Care Home: Broome End Care Centre

What the care home does well The staff recruitment process is thorough; this means that people living at Broome End are protected by the safe recruitment of professional and friendly staff. Relatives told us they were generally happy with the service and care provided. Visitors to the care home are made to feel welcome at all times. People enjoyed the food provided for them at the home. People received the health care support they needed. People felt safe at Broome End. What has improved since the last inspection? Since the last inspection of this service the staff training provision has improved, this means that the manager can evidence that staff have the skills and competencies to meet the needs of the people living at Broome End. There is a developing activity schedule with 2 activity co-ordinators employed to provide stimulation and interest for the residents. What the care home could do better: Whilst some work has been undertaken on the care planning system to ensure that relevant and up to date information is readily accessible for care staff to follow, this work needs to continue and be built upon. The daily recording needs to continue to improve to ensure that it accurately reflects the level of support provided for people on a daily basis. This is so that an accurate audit trail is maintained that will contribute to care planning reviews to assess if peoples` needs are changing. Investment into the home needs to take place in the form of redecoration and refurbishment. At the previous inspection visit of May 2009 we were assured that refurbishment of some areas of the home would take place to make a more pleasant and homely environment for the people living there. We were disappointed at this visit to find this work had not progressed and that the home appeared tired and shabby in many areas. Key inspection report Care homes for older people Name: Address: Broome End Care Centre Pines Hill Stansted Mountfitchet Essex CM24 8EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Broome End Care Centre Pines Hill Stansted Mountfitchet Essex CM24 8EX 01279816455 01269814598 broomeend@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Oluwatoyin Onabanjo Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 37 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (9) Date of last inspection Brief description of the care home Broome End is a three storey converted residence with a newer two storey extension, set in spacious grounds on the edge of the village of Stansted Mountfitchet. The home is registered to provide residential care for up to 37 people over the age of 65, with varying degrees of dependency, including nine places for people with diagnosed dementia. Residents are accommodated in twenty-nine single rooms and four double Care Homes for Older People Page 4 of 28 Over 65 0 37 9 0 Brief description of the care home rooms, with communal space comprising three lounges and two dining rooms. The home has two passenger lifts to enable access to all floors. The gardens and grounds are at the rear of the home with ramps providing access. Ample off road car parking is provided to the front of the home for visitors, and bus services pass the building along the main road. Local shopping facilities are a short walk away. The weekly fees at the time of inspection in April 2010 ranged from £456 to £787. The fees did not cover hairdressing, private chiropody, toiletries or items from the tuck shop. Past inspection reports are available from the home, and from the CQC internet website. Care Homes for Older People Page 5 of 28 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 was an unannounced key site visit that took place over 9 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Older People Page 6 of 28 Before the site visit a selection of surveys had been sent to the home for distribution to residents and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 5th May 2009. Care Homes for Older People Page 7 of 28 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 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 28 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 9 of 28 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. A full and detailed assessment of prospective residents wishes and requirements ensures the home can meet their needs. Evidence: There was Statement of Purpose available at the home that detailed the aims, objectives and philosophy of care at the home. There was a Service User Guide provided for each person living at the home, the guide stated that the information within was also available in audio cassette form for people with visual impairments. The document provided a clear picture of the services and facilities that people could expect to find at the care home. The managers AQAA stated that: The home carries out an assessment on a prospective Service User before a possible admission. This could take place at the prospective Users of the service home or in hospital and All prospective Users of the Care Homes for Older People Page 10 of 28 Evidence: service and/or families are invited to come and see the home prior to assessment to see if they like the room available etc. All Users of the service are admitted in to the home on a trial period with a meeting arranged with Social Worker/family representatives after 4/6 weeks to decide whether a permanent placement is needed and to discuss any issues that may have arisen i.e. changes of need. We looked at pre-admission assessments for two people recently admitted to Broome End. Both contained comprehensive information about various areas of need such as past medical history, medication, mobility, dressing, personal hygiene, feeding, eyesight, pressure sores, communication, social dependency and behaviours. This information together with the NHS hospital discharge information and Social Services needs assessments formed the basis of peoples initial care