Care Home: Broomcroft House

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What the care home does well Prospective people and their representatives have the information needed to choose the home, which will meet their needs. " The information on the brochure is good." " When we came around the manager showed us around and gave us a comprehensive run down of the place." These were some of the comments received by us.The people have their needs assessed by the staff before agreeing to move in. this helps staff to find out whether they have the capacity to meet the individual`s needs. The health and personal care that people receive are based on their individual needs. The principles of respect, dignity and privacy are put into practice by staff. These are some comments from the people and the staff. " The care staff are very helpful and do their best." "When our regular staff are on I know everything would be taken care of." "We encourage residents to maintain good personal care and encourage them to mobilise and be independent. This helps with their pressure areas and mobility." The staff with the help of the representatives found out the likes and dislikes of people who were unable to take control of their lives due to their ill health. But those who were able to, they were seen to have a say in the daily routines. The people who use the service are able to express their concerns and have access to a robust and effective complaints procedure. The people are protected from abuse by the training of staff and the company`s policies and procedures. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. The management and administration of the home is based on openness and respect to those who use the service. This was evidenced by the news letters sent out to the relatives informing them of changes. What has improved since the last inspection? The new care plan documentation has been introduced which helps the staff gather relevant information and follow a systematic pathway when planning the care. Those people who have problems maintaining their continence were encouraged by staff to use the toilets. This helps to avoid people with dementia getting agitated and helps to maintain continence as much as they are able to. The medication management has improved and the supplying pharmacist is having an active role in monitoring the medication management. One of the nurses said that during the recent audit the pharmacist had made recommendations and that they were working to meet them. Those people who were going into bedrooms of others without their permission were being supervised and systems have been introduced to reduce this. One of the people was pleased with this arrangement. There were records of complaints received and the actions carried out by the management to rectify them. All parts of the home were free from offensive odours. This made Broomcroft House welcoming to visitors and made those people living and working in the home feel homely and comfortable. What the care home could do better: The staff must receive training on Identifying abuse and adult protection. This is to protect the people living at the home and also the staff working at the home. There has been a lack of progress since the last inspection. The care staff must receive supervision at least six times a year and written records of the supervision must be kept at the home. Staff supervision is vital so that they are competent and confident when delivering care. Very little progress has been made on this. It is important that the care staff receive guidance and training on dealing with death and dying of service users i.e. End of Life care. So that not only they are able to support the people and their relatives but also equipped to cope with the bereavement of the person they had been caring for. The number and the skill mix of staff must not be compromised during evenings, holidays and weekends so that people are put at risk. The management need to monitor staff allocation within the units and their roles and responsibilities during each shift. New staff must complete induction training and be supervised at all times. The quality of induction training needs to be reviewed so that staff feel competent when they are allocated people to care for. The staff at Broomcroft need to attend mandatory training to ensure that they are competent and safe to carry out the tasks they are expected to perform. Training such as moving & handling, health & safety, fire safety, protection of vulnerable adults, Infection control and first aid are some of the topics the staff needed to attend. There was a lack of documentary evidence to support this. The quality monitoring systems at the home must focus on the outcome for the service. Management must take action and ensure that the staff sustain the improvements made following concerns made by the users of the service. So that the people using the service will be confident that their views have been taken seriously and progress had been made.The management need to introduce a policy where by people`s needs assessments were checked at the point of admission to the home to determine whether any changes had occurred to the primary assessment. This would prevent people coming into the home with conditions such as diarrhoea and vomiting and putting other people living at the home at risk of infection. The management need to ensure that suitable storage facilities are provided for the equipment, furniture and aids used at the home. At the moment the bathrooms, people`s own rooms and stair ways are used for this purpose. Information with regards to staff training and development was received this morning 07/12/07 and they were up to date. CARE HOMES FOR OLDER PEOPLE Broomcroft House Ecclesall Road South Sheffield South Yorkshire S11 9PY Lead Inspector Marina Warwicker Key Unannounced Inspection 29th November 2007 8 am X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broomcroft House DS0000021771.V355555.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. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomcroft House Address Ecclesall Road South Sheffield South Yorkshire S11 9PY 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) 0114 235 2352 0114 235 2351 brennsh@bupa.com BUPA Care Homes (AKW) Ltd Post Vacant Care Home 87 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (52) of places Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2007 Brief Description of the Service: Broomcroft House is situated in the suburbs of Sheffield, with the city centre being approximately four miles away. Located on the edge of Ecclesall Woods; it is on a bus route and within easy walking distance of the local shops, including the post office. This is a two-storey purpose built stone building specifically to meet the needs of eighty-seven elderly people who require nursing and/or personal care. The first floor of this home has been converted into a unit caring for people with dementia. The range of fee charged is £500.00p to £1100.00p per week. The fee covers personal care, nursing care and hotel services. The people buy their own toiletries and personal items such as newspapers, magazines and also pay for hairdressing and taxi when going out. However, outings arranged by the home are organised and paid for by Broomcroft House. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Thursday 29th November 2007 between 8am and 6pm. Residents and relatives were consulted and the staff on duty were spoken with. We also forwarded by post a further ten surveys to people using the service at Broomcroft, ten surveys to relatives, five health & social care professionals and ten surveys to staff to obtain feedback about the service. Comments received from the surveys up to the date of the site visit were shared with the manager and the responsible individual who were present at the feedback. An Expert by Experience (i.e. an individual who has had experience looking after relatives in care homes and had been selected by ‘Help the Aged’ for the Commission for Social Care Inspection as an observer to seek the service users views.) joined us at the site visit. She spent from late morning and up to mid afternoon. Her observations were shared with the manager and have been included in this report. We received comments about the lack of staff and that a few of the experienced permanent staff were to leave the service. People were concerned as to why this was happening and what the organisation had planned to do. This was one of the reasons for the site visit to be brought forward. Time was spent observing and interacting with staff and the service users. The premise was inspected which included bedrooms of service users and the communal areas inside and the outdoors. Samples of records were checked. They were medication records, care plans, staff recruitment and training files. I would like to thank the people living at Broomcroft House, their relatives, the expert by experience, the staff and the management for their contribution towards the findings in this report. What the service does well: Prospective people and their representatives have the information needed to choose the home, which will meet their needs. “ The information on the brochure is good.” “ When we came around the manager showed us around and gave us a comprehensive run down of the place.” These were some of the comments received by us. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 6 The people have their needs assessed by the staff before agreeing to move in. this helps staff to find out whether they have the capacity to meet the individual’s needs. The health and personal care that people receive are based on their individual needs. The principles of respect, dignity and privacy are put into practice by staff. These are some comments from the people and the staff. “ The care staff are very helpful and do their best.” “When our regular staff are on I know everything would be taken care of.” “We encourage residents to maintain good personal care and encourage them to mobilise and be independent. This helps with their pressure areas and mobility.” The staff with the help of the representatives found out the likes and dislikes of people who were unable to take control of their lives due to their ill health. But those who were able to, they were seen to have a say in the daily routines. The people who use the service are able to express their concerns and have access to a robust and effective complaints procedure. The people are protected from abuse by the training of staff and the company’s policies and procedures. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. The management and administration of the home is based on openness and respect to those who use the service. This was evidenced by the news letters sent out to the relatives informing them of changes. What has improved since the last inspection? The new care plan documentation has been introduced which helps the staff gather relevant information and follow a systematic pathway when planning the care. Those people who have problems maintaining their continence were encouraged by staff to use the toilets. This helps to avoid people with dementia getting agitated and helps to maintain continence as much as they are able to. The medication management has improved and the supplying pharmacist is having an active role in monitoring the medication management. One of the nurses said that during the recent audit the pharmacist had made recommendations and that they were working to meet them. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 7 Those people who were going into bedrooms of others without their permission were being supervised and systems have been introduced to reduce this. One of the people was pleased with this arrangement. There were records of complaints received and the actions carried out by the management to rectify them. All parts of the home were free from offensive odours. This made Broomcroft House welcoming to visitors and made those people living and working in the home feel homely and comfortable. What they could do better: The staff must receive training on Identifying abuse and adult protection. This is to protect the people living at the home and also the staff working at the home. There has been a lack of progress since the last inspection. The care staff must receive supervision at least six times a year and written records of the supervision must be kept at the home. Staff supervision is vital so that they are competent and confident when delivering care. Very little progress has been made on this. It is important that the care staff receive guidance and training on dealing with death and dying of service users i.e. End of Life care. So that not only they are able to support the people and their relatives but also equipped to cope with the bereavement of the person they had been caring for. The number and the skill mix of staff must not be compromised during evenings, holidays and weekends so that people are put at risk. The management need