Care Home: Broome Park Nursing Home

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What the care home does well The home offers a homely, relaxed and friendly atmosphere and the management and administration is robust. A survey respondent states....A very efficient and well run home. A health professional records....In my professional opinion, Broome Park is an exceptional nursing home. The home`s pre assessment procedures and excellent multi disciplinary working ensure that individual`s needs are appropriately identified and met. A health professional surveyed states....I have placed clients at the home and I have subsequently seen significant improvement and stabilisation, they are skilled at managing challenging behaviour, patient, tolerant and kind. Another survey respondent records....They provide excellent care for patients with significant mental health problems that may have suffered previous service breakdowns. Both the managers and the staff have a good rapport with service user`s relatives and representatives. A relative of a service user states.....They communicate with us very well. I really appreciate the open access to what medication is given to my......, and it is easy to speak to staff about any minor problems that arise. Another respondent records....The carers do care. It is clear that the open management culture has been instrumental in encouraging people to contribute their ideas and suggestions for improving the quality of service and the home could evidence clear developmental plans for improvement. What has improved since the last inspection? All three of the statutory requirements awarded and the two good practice recommendations made in the last inspection report have been addressed and resolved. They have been removed from this report. There have been environmental improvements and upgrades in relation to internal decor and some new equipment has been purchased. For example, the home now have a `light box` to improve hand washing/infection control standards and to assist with staff training. Successful retention of the `Investor in People` quality standard in March 2009, where the home exceeded the evidence requirements. Due to the vulnerability of the service user group the home has made Deprivation of Liberty Safeguards and Mental Capacity Act training a priority, to raise awareness and knowledge of the new legislation throughout the staff team this year. What the care home could do better: It will be a recommendation in this report that the registered person further reviews the content of the home`s information documents to ensure people of all capacities have the full range of information they need and revised content meets the demands of regulation and standard. Service users would benefit if care plans were further developed to be more person centred and clearly evidenced service user`s involvement in their formulation, to better evidence the home`s good practice. Some operational care practices need review to ensure they are targeted and individualised. Service users find the lifestyle in the home largely matches their expectations but would benefit from review and further development of the home`s social and recreational staffing provision, to better satisfy their leisure needs. Key inspection report Care homes for older people Name: Address: Broome Park Nursing Home Station Road Betchworth Surrey RH3 7DF     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: Marion Weller     Date: 1 3 0 8 2 0 0 9 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 33 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Broome Park Nursing Home Station Road Betchworth Surrey RH3 7DF 01737843333 01737842444 mchoy@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Law Hing Choy,Mrs Muriel Law Hing Choy care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia dementia learning disability mental disorder, excluding learning disability or dementia mental disorder, excluding learning disability or dementia physical disability physical disability Additional conditions: The maximum number of service users to be accommodated is 56 The maximum number of service users to be accommodated is 56 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD) Learning disability(LD) Mental disorder, excluding learning disability or dementia (MD) Care Homes for Older People Page 4 of 33 Over 65 0 0 0 0 0 0 0 56 56 56 56 56 56 56 The registered person may provide the following category of service; Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category; Physical disability (PD) Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection Brief description of the care home The nursing home consists of two separate buildings. The main building is Broome Park Nursing Home and to the north of this large listed building is an annex known as Stable Cottage. The homes are set in attractive and well maintained grounds. Service user accommodation consists of 46 single and 5 twin bedrooms across both sites, some with en-suite facilities. There are communal sitting rooms and separate dining rooms and ample bathroom facilities for the people living there. Access to the upper floor in Broome Park is via stairs and a passenger lift. The home is situated in a semi-rural location and is accessible by major road and rail networks. It is convenient for Dorking and Reigate town. The home has its own vehicle and drivers who can transport service users to appointments and other community resources. The current fee is recorded as upwards of £750.00 per week. Fees vary according to assessed personal need. Please speak to the Registered Manager for more information. Care Homes for Older People Page 5 of 33 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: Broome Park Nursing Home last had a Key Inspection on the 20th August 2007. Three statutory requirements were awarded and two good practice recommendations were made as a result of the site visit. The home