Care Home: Broadfield House

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What the care home does well The needs of people were thoroughly assessed before they moved into the home, to ensure that the staff team could provide the care and support required. Once admitted to the home people`s needs were well recorded on the plans of care, showing clearly how they were to be best met. This enabled staff to be fully aware of what each individual required so that their health, personal and social care needs could be fully met. Those living at the home were treated with respect, their privacy and dignity being maintained at all times. The management of medications was, in general, good so that the possibility of drug errors was minimised. Good nutritional, pressure and incontinence care was provided, which involved a range of external professionals, ensuring that people living at the home received appropriate health care. The daily routines within the home were flexible and people living there were offered a variety of choices throughout the day. Visitors were made very welcome to the home and people were able to access an independent person to act on their behalf, if they so wished. Complaints were well managed and robust policies, procedures and practices adopted by the home safeguarded the people living there from abusive situations. The environment was warm, comfortable and homely, providing pleasant surroundings for people to live in. The control of infection was good, so that those living at the home were protected from infectious diseases. What has improved since the last inspection? It was pleasing to see that both requirements made at the last key inspection had been appropriately addressed, showing an improvement in the standards of service provided. The social care needs of people living at the home had been identified and their leisure interests were recorded well. The service had improved by including people`s social needs in the care planning process and by supporting people to maintain their interests and hobbies whilst living at the home. The training programme had improved for staff so that those working at the home received a range of mandatory training courses, including moving and handling, to ensure that people living at the home were handled safely and so that injury was prevented to staff by the use of correct handling procedures. The carpets in the dementia care unit had been replaced with a more suitable type so that the people living on this unit were more comfortable. What the care home could do better: Any hand written transcriptions on the Medication Administration Records could have been signed, witnessed and countersigned in order to avoid any transcription errors.The paintwork in the kitchen was flaking off and needed attention in order to maintain good standards of hygiene. We were told that this work was due to be completed the following week after our visit to the service. Although the quality of service provided was thoroughly monitored it would have been useful if all the policies and procedures had been dated so that we could have determined if they were providing up to date information for all interested parties. It may also be useful if the home conducted surveys for stakeholders in the community so that their views could be sought about how the home was achieving goals for the people living there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broadfield House Broadfield Drive Leyland Preston Lancashire PR25 1NB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Broadfield House Broadfield Drive Leyland Preston Lancashire PR25 1NB 01772457672 01772457672 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lancashire County Care Services care home 45 Number of places (if applicable): Under 65 Over 65 0 14 dementia old age, not falling within any other category Additional conditions: 31 0 The home is registered for a maximum of 45 service users to include: Up to 14 service users in the category of OP (Old age, not falling within any other category). Up to 31 service users in the category of DE (Dementia). Date of last inspection Brief description of the care home Broadfield House is a well-established care home located in Leyland, which is operated by Lancashire County Care Services. There are shops and many other local facilities available nearby. The home has gone through extensive refurbishment and building work and provides accommodation in four separate units within the home. The furnishings and fittings within the home are of a high standard. The home is registered to accommodate 14 older people and 31 people who have care needs associated with a diagnosis of Dementia. One of the units in the home is designated to provide short-term rehabilitation services for people with dementia care needs. Care Homes for Older People Page 4 of 31 Brief description of the care home Information about the service is given to people who are thinking about living at Broadfield in the form of a service users guide, which provides clear guidance and information about what it is like living at the home and what to expect should people chose to make Broadfield House their home. At the time of our visit to this service the fees ranged from £366 to £433 per week with extra costs being incurred for hairdressing, chiropody, toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means that the people who use this service experience excellent quality outcomes. The site visit to Broadfield House formed part of the inspection process and was conducted over two days in January 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. An expert by experience accompanied the inspector to this service in order to get a feel of what it was like living at Broadfield House by spending some time sitting and chatting with those using the service and joining in with daily life. During the course of the site visit, discussions took place with those living at the home, Care Homes for Older People Page 6 of 31 as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from nine people who were living at the home and their feedback is reflected throughout this report. Every year the provider completes a selfassessment, known as an AQAA, which gives information to the Commission about how the home is meeting outcomes for the people using the service and how the quality of service provided is monitored. We also ask for some numerical information to be forwarded to us with this assessment, We observed the activity within the home and tracked the care of four people, not to the exclusion of others living at Broadfield House. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. No complaints have been received by the Commission since the last key inspection. What the care home does well: What has improved since the last inspection? What they could do better: Any hand written transcriptions on the Medication Administration Records could have been signed, witnessed and countersigned in order to avoid any transcription errors. Care Homes for Older People Page 8 of 31 The paintwork in the kitchen was flaking off and needed attention in order to maintain good standards of hygiene. We were told that this work was due to be completed the following week after our visit to the service. Although the quality of service provided was thoroughly monitored it would have been useful if all the policies and procedures had been dated so that we could have determined if they were providing up to date information for all interested parties. It may also be useful if the home conducted surveys for stakeholders in the community so that their views could be sought about how the home was achieving goals for the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were thoroughly assessed before they moved in to the home so that the staff team were confident that they could deliver the care required. Evidence: The care records of four people living at the home were examined. A lot of detailed information was gathered from a variety of sources before people were admitted to the home. This enabled the staff team to be confident that they had the right skills and experience to meet the assessed needs of the people they supported. The home had a seperate rehabilitation unit, which supported people to regain independent living skills as far as possible so that they could return to the community with or without additional support. We received comment cards from nine people who were using the service. Eight of Care Homes for Older People Page 11 of 31 Evidence: these people told us that they received enough information about the service before they moved in to allow them to make an informed choice about where to live. When asked what the service does well the registered manager wrote on the homes self -assessment, Broadfield House provides a comprehensive Statement of Purpose and Service User Guide. Prospective residents or their representatives are taken on a guided tour of the building and encouraged to visit at various times of the day to look at the service we provide in more detail. Trial periods are encouraged and preadmission assessments are completed on all residents prior to admission. Admissions usually come through Adult & Community Services department and a full social work assessment is available for us prior to admission. Care plans and reviews are comprehensive and reflect the needs of the service users, who are always encouraged to participate in the care planning process. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. Evidence: The care of four people living at the home was tracked during the course of this key inspection. The plans of care had been developed from the information gathered about people before they were admitted to the home. This ensured that all assessed needs were taken in to consideration when planning the care required. The plans of care were consistently very well written, providing staff with detailed, person centered information and clear guidance about how peoples assessed needs were to be met. People living at the home had been involved in the care planning process, so that they Care Homes for Older People Page 13 of 31 Evidence: had some input into the care delivered to them. Each persons care needs had been reviewed regularly with any changes in circumstances reflected well, so that staff were provided with up to date information about each individual. We saw that one person was involved with the care of her friend by helping her with a meal, which promoted contact with the friend. Records showed that a wide range of external professionals were involved with people living at Broadfield, so that their health care needs were appropriately met. A wide range of risk assessments had been conducted so that any identified hazards were eliminated or minimised, including risks relating to health, personal and social care needs. One visitor was seen complimenting staff on the marked improvement in the condition of his friend since her admission to the home. He said, the staff team are doing such a good job. The improvement is remarkable. My friend is like a different person. Keep up the good work. Those who lived at the home and sent us comment cards said that, in general, they received the care and support they needed, including medical care. However, one of these people wrote, I need my hearing aids put in first thing in the morning, every morning. Very often they do not get put in until about 4pm when my daughter comes and puts them in and a relative commented, my mother has benefited from the care and help at Broadfield. The plans of care showed that privacy and dignity was respected when personal care was being delivered and that independence was promoted as much as possible. People were seen to be treated with respect and staff spoken to were very aware of peoples needs, likes, dislikes and fears. There was a lot of information available about dignity in care and the service had signed up to the dignity charter. There was a very friendly environment and we saw that the privacy and dignity of those living at the home was well respected. Staff spoken to told us that the importance of privacy and dignity was covered on their induction when they first started to work at Broadfield. This information was confirmed by the inspection of induction records. The management of medications was, in general, satisfactory. However, hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. Care Homes for Older People Page 14 of 31 Evidence: The registered manager outlined on the homes self - assessment things that she felt the home did well and she gave some good examples of how this was achieved. She also told us about improvements that had been made to the care plans during the last twelve months so that the planning process was more efficient. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and hobbies whilst living there. The management of meals was good and visitors were made welcome to the home. Evidence: We were impressed by the enthusiasm of a young member of staff who was acting as leader of the rehabilitation unit due to sickness. We were shown around this unit, which was light and bright. The activities offered were on the notice board and included trips out, movement to music and board games. Baking was done with the help of the Technical Instructors who worked regularly on the unit. Occupational Therapists were attached to the unit as were Physiotherapists. During our visit one of the people living on the rehabilitation unit was washing the dishes in the kitchen, which was helping her to maintain some domestic skills. An activities co-coordinator was employed at Broadfield House, so that people living there were supported to participate in their chosen activities. A colourful, eye catching notice board was displayed in the reception area of the home, which showed a wide range of planned activities and a variety of scheduled meetings. Care Homes for Older People Page 16 of 31 Evidence: The plans of care incorporated a lot of detailed information about the leisure interests and hobbies of those living at the home and how they were supported to meet these social needs. The residents all looked clean and cared for but I did notice one resident with dirty long finger nails. The activity diary showed that a wide range of activities were provided, including some in accordance with recognised celebrations, such as the Chinese New Year. Theme days at Broadfield were a regular event and on the day of our visit the chosen theme reflected the Hungarian way of life. The dish of the day was a Hungarian recipe, served by staff in Hungarian costume. People living at the home joined in activities associated with Hungary whilst listening to Hungarian music. Those spoken to all enjoyed the monthly theme days and it was evident that a lot of thought and effort had gone in to making them possible. One person said, it is something a bit different, out of the ordinary and it helps us to keep interested. We were told that the home has a minibus and that trips out were organised every month so that people could maintain contact with the community and the surroundings. Broadfield was a hive of activity with people joining in planned group activities, others receiving individual support so that they had the same opportunities as the more able people living at the home and some reading or watching television if they preferred. One person said that they chose not to join in activities and was happy just watching and doing things they preferred, like reading and watching television. Church services were an item on the homes itinerary, so that people were able to continue to follow their faith whilst living at the home should they wish to do so. We saw that people were offered a variety of choices throughout the day and that the daily routine was flexible, allowing freedom of movement and promoting independence for those living at the home. When asked if there were activities that people could join in, there were mixed responses from those who sent us comment cards. Although five people said that, in general, there were activities they could join in others felt that some improvements could be made. One person wrote, we could do with more activities and two people said that they would like more trips out. The hairdresser was on site at the time of our visit and the people living at the home were looking forward to having their hair done. We were told that the mobile library visits the home every fortnight and we saw two people getting ready to exchange their library books. Care Homes for Older People Page 17 of 31 Evidence: We spoke to five people staying in the rehabilitation unit who were all happy being at Broadfield. They told us that they dont get a lot of spare time to join in the general activities because they have individual rehabilitation programmes to follow, supported by the physiotherapist and the occupational therapist so that they can get ready for going back in to the community. We felt that much thought and effort was given to try to offer a stimulating environment for the people living at the home with plenty of activities on offer, visits from school children and trips out. We did feel that small numbers of people grouped together was more pleasant for those living at the home. It certainly felt a homely atmosphere. Visitors seemed welcome to the home and several were present during our visit and sharing lunch with their relatives, which was nice to see. We saw that visitors to Broadfield were greeted politely by staff and were spoken to in a respectful manner. Those spoken to said that they feel comfortable visiting their relatives and friends who are living at the home and that they are able to speak to staff whenever they wish, who give them support and advice as needed. One visitor said, I visit my relative regularly and I am always made to feel welcome when I arrive. One person living at the home was using the local advocacy service so that they could have an independent person acting on their behalf. Information was readily available at the home telling people how they could access people from the advocacy services, if they so wished. A menu was available at the home, which offered people a choice of meals and alternatives were available should people not like the menu choices. The menu was presented in colourful picture format for those with a dementia related illness and meals served were well presented and nutritious. The kitchen was well organised, although some work was needed to the paintwork on the walls and ceiling to improve the standard of the catering facilities. We were told that this work was scheduled to be done the following week. All the people who sent us comment cards said that, in general, they liked the meals at the home. One person wrote, I think the food is very good and a relative said, mum has never complained about the food. One visitor was feeding her friend with lunch on the first day of our visit to the service. Care Homes for Older People Page 18 of 31 Evidence: We noted that there were pieces of meat in with the vegetables and gravy despite the lady not having any dentures in. The friend said that she doesnt give her the meat in case she choked on it. It was established that this person brings yoghurts for her friend, which could possibly be supplied by the home and she used a paper towel to protect her clothes, which was not really suitable for its purpose. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had a clear procedure to ensure that all complaints were managed well and people living at the home were safeguarded from abusive situations or harm. Evidence: The complaints procedure was clearly displayed throughout the home and made readily available for all interested parties, so that people would know how to make a complaint, should they wish to do so. People spoken to said they were happy with the care they received at the home and were able to tell staff and management if they had any concerns. They felt confident that any complaints would be dealt with promptly. Most of the people who sent us comment cards said that they would know how to make a complaint and knew who they needed to speak to if they were unhappy at the home. There were policies in place for the protection of vulnerable adults and staff spoken to were aware of the relevant procedures should they be concerned about anyone in their care. Records showed that staff received training in the protection of vulnerable adults and those spoken to were aware of their responsibilities in reporting any incidents of possible abuse. When asked what the service does well the registered manager told us, the organisation has a comprehensive complaints policy and procedures that we follow. Care Homes for Older People Page 20 of 31 Evidence: An externally provided Whistle Blowing Policy is in operation throughout the organisation. Broadfield House operates an Open Door policy and we are completely transparent in every aspect of our practice. All Complaints or concerns are taken seriously and acted upon, immediately where possible. Training is completed annually on the Protection and Safeguarding of Vulnerable Adults. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a safe and comfortable environment for the people living there. Evidence: The environment was very pleasant for the people living at Broadfield. The fixtures and furnishings were of a good quality and the home was, in general, tastefully decorated throughout so that peoples surroundings were homely and inviting. However, we did notice that some areas would have benefited from extra cleaning and on mentioning this to the manager she said that each unit has 20 hours cleaning per week allocated. People were able to take their own belongings with them, so that their bedrooms were like home. At the time of our visit Broadfield House was warm, clean and pleasant smelling, providing a comfortable and hygienic environment for people to live in. However, the floor area underneath one bed had not been properly cleaned for some time indicating that the bed was not pulled out regularly for cleaning purposes. The building was well maintained, so that the safety of people living and working at the home was protected. The registered manager told us that during the last twelve months carpets on the units looking after people with dementia had been replaced with a more suitable type of carpet. She also told us that they plan to develop the garden areas to provide Care Homes for Older People Page 22 of 31 Evidence: meaningful occupation, particularly for those with dementia. The control of infection was being managed well by the robust policies, procedures and practices, which had been adopted by the home to ensure that there was little possibility of cross infection or contamination. Records showed that staff had received training in the control of infection and we saw that they followed the procedures in day to day practice, so that people were protected. All those who sent us comment cards said that the home is, in general, fresh and clean. The bathrooms we felt looked a bit stark and some of the paintwork could have benefitted from refreshing, although we felt that the shower room was well planned to promote infection control. The sitting room on the rehabilitation unit was a small room but had doors leading out into a conservatory. The doors were closed due to it being a bit colder but we could see that in better weather it would be very pleasant indeed. It was nice to see that in winter a cosy feel could be achieved to this sitting room. The people sitting in this area of the home looked comfortable and warm. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and skill mix of staff on duty was sufficient to meet the needs of those living at the home and the recruitment practices were thorough enough to protect the people at Broadfield House. Evidence: There was a clear staff rota in place, which showed staff on duty at any time of the day or night. The staffing levels were calculated in accordance with peoples assessed needs and one member of staff told us that an additional carer had recently been allocated to cover the busy morning period, which she said was helpful. Staff spoken to felt that there were enough of them on duty to meet the assessed needs of everyone living at the home and that they received good training to allow them to meet specific individual needs of people. One member of staff said, that is why I came to work here. I knew there was a lot of training provided. Those living at the home who sent us comment cards said that, in general, staff were available when they were needed and the people spoken to all felt that their needs were being appropriately met. Records showed that 96 of care staff had achieved a recognised qualification in care Care Homes for Older People Page 24 of 31 Evidence: at level 2 and a further 21 were in the process of completing a higher level, which was commendable. This showed that the staff team were collectively qualified and skilled to meet the needs of the people living at Broadfield House. One person spoken to said, all the staff are very good at their jobs. They do whatever is needed to a high standard. We were told that the turnover of staff was very low at Broadfield House, which was evident by the length of time people had worked at the home. This promoted good continuity of care. The records of three staff members were examined, which showed that the home had adopted robust recruitment procedures to ensure that all relevant checks had been conducted before people started work at the home so that people living there were safeguarded. Staff told us that all relevant policies and procedures were sent to staff to read before they were employed. The training matrix showed that a wide range of training was