to monitor staff allocation within the units and their roles and responsibilities during each shift. New staff must complete induction training and be supervised at all times. The quality of induction training needs to be reviewed so that staff feel competent when they are allocated people to care for. The staff at Broomcroft need to attend mandatory training to ensure that they are competent and safe to carry out the tasks they are expected to perform. Training such as moving & handling, health & safety, fire safety, protection of vulnerable adults, Infection control and first aid are some of the topics the staff needed to attend. There was a lack of documentary evidence to support this. The quality monitoring systems at the home must focus on the outcome for the service. Management must take action and ensure that the staff sustain the improvements made following concerns made by the users of the service. So that the people using the service will be confident that their views have been taken seriously and progress had been made. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 8 The management need to introduce a policy where by people’s needs assessments were checked at the point of admission to the home to determine whether any changes had occurred to the primary assessment. This would prevent people coming into the home with conditions such as diarrhoea and vomiting and putting other people living at the home at risk of infection. The management need to ensure that suitable storage facilities are provided for the equipment, furniture and aids used at the home. At the moment the bathrooms, people’s own rooms and stair ways are used for this purpose. Information with regards to staff training and development was received this morning 07/12/07 and they were up to date. 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. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 9 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 Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective people and their representatives have the information needed to choose the home, which will meet their needs. They have their needs assessed by the staff before they enter the home and they are informed about the service they will receive before agreeing on a place. EVIDENCE: Three People and four relatives told us that they were able to access information about the home without any problems. The comments were, “ The information in the brochures is good.” “ When we came around the manager showed us around and gave us a comprehensive run down of the place.” Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 11 On the day of the site visit we observed two families being taken around and shown the facilities. The manager and the receptionist took in turn to take people around the home. The staff said that all the people had assessments of their needs prior to admission. This was to find out whether they had the capacity to care for the individuals needs. These assessments were carried out several weeks before the admission of the individuals and copies of the assessments were kept at the home for reference. It has become necessary for the management to introduce a system where by an update of the person’s present needs were sought immediately before admission to Broomcroft House to avoid incidents where people had moved in when they had been experiencing illness such as diarrhoea and vomiting without letting the staff know. This puts the other people living at the home at risk of contracting the infection. This will be addressed under standard 38 as a matter for action. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by staff. EVIDENCE: Three care plans were scanned to familiarise ourselves with the new QUEST documentation. The care plan documentation was in the process of transition from the old to the present QUEST system. The responsible individual said that during the monthly audits he had found the standard of care plans had improved. The people living at the home made the following comments about the care they received. “ The care staff are very helpful and do their best.” Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 13 “When our regular staff are on I know everything would be taken care of.” “Sometimes they are too busy to come and chat with me. I know they have plenty to do.” “ I can’t fault the care when there is enough of them.” Here are some comments from the staff interviews and feedbacks. “We make sure people are turned two hourly when they are in bed to prevent them getting pressure sores.” “We encourage residents to maintain good personal care and encourage them to mobilise and be independent. This helps with their pressure areas and mobility.” The nurses administered medication. The manager said that the supplying pharmacists carried out audits. They were unable to supply us with a copy of the latest audit record. This was to be submitted to us at their earliest. One of the nurses said that there had been audits by the pharmacist and that they were working towards the recommendations. The staff kept records of medication received, administered to the people and disposed of. There was medication waiting to be returned to the pharmacy. We were informed that there has been a change of the named person responsible for medication and this was the reason for the delay in returning the unwanted medication to the pharmacy. The records on the Medication Administration Sheets were accurate. The care workers said that they did not take part in the administration of medication. The manager said that the people had access to a telephone and if they wanted they were able to have their own private phone in their rooms. One of the people had said, “I miss having a telephone in my room. I am told that it would cost quite a lot of money and take time.” But this person did not know that they could access a pay phone. The staff were heard addressing people in a dignified and respectful manner. The people living at the home were seen wearing clean clothes and looked comfortable. When staff were asked how they maintain the privacy and dignity of those suffering with dementia, these were some of the comments received. “It helps when we know about them and what they were like before getting dementia. I like asking their relatives so that I know the real person.” “I explain what I am about to do. I know my residents and I know when they want to be left alone.” Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 14 “Sometimes we encourage them to do more. I know it takes longer when they do things themselves. I like to see how much they could help themselves.” “ People with dementia don’t like to be surprised. They like to be familiar with things even though they tend to forget.” “ We always knock before entering the rooms. Make sure they are covered appropriately when helping with personal care. Give them time.” The care staff said when the general practitioner visited they explained to the person and escorted the person to their bedroom. The staff said that they stayed with the person to support them and help with any queries. One staff said, “I report to the sister in charge if the doctor had discussed anything during the visit.” Health professional feedback was very positive about the staff at the home. There was no evidence of formal training on end of life care on the four staff files checked. Some staff said that they had received training on palliative care. Some said that they have had experience in looking after people during end of life. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 15 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 and 15. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Individuals are involved in decisions about their lives, they play an active role in planning the care and support they receive. The staff with the help of the representatives support those who are unable to take control of their lives due to their medical conditions. People who use services are able to make choices about their social, cultural and recreational activities. The individual’s expectations are not always met by the activities offered at the home. EVIDENCE: During the site visit, the expert by experience witnessed 17 people in a lounge taking part in ‘Music and Movement’ activity. ‘An external trainer ran this. She observed the trainer encouraging everyone in the lounge to take part but she was aware of their limitations. Three staff had joined in and assisted the people when necessary.’ Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 16 One person had said that the trainer was ‘brilliant’. Another person had said that ‘there were supposed to be quizzes, but they often did not materialise. There were not as many quizzes as there used to be.” Two relatives commented, ‘although there were lists of activities for the residents often they did not reflect the individuals’ preferences.’ There was an activities co-ordinator who was shared between the two units. The manager and the responsible individual assured us that as part of the new care plan people’s profiles would be updated and this would give them the information about the preferred activities. We explained to the manager and the responsible individual about the introduction and the scope for ‘Protected time for patients/people’. This is an uninterrupted 20-30 mins per week where key workers spending 1:1 time with the people and use the time productively to enhance the person centred care. Although there had been outings the feedback confirmed that the activities were not varied and appropriate to some of the individuals. There was a comment about the lack of activities in the evening. One person said, “The nights are long and it gets dark very early. I don’t like family travelling in the dark to come and visit. It can be very lonely and I get fed up.” The people and their families said that they maintained contact with the staff to find out progress. The people said that they could see anyone they wish and in private if they wanted to. The people were allowed to bring with them their personal possessions to make their room personalised. Most bedrooms were individualised. The people received a varied, appealing, wholesome and nutritious diet. They were given assistance and offered a choice of meals at mealtimes. We saw staff helping the people discreetly with feeding. The expert by experience had lunch with the older people in one of the dining rooms. Her comments were, “The food was well cooked and presented. It was a pleasant room with a servery to ensure that the food was kept hot. Table cloths and linen serviettes were used. I later saw the full menu displayed. It looked excellent.” Those relatives visiting during meal times were offered a meal to make them feel welcome. We witnessed this on the day of the site visit. We too had lunch at the home. The meal was tasty and there was a choice available. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 17 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 and 18. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are able to express their concerns and have access to a robust and effective complaints procedure. The people are protected from abuse by the training of staff and the company’s policies and procedures. EVIDENCE: There was a clear and accessible complaints policy available for people living at the home and the visitors. The manager had a record of the complaints and the action the management had taken to rectify them. The staff were able to verbalise the complaints procedure and they knew the different stages and who was responsible for each stage. This is some of the feedback from the staff. “Often complaints are raised because of misunderstanding between the relatives and the staff. Some relatives have unreasonable expectations.” “Some relative’s perception is that the resident get 1:1 care. They want value for money. The families expect a carer there all the time. We don’t have such high levels of staffing. This is often the case when relatives make complaints” We have made recommendations under standard 33 reflecting this point. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 18 “ I try to say sorry if they complain to me and put things right if I can or tell the nurse or sister in charge.” Out of eight staff training records only one person had evidence of staff attending training on Safe Guarding Adults. The manager and the Responsible Individual were surprised at this and said that the training records had not been updated and that they would forward the information to us the following day. During staff interviews they demonstrated a good understanding of different types of abuse and how they would identify any abuse at their place of work and the action they would take. There had been allegations of abuse at the home and the management and the staff had competently dealt with the situations and had involved the appropriate people. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The following comments were made by the expert by experience. ‘ The outside of the building and the grounds looked very tidy and well maintained. The entrance was very attractive and well furnished, like a hotel foyer. The whole building looked like a good hotel. It was tastefully furnished, carpeted and decorated. Everywhere was very clean. There were no unpleasant odours. The rooms were spacious, well decorated and personalised.’ We found an improvement in the cleanliness since the last visit especially on the first floor. There weren’t any unpleasant odours and the people were Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 20 encouraged to use the toilets during the day by staff. It was also observed that there was always a staff member with the people in the lounge on the first floor. The manager on hearing this comment was very pleased and explained that it took him a lot of persuasion to get the staff presence at all times in the communal areas when it was occupied by people. There were some comments received with regards to lost clothing when the items had been sent to the laundry. During conversations the staff said that they were mindful of the misplaced items of clothing and they try to find the items or replace them. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 21 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 and 30. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The staff on the whole are trained, skilled and usually in sufficient numbers to support the people who use the service. EVIDENCE: To maintain the appropriate staff complement the manager said that they had been using agency staff. However, the feedback from some staff and some relatives contradicted this. There was also a strong suggestion that the lack of staff presence was noticeable at the evenings, weekends and during holiday times when staff did not turn up or did not inform the management that they were ill. Those who made the comments identified the following as the reasons for such staff behaviour. • • • • low staff morale, lack of pay and conditions lack of appreciation of their worth lack of commitment and team working. Discussions took place between the manager and us with regards to better organisation of staff within each unit. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 22 During our visit we noticed that the staff were not efficiently utilised to achieve the maximum effect for the people receiving the service. On the day of the site visit there were five nurses on duty, three nurses on the first floor and two on the ground floor. We were told that three out of the five nurses were working as care staff. If the nurses were engaging in direct delivery of care and supervision of the care staff then it would be commendable. However, working as care staff was not an efficient way of utilising resources. We spoke with the manager and sought clarification. Staff commented that some days there were three nurses on duty and on another occasion six nurses were put on rota and the management did not monitor this. In addition we noted that there were hostesses, domestic staff, maintenance staff and the activities co-ordinator also on duty. Comments received confirmed that the staff and skill mix on each shift needed monitoring since they were not equally balanced. Recruitment files of four staff were checked. It was established that the registered person operated a thorough recruitment procedure based on equal opportunities and making sure that the people living at the home were protected from harm or abuse by their processes. The staff said that the new staff received induction training. On further inquiry, a new staff said that they were assigned to a member of staff to shadow for two weeks. They were expected to learn the way to care for people by mentorship. Feedback from other new staff supported this. The general feedback was that the responsibility for induction did not sit with a particular person and that it was not organised and delivered the way it should be. The staff said that they had the handbook and tools. Following two weeks of shadowing they were counted in the numbers and allowed to deliver care. When questioned as to whether they received formal training on moving & handling, health & safety, fire safety and protection of adults from abuse; the comments were that they shadowed their mentors and learnt on the job. During the conversation with the manager he informed us that the staff were expected to work through the induction book over a period of time and finally he signed the book to say that they had completed the probationary period and deemed competent. We spoke about the new staff competency when allowed to work on his or her own after two weeks of shadowing. The responsible individual was also present and agreed to look into this practice. However, we the Commission for Social Care Inspection expect all new staff to have the following mandatory training before being counted in the numbers. This is to ensure that staff are competent and therefore they were not putting themselves or the people using the service at risk of harm. The topics for Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 23 training are moving & handling, health & safety, fire safety, Infection control and safe guarding adults. 75 of the care staff were either working towards or had completed NVQ Level2 this is commendable. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 24 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): 33, 35, 36 and 38. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and respect. The home has a quality assurance system. As part of this monitoring regular meetings are held between the management and the people living at the home, their relatives and also staff to find out their views and comments. The improvement made due to the monitoring need to be sustained and systems are needed to check the maintenance of the progress made. EVIDENCE: The home’s manager, two senior nurses and two experienced care staff were to leave during this month (December 2007). This was confirmed at the site visit. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 25 We received comments about the lack of staff and the experienced permanent staff leaving the service. People were apprehensive as to why this was happening and what the organisation had planned to do. This was partly the reason for the site visit to be brought forward. The responsible individual assured us that a Peripatetic manager was to take over and run the home. This person would be working with the present manager during a handover period and during the recruitment of a permanent manager. The relatives and the residents informed us that meetings took place with the manager and the responsible individual but they said very few improvements were made following the meetings. When changes were made they did not last long. These are some comments received by us. “When we suggest for changes or raise concerns at the meetings, the management make sure that the staff take action to correct it. But there is no one who keeps check after the initial improvement. So things go back to the way it used to be.” “When we bring up staffing numbers at the meetings the management listen and do very little.” “People with dementia need short bursts of activities and often. They get restless in the evening. There doesn’t seem to be any activities when they need it.” “How can staff be receptive when they work 12 hour shifts. Some look tired. What can you do about it?” The people at the home either manage their own finances or have representatives managing their finances for them. The staff supervision records were checked. The staff have had annual appraisals but not regular supervision. This information was obtained from the records kept by the home. Two staff said that they had supervision but not regularly. The staff comments were, “ It is difficult to find time for formal supervision when we are struggling to carry out our day to day tasks. We have new paper work to complete.” “The dependency levels of residents have increased and their demands have gone up. The people know what they want and they want it now. We don’t have enough staff to remove two people away for an hour at a time for supervision during the shift time.” Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 26 The staff said all accidents and incidents were reported to the manager and the information was passed on to the head office. Staff were interested to know the outcome of the analysis of the data. Their feedback revealed that the outcome of the analysis might influence the staffing levels and better equipment for them to use at the home. They gave the following examples. • The bath chairs’ wheels are rusty and sticky making movement of people difficult, • The staff and people having to wait for the hoist to come free most times when they needed to use it. This causes dissatisfaction among the people and relatives. • The ridge on the en suite shower basin being a problem when wheeling people over it. • The manager and the responsible individual were informed of the above. The manager said that they had placed an order for an additional hoist and that he would look into the shower chairs but explained that the ridge on the shower basin could not be removed since this was helping water flow down the drain. The staff training and induction has been commented on under Standard 30. An introduction of a policy to prevent people entering the home without informing the staff of any new illnesses needed to be addressed by the management. This was fully explained under the outcome area ‘Choice of Home’. The expert by experience commented that mattresses and chairs were stored at the top of a staircase. This is an ongoing problem. There was not enough storage space to store the equipment and furniture which are not in use. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X 2 Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18 Requirement All care staff must receive supervision at least six times a year and written records of the supervision must be kept at the home. Staff supervision is vital so that they are competent and confident when delivering care. Previous requirement 06/12/05, 12/06/07. All care staff must receive guidance and training on dealing with death and dying of service users i.e. End of Life care. So that the staff are able to support the people and their relatives and also able to cope with the bereavement themselves. Previous requirement 27/01/06, 12/06/07. The number and the skill mix of staff must not be compromised during evenings, holidays and weekends so that people are safely cared for. Previous requirement 22/03/07 With Immediate effect and then ongoing. New staff must complete induction training and be DS0000021771.V355555.R01.S.doc Timescale for action 22/01/08 2. OP11 12,15 04/03/08 3. OP27 18 28/12/07 4. OP30 12,18 22/01/08 Broomcroft House Version 5.2 Page 29 5. OP38 13,23 6. OP12 12 7. OP33 24,26 supervised at all times. The process of induction must be reviewed so that staff feel competent when they are allocated to people to deliver care. Previous requirement 22/03/07. All staff must attend mandatory 22/01/08 training to ensure that they are competent and safe to do the jobs they are expected to perform. Training such as moving & handling, health & safety, fire safety, protection of vulnerable adults, Infection control and first aid are some of the topics the staff must attend. Previous requirement 15/05/07. The activities for the people 04/03/08 living at the home must be varied, flexible and suit expectations, preferences and capacities. The times of the activities must also be flexible so that individuals are able to benefit. The quality monitoring systems 04/03/08 at the home must focus on the outcome for the people living at the home. The following areas must be monitored as part of quality assurance to maintain the confidence and safety of those who use the service . • Management must take action and ensure that the staff sustain the improvements made. So that the people using the service are confident that their views have been taken seriously and progress has been made. • The management and staff must ensure that all the people living at the home are aware that they have to access a telephone and DS0000021771.V355555.R01.S.doc Version 5.2 Page 30 Broomcroft House that they could have a private conversation. • The introduction of a policy to prevent people entering the home without informing the staff of any new illnesses needed to be addressed by the management. Management must ensure staff are utilised to achieve the maximum benefit to those living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations The management must ensure suitable storage facilities are provided for the equipment and aids used at the home. Previous recommendation. Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Broomcroft House DS0000021771.V355555.R01.S.doc Version 5.2 Page 32 - 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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