was subsequently assessed as a two star good service. An Annual Service Review ( ASR) was completed on 29th August 2008. As a result of the ASR, no changes were felt necessary to our scheduled inspection programme for the home. This scheduled Key Inspection was undertaken on the 13th August 2009. The inspector was in the home from 10:40 am until 19:10 pm and was accompanied for part of the time by an Expert by Experience from Help the Aged. Experts by Experience provide an additional source of evidence. They pay particular attention to spending time with the people who use the service to establish their experiences of living in the home. The Expert by Experience produces a report of their findings for the inspector, which informs and supports the inspectors own judgments. On the day of the site visit the Care Homes for Older People Page 6 of 33 Expert by Experience spent time talking with service users in communal areas, spoke with the proprietors, some staff members and observed lunch in Stable Cottage. During the site visit the inspector spoke with the proprietors, the head of care, and the nurse manager for Stable Cottage and the acting nurse manager for Broome Park. The homes administrator, the activity organiser and the chef. Brief conversations were also held with a registered nurse in relation to the homes Medication Administration. One relative of a service user asked to speak with the inspector in private and this was included. The inspector was shown around the communal areas of the home and was invited to view individual bedroom accommodation. In addition, some service user records and other documents were inspected. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and letters received and any information concerning complaints or allegations. The Registered Persons were asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The AQAA document was received by us within the timescale given. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us information which provided a good picture of what was happening in the service and their plans for further development. Prior to the site visit we sent surveys to people currently receiving services at Broome Park and Stable Cottage, relatives of service users, members of the staff group employed in the home and in addition, we surveyed health and social care professionals involved with the service, to gather their views. A total of 38 completed surveys were returned to us. Comments taken from surveys have been used throughout the report, including some taken from the homes own quality assurance report dated July 2009. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: It will be a recommendation in this report that the registered person further reviews the content of the homes information documents to ensure people of all capacities have the full range of information they need and revised content meets the demands of regulation and standard. Service users would benefit if care plans were further developed to be more person centred and clearly evidenced service users involvement in their formulation, to better Care Homes for Older People Page 8 of 33 evidence the homes good practice. Some operational care practices need review to ensure they are targeted and individualised. Service users find the lifestyle in the home largely matches their expectations but would benefit from review and further development of the homes social and recreational staffing provision, to better satisfy their leisure needs. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that their needs would be comprehensively assessed prior to a place at the home being offered. The homes information documents require further review and development to ensure people accessing this service have all the information they need prior to moving in and later for reference. Evidence: In response to a statutory requirement awarded at the last key inspection to develop the homes information documents, the inspector was given a current summary of the homes Statement of Purpose, updated on July 2009, a copy of the service user guide and a brochure. The brochure is designed specifically to provide initial information to prospective service users, their relatives or representatives. In addition, the brochure and the Service User Guide provide details about the homes web site, for people with Care Homes for Older People Page 11 of 33 Evidence: access to internet services. The home understands the importance of people having sufficient information when choosing a care home. The Head of Care records in the AQAA when asked what the home could do better in this outcome area.....Evaluate the prospective service user and their relatives journey in choosing a nursing home placement. Some further development to the content and to the production of various types of format, in line with regulation, standard and best practice is necessary to both support this aim and to ensure that people of all levels of capacity have the information they need prior to moving in, and later to use as reference. For example, the Service User Guide is currently undated and does not provide a review date. This means people may be unsure if it is the most up to date and current information about the home and the services they can expect. The content of the document is well written, but produced in a rather rudimentary pictorial format, it could be improved upon to better meet the needs of some people accommodated who may find reading difficult. The homes complaints procedure is not included for peoples information and guidance and although the CQCs contact details are provided, service users are not given the contact details of the local Social Services Department or the Health Care Authority. It lacks a brief description of individual accommodation and communal spaces to be provided to people or the current service users views of the home. Arrangements for service users or their visitors who may wish to smoke, should also be included. The Expert by Experience, who accompanied the inspector, writes in her report....A Service User Guide is available, but there is nothing written with the input of residents. The section of the Service User Guide that deals with the Health and Social care of service users records....You will be registered with Dr....