plans. We spoke with a local authority care manager involved with the admission of one of these residents, they told us: They were really very good in trying to accommodate (Persons name) needs and The home was very pleasant with very pleasant staff. The staff training matrix showed that the staff team had received an increased amount of training since the previous inspection to ensure they had the skills and competencies to meet the needs of the people living at Broome End. Care Homes for Older People Page 11 of 28 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 people receive is based on their individual needs and preferences. Evidence: The managers AQAA stated: Every Service User in the home has an individual care plan which details health, personal and social care needs. This enables staff to cater for the Users of the service needs in a holistic approach. The care plans are evaluated at least once a month to reflect changing needs along with the corresponding risk assessments. This is done in conjunction with the Service User and their family. We promote Person Centred Care whilst maintaining independence and dignity. Specifically we address our Service Users by their preferred name and ensure that their choices of everyday living activities are observed and carried out. We looked at care plans for 3 people living at the home. We saw these were well organised, person centred and agreed with the individual where possible. The information flowed smoothly through the care plan from assessment of needs to risk assessment and the care and support needed to meet peoples needs and keep them Care Homes for Older People Page 12 of 28 Evidence: safe. Where risks had been identified corresponding support plans had been developed to provide strategies to manage the risk. At the previous inspection of this service we found that the quality of daily recording varied including comments such as daily hygiene assisted. As part of this inspection site visit we looked at daily records to assess if the care and support provided for people was in accordance with their care plans. There was some good information showing what people had done with their day such as sitting in the gardens with their friends laughing together or receiving visitors. The statement All personal hygiene attended to was seen in some daily records, this did not provide any information about the level of support the person needed and received from day to day. Staff we spoke with told us that this could vary considerably depending on peoples state of mind on the day. Detailed daily records would provide an audit trail of the care and support provided and would contribute to effective care plan reviews by showing a clear picture of how peoples needs changed over time. Overall, the care plans we looked at had been signed and dated by staff to confirm they were regularly reviewed to ensure peoples care and support regimes reflected any changes in their personal circumstances. People we spoke with during the inspection were all very positive about the care they received and our observations confirmed that people appeared happy and well looked after. A service user opinion survey was undertaken by the home during October and November 2009. People responding to questions about the personal care and support they receive indicated they felt that staff attended to their needs when they were unwell and that they were satisfied with their care. The manager was trying again to implement a key working system so that residents had a named person to work with them to ensure their needs and wishes were being met and to provide people with a familiar and personal contact within the home. There had been previous attempts to introduce this system at Broome End but this had broken down due to staff changes. The staff team had stabilised with no use of agency staff at the time of this visit, the deputy manager was able to tell us how she was working with the residents and staff to appropriately match key workers for people. Medication Administration Records were completed correctly, with no gaps. Medications to be taken as required and homely medications were appropriately documented. Medications were mainly provided in a Monitored Dosage System, those provided in boxes or bottles were appropriately dated to indicate when they had been opened to provide an audit trail of medicines held at the home. We checked the Care Homes for Older People Page 13 of 28 Evidence: Controlled Medications against the register, we found these records to be accurate. The staff training matrix showed that all staff responsible for the administration of medications had received regular refresher training and the staff we spoke with were able to confirm they received this training. Overall our observations at this visit showed that staff treated the people living at the home with courtesy and respect, preserving their dignity as much as possible. We were made aware of one incident on this day where a resident had a visitor in their room and a member of the care staff team entered their room without knocking. Care Homes for Older People Page 14 of 28 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. People living at Broome End receive a balanced and varied diet and have the opportunity to enjoy a developing leisure activity programme to meet their individual needs. Evidence: The managers AQAA stated: The home now has 2 dedicated Activities Co-ordinators who have been in post since October 2009. They are currently in the process of devising a wide and varied programme to suit the needs of all Users of the service in the home be it as a group activity or on a one to one basis. There are regular party events that are sometimes themed i.e. Halloween, St Patricks Day. There are regular visits from a local lay preacher and priest for Communion for whoever wishes to take part in this. The Home is developing a relationship with a local pre-school group and individual