Care Home: Bromfield House Residential Care Home Ltd

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What the care home does well Service users and visiting relatives were very positive about the care, support and facilities in the home. Comments such as, `I can`t complain, i love it here` and `the food is very good, we get lots of choices` were made by residents. `The home is excellent, everything about it is perfect` and `the home is absolutely brilliant, i couldn`t recommend it enough` were examples of statements made by visitors. The manager has developed clear and comprehensive individual plans of care, which are regularly reviewed and involve service users. The service is comfortable, homely and meets the needs of the service users. 8 of the bedrooms have en suite facilities and a number of residents spoken to stated that they like their rooms. The home has developed a good range of clear policies and procedures including a complaints process and systems underpinning safe working practices. All health and safety documentation is kept up to date and monitored. There is a relatively stable staff team who demonstrated good philosophies of care and were observed to treat service users with dignity and respect. What has improved since the last inspection? The manager has continued to develop care planning processes since the last inspection, which provide clear, unambiguous information in an easily accessible format for staff. The general environment has been well-maintained and further work is planned for the coming year including the refurbishment of the kitchen. Staff training provision has been further developed and a clear structured programme of supervision introduced for staff. The home have, within accepted constraints, continued to develop the range of activities available to service users. What the care home could do better: 1 recommendation has been made as a result of this inspection process. It is recommended that all staff employed within the home gain a certificate in food hygiene training. A number of other issues were discussed with the manager for consideration in the future. The manager is aware of the need to delegate more tasks to the staff team in order to decrease her workload and involve staff positively in the day to day running of the home. Medication issues are managed well, but some minor suggestions were made that may improve this process. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bromfield House Residential Care Home Ltd 316 Minster Road Minster On Sea Sheerness Kent ME12 3NR     The quality rating for this care home is:   two star good 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: Joseph Harris     Date: 2 2 0 4 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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 26 Information about the care home Name of care home: Address: Bromfield House Residential Care Home Ltd 316 Minster Road Minster On Sea Sheerness Kent ME12 3NR 01795873018 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) : mpbrom@dsl.pipex.com Mr Malcolm Paul Jackman care home 10 Number of places (if applicable): Under 65 Over 65 10 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 10 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Bromfield House is a large detached property providing accommodation on two floors. The home is a registered residential service, providing care and support for up to 10 Adults over the age of 65, 8 rooms have en-suite facilities. The home is owned by Mr Paul Jackman and Mrs Teresa Oakey is the Registered Manager. The home is located on the Isle of Sheppey, in the small town of Minster on Sea. It has local amenities close by. Bromfield House has comprehensive policies and procedures, and a transparent culture, which underpin the rights, fulfilment, dignity, privacy, independence and choice of the service users who live there. The home has a Care Homes for Older People Page 4 of 26 Brief description of the care home passenger lift to assist with any mobility difficulties of the residents. The home has a gravelled parking area at the front of the house that can accommodate up to 10 cars. The fees range from 356.81 to 450 pounds per week. A full description of the services and facilities are available in the Statement of Purpose and Service User Guide, which are provided by the home on request. Care Homes for Older People Page 5 of 26 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: two star good 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: This key unannounced inspection process culminated in a site visit to the service on 22nd April 2009. Prior to the site visit a range of information was examined and reviewed including the Annual Quality Assurance Assessment (AQAA), previous inspection reports and other information we have received about the service. During the course of the visit discussions were held with service users, visiting relatives, staff, the manager and the responsible individual. A tour of the premises was conducted and a range of documentation examined including service user plans, staff personnel files, health and safety records and other information relating to the management and running of the home. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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 –0870 240 7535. Care Homes for Older People Page 8 of 26 Care Homes for Older People Page 9 of 26 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 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with information that they require and their needs are assessed prior to admission. Evidence: The home has a statement of purpose and service users guide that is provided to all prospective service users. The information contained within these documents is up to date and is in accordance with Schedule 2 of the Care Home Regulations 2001. Three service user files were examined including that of someone who had recently moved into the home. In all cases there was evidence of a structured pre-admission assessment process. The manager visits prospective service users following the initial referral completing an in-depth assessment covering all aspects of care and support requirements including personal preferences. Where appropriate information is received from care managers or the referral source. There was also evidence that service users have the opportunity to spend time in the home prior to moving in. Care Homes for Older People Page 11 of 26 Evidence: Residents stated that when they moved into the home they were given all of the information that they required and that they were enabled to settle into the home well. The home does not accept service users requiring short-term or intermediate care. Care Homes for Older People Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are met. Evidence: Three individual service user plans were examined, all of which contained detailed information relating to each residents personal, social and health care needs. The plans are set out in both a narrative format and a more orthodox bullet-pointed style. This ensures that all information is clearly outlined and easily accessible by care staff. The plans are reviewed on, at least, a monthly basis. There was evidence in the form of an emergency care plan for one person, that the changing needs of service users are considered and addressed promptly. All individual plans had been signed by the service user and/or their representative demonstrating involvement in the process. Risk assessments have been developed in conjunction with the plans of care clearly identifying perceived risks and promoting responsible risk taking. One relative of a service user said, The home is absolutely brilliant, I couldnt recommend it enough. They way they look after my relative is superb. The manager has developed a clear method for recording healthcare input that Care Homes for Older People Page 13 of 26 Evidence: provides both a chronological resume of events and appointments and in a format that relates to each healthcare professional. The outcomes and actions resulting from healthcare appointments and consultations are recorded and there is evidence that all service users receive required primary and secondary healthcare input. The home uses a NOMAD system of medication administration and all records examined were well managed and up to date. the storage facilities in the home are suitable for the purposes of the service and include Controlled Drug storage if required. All staff who administer medication have received the required training and the manager periodically observes and questions staff about medication issues to ensure competency in this area. During the inspection it was noted that there are a few minor issues that may improve medication systems that were discussed with the manager at the site visit. These points were taken on board and consideration will be given to addressing these. Care Homes for Older People Page 14 of 26 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. Service users have a lifestyle that suits their needs. Evidence: Bromfield House provides a homely and relaxed atmosphere for the service users and there are a range of activities available on a daily basis. There are activity sessions every afternoon including Bingo, exercise games and arts and crafts sessions. All of the service users spoken to said that they have an active lifestyle and can choose whether or not to participate in activities. The home arranges for an outside entertainer to visit periodically, especially for special occasions such as birthdays and seasonal festivities. There is a large, accessible garden to the rear of the home and service users have the opportunity to go out into the community from time to time. Visitors are welcomed into the home at all reasonable times. Three visitors were spoken to during the site visit all of whom were extremely positive about all aspects of the service. One person said, The home is excellent. Everything about it is perfect and we looked at many places before deciding on Bromfield. The staff are very caring and i see that when they talk to all of the residents. Another visitor said, Im part of the furniture here, its always very welcoming, i spend alot of time here. They let me know when any decisions need to be made. I couldnt be happier with them. Care Homes for Older People Page 15 of 26 Evidence: All of the residents spoken to were very positive about the food, one person said, The food is very good, we get lots of choices. Menu records demonstrate that a healthy, balanced diet is offered and good quality food was in stock. Mealtimes are relaxed and unhurried and provide a social focal point to each day. Care Homes for Older People Page 16 of 26 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. Service users views are listened to and acted upon and they are protected from forms of abuse. Evidence: The home has a clear complaints process in place, copies of which are provided to service users and the representatives. It is also on display within the home. No complaints have been received since the last inspection. There is a complaints book in operation and the outcomes of any concerns are recorded. Service users stated that they would feel comfortable raising any concerns or complaints with any of the staff, the manager or the owner should they feel the need to do so. There are policies and procedures in place relating to abuse awareness and all staff have undertaken necessary training in this regard. Staff spoken to demonstrated a good awareness of their individual and