(General Practitioner)and he holds a weekly ward round. Standard and Regulation demand that the registered person enables service users to register with a GP of their choice, as long as the chosen GP is in agreement. The Expert by Experience records in her report....Residents thought Broome Park took responsibility for selecting a local GP Practice, and they did not know they had a choice of GP. The provider explained to the inspector the benefits to the service user group in connection with the current GP cover arrangements. These arrangements should however be explained to people where they differ from the demands of regulation and standard, so people can make an informed decision as to whether the arrangements in place will meet their individual need and be to their benefit. It will be a recommendation in this report that the registered person further review the content of the homes information documents to ensure people of all capacities have the full range of information they need and the revised content meets the Care Homes for Older People Page 12 of 33 Evidence: demands of regulation and standard. Trained staff visits prospective residents prior to admission to make a decision as to whether the home can meet the persons needs. Information is obtained from other parties, including relevant health care professionals to assist in assessment decisions. Two pre admission assessments were inspected and found to be detailed and comprehensive. The Head of Care said they encourage prospective residents and their relatives or representatives to visit the home prior to any firm decision being made to move in. Staff evidenced they had the clinical knowledge and practical skills to care for individuals admitted to the home and were observed to be very hard working. Intermediate Care is not provided at Broome Park Nursing Home Care Homes for Older People Page 13 of 33 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 that people receive is based on identified need and is set out in their plans of care. Systems are in place to ensure that peoples health and welfare needs are promoted and met with evidence of good multi-disciplinary working taking place on a regular basis. Service users would benefit further if care plans were developed to be more person centred and clearly evidenced service users involvement. Some daily oprational practices need to be reviewed to ensure they are targeted and individualised. Service user are protected by the homes policies and procedures regarding medication. Evidence: The head of care for Broome Park advised of the development over the last 12 months of a computerised software package and data base known as Caresys which is designed to incorporate all service users care plans, daily notes, healthcare appointments, risk assessments and other information relevant to the individuals care and support needs. Staff are currently being trained to use the system to service Care Homes for Older People Page 14 of 33 Evidence: users benefit. The inspector was provided with an explanation and a practical overview of the system. The Registered Manager is mindful however that regulation demands that service users care plans must continue to be drawn up with the involvement of the service user, recorded in a style accessible to the service user and be agreed and signed by the service user, wherever capable, and must also be available for audit / inspection and review purposes. The three written care plans sampled on this inspection were based on a full needs assessment and set out in detail the action required to ensure all aspects of the health, personal and social care needs of the individual were met. They gave clear direction and guidance for staff to follow. It was evident that all care plans were being reviewed monthly in line with regulation, and more often if there were significant changes. Terminology used by trained staff in two of the care plans seen could be improved upon. Specific examples were identified and discussed with the Registered Manager, who spoke of his firm intention to rectify the shortfalls with the staff involved. It would better evidence the homes good practice if each service user signed their care plan to illustrate their involvement in its compilation and their agreement to it. It was discussed that where individuals lack capacity to understand the full content of their care plan, the home should record the reasons why the individual is not able to sign. The involvement of relatives and representatives in service users care planning should be encouraged, their signing of a care plan however is not an authorisation of what is in it. Rather, it is a record of their involvement in discussions and sight of the care plan. Relatives are not able to make welfare decisions unless the person lacks capacity and the relative has a Lasting Power of Attorney. Where there are concerns about individual capacity to take decisions, relevant professionals should be involved. It was confirmed that senior staff have received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. In the last inspection report the inspector raises the issue that care plans, although of a good standard, could be more person-centred. This remains the case. The registered persons and the staff spoken with during the inspection generally think in a person centred way when considering peoples individual care and support needs and yet there were some generic practices evidenced, such as placing pads on the seats of armchairs in communal rooms and service users using bibs at mealtimes, that