Service Users have taken part in relationship activities which have included a trip out to see a Christmas Nativity and members of the Pre-School have attended events at the Home. A number of outside activities are brought into the Home and efforts are made to encourage, develop and maintain contact with members of the community. During the better weather pub lunch trips are held and there are regular visits to the High street for shopping. The home is very lucky to have a supportive group of family and friends who are able to assist at events and with activities. Care Homes for Older People Page 15 of 28 Evidence: Families are encouraged to take their relatives out if they wish to go. The provider organisations Service User opinion survey undertaken by the home during October and November 2009 identified that overall, people responding to questions about the daily life experience at Broome End indicated satisfaction and said that staff were friendly and treated them with respect. One area that residents had identified for improvement was social events, activities and entertainment with 33 saying there were sufficient opportunities provided and 67 saying this was sometimes the case. Minutes of a relatives meeting in February 2010 showed that people had commented on how well the two activities co-ordinators were settling in and that there was praise by all the relatives about their ideas and plans. Particular mention was made about the photo albums initiative. Relatives could use the albums to talk to the residents, during visits, about the activities they had been involved in which made visiting times that much more interactive and constructive. Minutes of a residents meeting of February 2010 showed that people had talked about the children coming in for the Chinese New Year. They also talked about how much they loved the Belly dancers that visited early that month. Some had not seen a live performance before and thoroughly enjoyed it. We looked at the scrapbooks showing activities, themed events, visiting entertainers and arts and crafts that had taken place at Broome End. This provision had improved greatly since the previous inspection visit. Photographs showed residents making table and room decorations for themed events such as St Patricks Day and Hallow een. The activity co-ordinators enthusiastically shared some plans for future events with us. These included supporting people to do things they said they had always wanted to do, an example of this was where a person said they had always wanted to ride a horse. This was not necessarily a practical option however the opportunity of riding in a horse drawn carriage was being explored. An outing to a Jousting event was being considered and outings to the sea-side were being planned at residents request. The activity co-ordinators told us that they acknowledged that it was not practical to take all the residents to the beach so they were planning to bring the beach to Broome End. They intended to bring sand trays, have water troughs for people to dip their feet into, have a Punch and Judy show, have fish and chips and ice cream. A Gazebo was available to shade residents from hot weather or should the weather turn inclement during any outside activities. We were also told of plans to implement a silver surfers cafe so that residents could maintain contact with relatives living some distance away or overseas. Care Homes for Older People Page 16 of 28 Evidence: The home had employed a new cook since the previous inspection. We visited the kitchen and found this to be clean and organised. The cook told us: Everything I have served here I have been happy with the quality. Completed surveys returned to us by the people living at the home indicated that they were satisfied with the food provision, comments included: Good and tasty food. Residents told us at this visit Very nice roast dinners. We took lunch with the residents on the day of this visit. People were offered choices at the table, the food was served hot and all people appeared to enjoy their meal. There were menus available on the tables, these were in clear bold type. There was a happy atmosphere in the dining room as two people were celebrating their birthdays. The cook had prepared birthday cakes and residents shared wine that visitors had brought into the home for them. We looked at the planned menus, these showed that people were offered a cooked breakfast daily if they so wished, there were always 2 options for the main meal and the menu was varied. Activity co-ordinators told us they worked in conjunction with the cook over themed events such as the Burns night meal where Haggis was served. Peoples care files had information regarding their nutritional needs and dietary preferences, and the staff we spoke with were fully aware of these. Kitchen staff spoken with showed that good practice regarding health and safety, hygiene and nutritional awareness was in place and that they were aware of individuals needs. Relatives visiting the home on this day told us they were encouraged to visit at any time, and they could meet with people in the privacy in their bedrooms. Care Homes for Older People Page 17 of 28 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. People living at Broome End are safe, secure and can be confident that their welfare and safety needs are always promoted. Evidence: The managers AQAA stated: All Users of the service and their relatives/friends are given the opportunity and are aware that they can voice their opinions and concerns at any time to any member of staff. Staff are aware to pass this information on to the Home Manager or Senior person in charge at the time to be documented and investigated. The home has a complaints procedure in reception on view to all and it is included in the Service User Guide of which a copy of is given to all new admissions to the home. The service user opinion survey undertaken by the home during October