does well: Broad Oak Manor provides high quality nursing and personal care to its residents. Feedback from residents and relatives about the care provided was excellent. One resident said ‘it’s very nice here and I am very well looked after, the nurses and care staff are very good and the food is excellent.’ A relative said ‘we are very happy with the care provided, the home has a happy, caring atmosphere.’ Another said ‘all the staff are friendly have time to talk about any problems. The home is always clean and fresh and the food is a very good standard.’ Care plans contain comprehensive information about residents individual needs and each resident is allocated a primary nurse and key worker.’ The service has employed two activity co-ordinators who have arranged a regular programme of activities. Visitors are welcome at any time and a restaurant on site enables residents to enjoy a meal with family or friends. There is also an extensive outside area with a seating area outside the restaurant where residents can enjoy a drink and snack outdoors. Feedback about the food was excellent and the new chef manager has introduced new menu’s, which combine ideas from the residents. The chef is very involved in the running of the home and has previous experience of working as a care worker with older people. The home has undergone a major refurbishment and provides a homely, safe environment. The home was very clean and tidy throughout. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 6 Staff receive regular training and the service has a thorough recruitment procedure. No complaints have been received. 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 Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 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 Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken and the manager is reassured that the prospective service users can be met. EVIDENCE: The matron visits prospective service users to carry out a comprehensive needs assessment prior to agreeing admission. The assessment then forms the basis for the care plan, which is agreed with the service user prior to admission. The home does not provide intermediate care. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good quality nursing and personal care. Care plans contain comprehensive information and the health care needs of service users appear to be met. Procedures relating to medication require more attention. EVIDENCE: Individual care plans contain comprehensive information about the people being cared for. The plans consider all aspects of service users health and social care needs. Nurses are responsible for completing daily notes and ensuring that information in the care plan is up to date. The manager has introduced a separate care plan for care workers which does not contain ‘nursing jargon’ and which involves care workers in the care planning process. The care plans and risk assessments are used as working tools and are regularly reviewed. Each resident is allocated a primary nurse and a key worker. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 10 Service users health care needs appear to be met although one issue in relation to medication was identified. All residents spoken to were satisfied with the care they receive. One lady said ‘I have an ulcer on my leg, the nurses are very good and they attend to it regularly. It’s much better and I thank the nurses for that.’ One relative stated ‘the personal care is very good.’ Another said ‘my mother is well looked after in a safe environment.’ The visiting GP stated ‘they provide good nursing care and the health care needs of residents are closely monitored. The communication is good as I usually visit the home once a week.’ Another relative stated ‘he is not always shaved and I have asked that spilt food is cleaned from his clothes after meals.’ During the inspection all service users personal appearance remained very clean and tidy throughout the day and all men looked cleanly shaved. No other comments were made in relation to this and therefore a requirement has not been made. During the inspection of medication it was noted that one new resident was not given his medication on three consecutive days. A note made on the medication administration record stated ‘not available.’ After investigating it was concluded that there had been a lack of communication between nursing staff and evidence could not be provided that this had been administered. Handwritten instructions on medication records had not all been signed by the GP or by two nurses. This ensures accuracy and reduces the risk of errors. Several bottles of medication had not been dated on opening. All residents spoken to said that they are treated with dignity and respect. One relative stated ‘I would like my mother to integrate with other residents more, the staff have tried but her choice is otherwise, which they respect.’ All staff observed the homes knock and wait policy when entering resident’s bedrooms. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the resident. The cook in the home is experienced in working with older people, is an important member of the care team and is well aware of the recorded dietary and cultural needs of each service user. Food is served to meet the need of all service users including those who have swallowing or chewing difficulty. EVIDENCE: Two activity co-ordinators have been employed since the last inspection and a programme of activities is available on the notice board in the lounge. On the day of the inspection several residents were observed enjoying exercises to music. Other activities include discussions about what’s in the newspaper, board games, cards, cake decorating, reminiscence, bowls and darts. One activity co-ordinator has provided some one to one sensory stimulation for those that cannot communicate or participate in group activities. One resident Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 12 who has dementia was given a teddy bear to hold which appeared to provide her with much comfort. A ladies choir visited the home to sing to the residents and a traditional tea party was held where family members were invited. A church service is held once a month and one resident stated ‘I don’t like to join in with the service in the lounge, so the priest visits me in my room to offer me a prayer.’ Family and friends feel welcome and know they can visit the home at any time. One relative said that staff always make time to talk to her and share information with the agreement of the resident. There is a restaurant on site where residents can enjoy a meal or snack with their visitors. A new head chef has been employed who has made a lot of improvements to not only the menu but also to the choice of food available. The chef has previous care work experience and has an excellent rapport with the residents and staff. One resident said ‘the food is very good, you get a choice and the kitchen staff are exceptionally friendly.’ The chef stated that she felt that talking to the residents about what they like is very important as their needs and preferences change.’ She also explained that breakfast will be served by the chef from the dining room so that this can be served hot and there will always be a staff presence in the dining room should assistance be required. Feedback from all residents and relatives was very positive about the food. One relative said ‘the food is of a very good standard, mother has put on weight!’ Another said ‘the food is excellent and the choice is very good.’ Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures regarding protection of residents are of a high quality and are regularly reviewed and updated. The service is clear when incidents need external input and who to refer the incident to. EVIDENCE: No complaints have been received since the previous inspection. All service users and relatives said that they would know how to raise a concern or complaint and felt confident that they would be listened to. One incident was reported to the manager by a relative that small amounts of money and valuables were thought to be missing. The manager followed the correct protocol in order to reduce further risks to service users. All residents and relatives have been advised to secure valuable items. No further issues have been reported. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides a homely, safe environment to the people who live there. It is very clean and tidy throughout and good universal infection control procedures were observed. EVIDENCE: Many areas of the home have been completely refurbished and offer a homely, attractively decorated environment. Resident’s bedrooms are personalised and staff ensure that residents are comfortable in their own bedrooms. One relative stated ‘there is always an atmosphere of home rather than institution. Staff are friendly and approachable, the home is kept clean and tidy, the floral arrangements provide a nice touch!’ Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 15 Residents were involved in the choosing of wallpaper and fabric colours. One resident has her paintings displayed on the wall in the dining room. There is an extensive outdoor area where residents can enjoy the fresh air. One resident was observed drinking coffee with his relative on the patio area outside the restaurant. A resident reported to the inspector that his air mattress, which, is used for the prevention of pressure sores was reported faulty. It took staff several days to resolve and the resident expressed the discomfort this caused during this time. Another resident said ‘it would be good to have some grab rails in the shower room as I like to be able to stand up in the shower.’ A relative commented that there is no means of communication for residents to call staff if they are sitting in the communal areas unless staff happen to pass by. It was observed by the inspector that staff were not in the vicinity of the lounge for several minutes on three occasions throughout the day, communication must be enabled. Staff follow universal infection procedures. Each bedroom has alcohol gel for hand sanitisation and staff receive training on infection control procedures. All equipment looked clean and hygienic. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff within its organisation receives relevant training that is targeted and focussed on improving outcomes for residents. The service has a good recruitment procedure that clearly defines the process to be followed. EVIDENCE: The service provides sufficient staffing in order to meet the needs of the people who live there. One relative said ‘there used to be a shortage of staff which has now been rectified, at present all the staff at Broad Oak are excellent.’ All staff complete an extensive induction programme and mandatory training requirements are met. The service has a thorough recruitment procedure and all new staff are vetted prior to working with the residents. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 17 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. EVIDENCE: The manager is a qualified nurse who has completed her Registered Managers Award. She is open to ideas and suggestions and staff say they feel supported in their role. Although a quality assurance process is in place, many of the residents said that they are not asked their opinion about the service. The manager explained Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 18 that she visits residents on a day-to-day basis, however more formal ways of gaining views may be beneficial. One resident said ‘no we don’t have any residents meetings, that would be a good idea.’ Surveys are sent out to relatives to gain feedback and the manager stated that she hopes to publish a newsletter in the future, which will give residents information about ‘what’s happening.’ The home has a policy in place for the handling of resident’s monies. Procedures relating to health and safety are satisfactorily maintained. All previous statutory requirements have been met. Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 20 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. 1 Standard OP9 Regulation 13(2) & 13(4)(c) Requirement Timescale for action 31/08/07 2 OP22 23(c) 3 OP22 13 (4) (c) 1. Medication must be administered as instructed and prescribed medication must be available at all times. 2. A GP or 2 nurses must sign handwritten instructions on MAR sheets. 3. Bottles of medication must be dated on opening. Faulty pressure relieving 31/08/07 equipment must be maintained and in good working order at all times. Residents must be able to 30/11/07 communicate and call for staff assistance when they are located in the communal areas. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000061180.V348351.R01.S.doc Version 5.2 Page 21 Broad Oak Manor Nursing Home 1. Standard OP9 It is recommended that stock balances of medication be carried forward from previous MAR sheet to enable auditing. It is recommended that grab rails are fitted in the shower area, which can enable residents to stand whilst showering if safe to do so. It is recommended that regular residents meetings are held where those who wish not to attend can also feedback their views and ideas. 2 3 OP22 OP33 Broad Oak Manor Nursing Home DS0000061180.V348351.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area 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 - 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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