could be misinterpreted as not showing concern for peoples dignity and individual ability. Such measures should only ever be aimed at the individual and be clearly recorded in their care plan. The Expert by Experience records in her report....The food looked appetizing at lunch and residents spoken with said it was adequate and enjoyable. It Care Homes for Older People Page 15 of 33 Evidence: was noted that bibs were in use. The health needs of individuals were identified and their preferences for support were documented. Nutritional screening was conducted and moving and handling assessments completed. In line with a requirement issued at the last inspection, risk assessments had been further developed to include more detail regarding the hazards presented and the actions necessary to eliminate or reduce the risk to service users. Care plans indicated that a range of health care professionals, such as a chiropodist, physiotherapist, dietician, optician, tissue viability nurse and a dentist visit the home regularly to support residents. Records were being maintained of all health care consultations and interventions received by service users. The Registered Manager explained that the home has strong links with, and good support from their general practitioner (GP) who visits on a weekly basis. The senior staff stated that the GP reviews all medications every year and more often if it is necessary. Since the last inspection the home have adopted a monitored dosage system for medication administration, designed to better secure peoples safety. The arrangements for the safe receipt and disposal of medication were robust. The home has a policy and procedure in regard to the administration of medicines in place. Medicine Administration Record sheets (MARs) were evidenced for recording medicines given to service users. The MAR records for residents were being accurately maintained, with no obvious gaps or breaches to good practice. There are plans for the supplying pharmacy to visit the home annually to carry out an audit, and to give the home good practice advice. Guidance about prescribed oxygen, which may currently be used in emergency first aid situations in the home was discussed. A copy of best practice in this respect will be sent to the home for their future reference. Staff were observed to preserve and maintain peoples dignity and privacy by knocking on their bedroom doors and waiting to enter, supporting people discreetly to the bathroom and being observant and attentive. Quiet areas in Broome Park were available for people to use if they wished to spend time alone. Service users spoke highly of staff. The Expert by Experience records in her report....Broome Park appeared a friendly, comfortable home for residents who spoke highly of staff, and the care they received. Survey respondents equally evidenced a high level of satisfaction with the home and the services it provides. A survey respondent said....Staff are very caring and aware. I can discuss health needs and other problems with them very easily and we are very happy in all aspects. Another said....The residents are treated well, always with care and consideration, often under very trying circumstances. A health professional records....This is a well run EMI Care Homes for Older People Page 16 of 33 Evidence: Nursing Home. Another health professional states....Well organized staff that are attentive to clients needs and wishes. They try to help patients without relying on medical therapy to sedate people. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users find the lifestyle in the home largely matches their expectations and meets their cultural needs but would benefit from some further review and development to social and recreational provision, to fully satisfy their leisure needs. People living at the home are able to maintain bonds with family and friends and they receive a wholesome, appealing and balanced diet in pleasant surroundings. Evidence: Service users social history and leisure interests form part of the homes initial pre admission assessment. Social needs are recorded on individual care plans together with peoples likes, dislikes and preferences. The AQAA records...There is a personal profile on our service users that aids our knowledge of the individual in regards to their preferences and tastes, past life events, hobbies and interests, achievements and family history and relationships. In discussion, the head of care also confirmed that service users religious and cultural needs are catered for and representatives of various religious denominations visit the home regularly and holy communion can be arranged. Some people are assisted to visit the local church and the home has a good relationship with the minister, who when surveyed, confirmed that a planned programme of worship and holy communion has been developed and visits to the Care Homes for Older People Page 18 of 33 Evidence: church by service users regularly take place. The home has a programme of activities arranged each week day and time for some One to One sessions with service users are built into the programme. The Expert by Experience records in her report...There is a full-time activity organiser who has been in post since January 2009. The activity organiser was enthusiastic and keen to show folders that were being developed to provide a range of activities and support to residents. The Expert by Experience goes on to record that the activity organiser was sometimes under pressure to meet both the collective and individual needs of up to 56 service users living at Broome Park and Stables Cottage and felt that more could be achieved if additional help was available. The majority of service users evidence high support needs. Numerous survey respondents also raised the issue of activities, one person records...I would like to see a slightly wider range of activities to engage residents interests. Another