provided for staff to ensure that those working at the home were kept up to date with new ways of working, current legislation and guidelines. The training programme included a range of mandatory courses, such as moving and handling and infection control, as well as training relevant to the specific needs of people living at the home, such as dementia care. New staff were assisted through the skills for care induction programme, which was extremely detailed and those spoken to confirmed that their induction was very thorough and covered everything they needed to know to do the job properly. When asked what the service does well, the registered manager wrote on the homes self-assessment, Broadfield House ensures that its employees work together as a team for the benefit of the people living at the home. Staff are trained to a high standard. Recruitment and selection procedures and training ensure that the right staff are recruited for the right post and that they are retained. The Equal Opportunities Policy is used during the recruitment process. Its Good to Talk events take place for staff and residents to speak freely and openly with senior managers to highlight areas of Good Practice and where improvement is needed. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well so that the health, welfare and safety of the people living and working there was protected. Evidence: The manager had the right qualifications and experience to run the home and she had been registered with the Commission for Social Care Inspection. She had continued to update her knowledge and skills whilst managing the care service and was well aware of current legislation and guidelines. The home was managed in an efficient and effective manner and in the best interests of the people living there. An outside agency had commented in the comment book in the reception area of the home, Broadfield House is one of the best care homes that I visit. People spoken to during the course of the site visit told us that they felt supported by the management of the home and were able to go to speak to senior staff if they had any concerns or worries. Care Homes for Older People Page 26 of 31 Evidence: The quality of service provided was thoroughly monitored by a variety of different methods, so that any strengths or weaknesses could be identified and, where necessary, addressed in order to improve the outcome for those living at Broadfield House. A wide range of internal and external audits and risk assessments were conducted at regular intervals to ensure that high standards of care was being delivered and so that the safety of people involved with the service was protected. Regular meetings were held for those living at the home, their relatives and staff, so that relevent information could be passed on and so people involved with the service could openly discuss any topics or issues. An extensive range of policies and procedures were in place at the home, so that staff were aware of acceptable practices within the home. However, some of these had not been dated so it was not possible to determine if they had been reviewed, although the selection seen did provide up to date information for those concerned. People living at the home and their relatives were asked to complete hows your week surveys so that feedback could be regularly sought about the standard of service provided. It was quite evident that the registered manager had worked hard to gather feedback from those with a dementia related illness and we noted that a lot of positive changes had been made as a result of feedback and suggestions made by people living at the home, which was commendable. The results of any surveys had been produced in graph format so that any interested parties could easily access the information required. Staff surveys were conducted at raandom so that the management team could find out what staff thought it was like working at Broadfield. Surveys had not been introduced for stakeholders in the community so that their views could be sought about how goals for the people living at the home were being met. Unannounced visits were carried out every month by a representative from the organisation, following which a report was produced so that the manager of the home was aware of any positive findings and any issues requiring attention. Monies held on behalf of people living at the home were being managed well, with clear records being maintained and receipts of any expenditure being kept to ensure that peoples finanaces were safeguarded. Care Homes for Older People Page 27 of 31 Evidence: A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked to ensure that they were safe for use. On touring the building we found that safety notices were displayed appropriately so that any hazards were identified and then strategies could be implemented in order to protect the people living at Broadfield House. We noted that the bath hoist in one of the bathrooms was out of order and needed to be repaired. We noted that clinical waste was being disposed of in the correct manner to ensure that good hygiene standards were being maintained. Accidents were being appropriately recorded although this was being done on forms designed by the organisation. This matter was discussed with the organisations Health and Safety department, who told us that the documentation had been approved by the department of works and pensions. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Any hand written entries on the Medication Administration Records should be signed, witnessed and counter signed to reduce the possibility of any Suitable bibs should be provided so that peoples clothing is protected during meals as necessary. Attention to the paintwork in the kitchen should be completed as scheduled. It is recommended that the beds be pulled out at regular intervals to allow for cleaning of the floor areas beneath them. It is recommended that the policies and procedures of the home be dated when reviewed to ensure that up to date guidance is provided for all concerned. It is recommended that surveys be conducted for stakeholders in the community so that their views can be sought about how goals for those living at the home are being met. The bath hoist that was not working at the time of our visit should be repaired as soon as possible. 2 3 4 15 15 26 5 33 6 33 7 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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