and November 2009 showed that all people responding said they would feel free to raise concerns with staff. However, 50 of people said they were not aware of the formal Complaints Procedures and 34 said they did not know who to speak to regarding a complaint. One comment included from the survey was No, but I would find out very easily. The managers action plan to address areas of shortfall stated: A copy of the Complaints procedure to be given to all residents and to be discussed at the next residents and relatives meetings. We discussed this with residents, their visitors and the manager. People were able to Care Homes for Older People Page 18 of 28 Evidence: confirm they had received a copy of the Complaints Policy and Procedure however, they felt that small issues brought up with the staff did not always constitute a complaint and were generally resolved immediately. The manager operated a robust complaints procedure and responded appropriately in accordance with the homes Policy and procedure when issues were brought to his attention. More training needs to be delivered to the staff team for them to recognise verbal complaints and escalate them to the management in order they may be dealt with in the best interests of the residents. The managers AQAA stated in the section entitled What we could do better: Staff to ensure that the little things that are commented on i.e. a missing item of clothing is reported directly to the Head of Department so that it can be dealt with promptly. This showed that the manager was aware of the shortfall and working to address it. All people responding to the organisations quality monitoring survey said they felt safe at Broome End. The staff training matrix showed that all staff employed to work at Broome End had attended safeguarding training in past 12 months. Staff we spoke with were able to clearly state what actions they would take in the event they suspected any abusive practice. The staff recruitment processes were robust ensuring that people were safely recruited to work with this vulnerable group of people. Care Homes for Older People Page 19 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that needs refurbishment to make it a more pleasant and homely place to be. Evidence: The previous inspection of this service identified that some areas of the home were tired and worn and that the dementia unit on the first floor of the home did not provide an interesting or stimulating environment for the people living there. The managers AQAA stated: The home has included the views of Users of the service in the redecoration programme of the home by inviting them to choose colour schemes and inform them of any changes to the environment taking place. There is a redecoration and refurbishment schedule in place for the home and the maintenance person redecorates bedrooms when they become vacant. We took a physical tour of the home as part of this inspection site visit. We noted that many areas of the home remained in need of refurbishment and appeared shabby. The door frames in the communal areas had sustained considerable damage from wheelchairs and were heavily scratched with bare and splintered wood showing. We looked at some peoples bedrooms. It was evident that people were encouraged to bring their personal items into the home to make the environment feel more homely however, where people had not been able to do this the rooms were spartan and Care Homes for Older People Page 20 of 28 Evidence: lacked a domestic feel. Some carpets throughout the home were stained and showing signs of wear. The managers AQAA from the previous year had stated that we have improved by instigating a redecoration programme. We could improve the quality of the environment by continuing with the redecoration and refurbishment plan. However, our observation at this site visit was that little investment had been made by the organisation into providing a more pleasant and enabling environment for the people living at Broome End. The majority of the home appeared clean with some exceptions such as the stairway leading to the upstairs in Beechwood unit and some bathing and toilet facilities throughout the home. Completed surveys returned to us from residents, some being completed on their behalf by relatives, stated: Urine can sometimes be smelt in the home and Several clothing items regularly go missing when they have been sent to the laundry. I do feel improvement could be made in this department. Completed staff surveys included comments such as: The home could improve by spending money on decorating and furnishing to improve its look and make it more homely. The staff training matrix provided evidence to show that all staff had attended infection control training. Care Homes for Older People Page 21 of 28 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. People living at Broome End are supported by a staff team that are safely recruited, trained, skilled and employed in sufficient numbers. Evidence: We looked at staffing levels and found that these had been maintained as found at the previous inspection of May 2009 with five care staff including 2 senior care staff on duty for the day shift. The night staff shift consisted of three waking staff including one senior. In addition there was the manager, the deputy manager 2 activities coordinators, housekeeping, admin and catering staff on duty during the day. The managers AQAA stated: At busy times the home can have extra care staff on duty to assist and staff from other departments are flexible and will assist if needed with duties that do not involve personal care i.e. at mealtimes. There has been reduced agency usage in the past 12 months. Retention of staff has improved and the qualifications of staff recruited. Training statistics have risen in all categories and the number of staff having an NVQ qualification or in progress of has improved greatly. As at the previous inspection the vast majority of