collective responsibilities in this area. The manager has recently attended a course covering the Mental Capacity Act and the Deprivation of Liberty Safeguards. There have been no Safeguarding Vulnerable Adult alerts since the last inspection. Care Homes for Older People Page 17 of 26 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 is suitable for the needs of the service users. Evidence: Bromfield House is situated on a main road leading into Minster-on-Sea, there is parking space available on the drive in front of the building. The home has been wellmaintained and provides a comfortable and homely environment for the the people who use the service. A tour of the premises was undertaken and a number of bedrooms were viewed all of which are suitable for the needs of the service users. Residents confirmed that they like their rooms and the space in the home. 8 of the bedrooms have en-suite facilities. There is a large lounge/dining area with an attached conservatory making a bright, airy and comfortable communal living space. To the rear of the house there is a large garden that is fully accessible to all service users. One resident stated that Bromfield House is a lovely home, its very comfortable. There are toilet and bathroom facilities conveniently situated throughout the building and are suitable for service users needs. There is a domestic style kitchen that is due to be refurbished in the near future and suitable laundry facilities are available. It was reported that all equipment is in good working order. The home was clean and hygienic and staff follow appropriate guidance for ensuring the control of infection. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a well trained and competent staff team in sufficient numbers. There is a robust recruitment process. Evidence: There are sufficient numbers of staff on duty throughout the day and night to meet the service users needs. 2 care staff work throughout the day in addition to the manager and there is 1 waking staff at night. Service users confirmed that there are enough staff to meet their needs at all times and staff were observed to complete their tasks in an unhurried manner with time to talk to residents. Over 50 of the staff team have achieved at least a National Vocational Qualification in care at level 2 or above. In discussion, care staff spoken to appeared knowledgeable and had a good understanding of the needs of the service users. One relative stated that the staff are very caring. Staff receive training and instruction covering all mandatory topics and the manager has introduced a range of competency assessments to underpin this knowledge. It was noted that not all staff have completed food hygiene training which is recommended. Refer to recommendation 1. Staff have the opportunity to attend additional courses including POVA, medication, infection control and palliative care. All new staff members work through a sufficiently detailed induction programme and there was evidence that this is completed in a timely manner. Care Homes for Older People Page 20 of 26 Evidence: 2 staff personnel files were examined both of which contained all required information including CRB and POVA checks, two written references and proof of identity amongst other things. The home operates a consistent and robust recruitment process. Care Homes for Older People Page 21 of 26 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 is run in the best interests of the service users. Evidence: The manager has worked at Bromfield House for over 10 years and has been in the management role for approximately 5 years. She has attained all of the required qualifications to supplement her managerial experience. There is also evidence that she has continued to expand her knowledge base. Staff, service users and relatives all spoke positively about her positive approach and effect on the service. In discussion it was evident that she has a clear understanding of her role and the requirements of her job. She stated that she is currently trying to develop improved delegation skills with the intention of promoting more responsibilities amongst the staff team. The responsible individual and the manager both take hands on roles within the home on a daily basis and can demonstrate that they continue to develop, monitor and improve the service. Service users and relatives stated that they feel that their views are listened to and that they have a say in the running of the home. The service Care Homes for Older People Page 22 of 26 Evidence: provides regular opportunities for feedback through satisfaction questionnaires, formal and informal meetings. The home does not take an appointee role in relation to service users finances, but a safekeeping service is offered for residents personal monies should they wish. Records are clearly maintained and kept up to date in this regard and residents have access to their money when they require it. A range of documentation relating to health and safety issues was examined. Fire safety records and accident records are kept up to date and monitored. Risk assessments are in place relating to both individuals and the general environment. All service safety certificates including electrical wiring, gas safety, equipment and waste disposal were in place and up to date. The home has established safe codes of practice and ensures staff competency in issues relating to health, safety and welfare. Care Homes for Older People Page 23 of 26 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 24 of 26 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 Care Homes for Older People Page 25 of 26 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). 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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