care staff shifts remained as long days. We discussed this with the manager, he was able to demonstrate that staff working long shifts had regular days off to ensure they were able to rest. Care Homes for Older People Page 22 of 28 Evidence: We looked at recruitment documentation for 2 members of staff employed to work at the home since the previous inspection site visit. This showed that the manager operated a sound recruitment practice ensuring that all the checks necessary, to promote the safety and welfare of the residents, were made before the person started to work at the home. We looked at records of induction training undertaken by new employees working at the home. These were seen to be in line with the Common Induction Standards and were completed within 12 weeks of employment at the home. Records showed that all staff working at the home received formal monthly supervisions, these were clearly documented and actions plans were developed in response to any areas of concern identified during supervision such as training needs etc. The staff training matrix showed that a clear programme of training and refresher training was provided to ensure the staff had current skills and competencies to meet the needs of people living at the home. The matrix automatically flagged up where refresher training was becoming due so that courses could be arranged to make sure people received the relevant updates. Discussion with staff and management during the course of this visit identified that staff morale was low at this time. Staff responding in surveys commented: The home could make a great difference by motivating the staff. Visitors spoken with during the course of this visit said: The staff are excellent and in surveys residents commented: Caring and committed staff carers. Care Homes for Older People Page 23 of 28 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. People live in a home that continues to be managed in an open and transparent manner in the best interests of the people living there. Evidence: At the previous inspection relatives told us they felt the home could improve by having a permanent manager. Since our previous visit to this service the manager has successfully achieved registration with the Care Quality Commission. The managers AQAA stated: The Home Manager has been employed at the home since 2008 and has gained experience by holding other roles from Care Assistant upwards. This shows to the care staff an understanding of their role and can be hands on when needed. The Home Manager is in possession of RMA and has a BSc degree in Psychology and counseling certificates. Currently studying towards his MSc in dementia. There is an open atmosphere at the home for the staff and Users of the service to have their say and voice opinions. Care Homes for Older People Page 24 of 28 Evidence: A visitor to the home commented: I cant fault the home, the manager leads staff well. A comment received in a survey returned to us prior to this visit included the comment: I value the caring and friendly staff however, I note the manager is frequently absent or keeps short hours. He needs to set a better example to staff and give firmer leadership. The service operated an established annual quality assurance, obtaining the views of people living at the home and their relatives and representatives. We have included some feedback from the most recent surveys in this report. Evidence was available to confirm that regular residents, relatives and staff meetings took place at Broome End. These were all minuted and showed that the management ethos was open and transparent. The information contained within these minutes showed that overall, the service provision had improved over the past year with a more stable staff team and an increase in the activity and stimulation provided for the residents. Procedures for the safekeeping and administration of monies maintained on behalf of the people living at the home had not changed since the previous inspection of this service where they had been assessed as good. Evidence was available to confirm that regular and effective staff supervisions took place at Broome End. The manager received supervision from his line manager. We noted in the managers AQAA that a number of the homes policies and procedures have not been reviewed since January 2006. We discussed this with the manager who was able to inform us that the organisation was in the process of undertaking a full review of all existing policies and procedures. Broome End had a dedicated full time maintenance person who was responsible for all routine checks such as water temperatures etc. The maintenance person was able to confirm that the organisation was prompt to respond appropriately on any urgent repairs where peoples safety or comfort were at risk. Staff training records confirmed that training in safe working practice such as moving and handling, health and safety, COSHH and infection control had been attended by all the staff team. This is a significant improvement from the previous inspection of this service. Care Homes for Older People Page 25 of 28 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 26 of 28 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 7 It is a recommendation of good practice that care plans continue to be developed to include specific information about how individuals want and need their personal care and support provided and for daily records to include detail of how the care and support was delivered. Detailed daily records will enable an audit of the care provided to ensure people receive their care and support in the way they want and need. It is recommended that consideration be given to the refurbishment of the home to make it a more pleasant environment for people to live in. The dementia unit needs to be developed to provide a more enabling environment for the people living there. 2 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!