records...Provide more activities to give residents a better quality of life. A health care professional records when asked what the home could do better....More occupational support. The homes own quality assurance exercise undertaken in July 2009 received comments that people liked the fact that there was an activities organiser employed, but there were also comments received such as....I would like to do more colouring and artwork and The grounds are beautiful - it would be great to make more use of them! The AQAA records the homes developmental plans in this outcome area. .....we intend to purchase of a new ambulance and seek specific & specialist training for the activity coordinator. Visitors are welcome at anytime and facilities are available for them to access drinks or a meal. Residents are free to entertain visitors in the homes communal areas or in their bedrooms. A survey respondent records...staff always greet me happily, even when I arrive at mealtimes! The menus in the home are tailored to the needs of individuals and offer choice. The homes AQAA records....The homes menu cycle is updated & changed on a regular basis according to needs & preferences. We have Theme Days to mark significant occasions, accompanied by a matching menu and we have positive quality assurance & catering survey results. Survey respondents evidenced high levels of satisfaction with the food provided, saying...My relative is well fed and fluids are always available. And ....Meals always look and smell appetising. And... Great food! A health professional asked what the home did well, records...they support residents well at meal times, recognising the Care Homes for Older People Page 19 of 33 Evidence: potential risks in relation to eating and drinking for some peole, and requesting assessments. They implement the recommendations given to them. Care Homes for Older People Page 20 of 33 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. There are systems in place to ensue that residents are protected from abuse and they can be confident that their concerns and complaints will be acted upon. People using the service will benefit further when minor shortfalls in the complaints procedure format are addressed and it is included in the service user guide for reference. Evidence: The home has strategies in place to ensure that those who live there and those that visit can make their views and complaints known. It is also recognised by staff that some service users require significant support to make a complaint and raise their concerns. Some staff said the named nurse / keyworker system in use is beneficial in identifying service users concerns and making sure they are heard and dealt with. Survey respondents said they felt confident about raising concerns with the service and knew they would be listened to and any necessary action would be taken. One respondent recorded....If there is something which could be done better and it is identified with the managers, it will be explored and if possible resolved. Another survey respondent said....Help with any concern, however minor, has always been available when I have needed it. The homes complaints procedure would benefit from the inclusion of timescales for the process and the contact details of the local Social Services Department and the Health Care Authorities. Social services hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. The Care Homes for Older People Page 21 of 33 Evidence: head of care stated a firm intention to add this information for the benefit of people accessing and using the service. As mentioned previously, the complaints procedure is not currently included in the service user guide. The inspector is confident that this will be rectified and also provided in formats to suit all service user capacities. The registered manager has a heightened awareness that the quality of the service provided is the responsibility of the provider and all concerns and complaints should be raised with the home in the first instance. The home keeps a record of all complaints received by them. The homes AQAA records that they have received no formal complaints in the last 12 months. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of service users. The staff induction and NVQ training have elements of adult protection and there has been POVA training for staff. Safeguarding adults training is ongoing and more update training is planned for 2009/10. In addition, the homes AQAA records how the home has developed training over the last 12 months....We have made Deprivation of Liberty & Mental Capacity Act training a priority to raise awareness and knowledge throughout the organisation and we assess as a matter of course during case reviews, whether the service user requires Deprivation of Liberty Safeguards to be in place. Staff spoken with had a sound understanding of adult safeguarding and protection procedures. The head of care stated any allegation of abuse would be referred to the concerned agencies without delay. There have been no safeguarding alerts or investigations in which the home was involved in the last twelve months. POVA First and Criminal Record Bureau checks have been obtained for all staff. The registered manager is aware of his obligations with regard to ensuring the safety of residents and protecting them from abuse. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean, comfortable and homely environment that meets their needs. The provider is aware of some environmental aspects that require review and has a rolling refurbishment plan in place to ensure that the home remains fit for purpose and protects service users from harm. Evidence: The nursing home consists of two separate buildings. The main building is Broome Park Nursing Home and to the north of this large listed building is an annex known as Stable Cottage. The homes are set in ten acres of attractive parkland. Service user accommodation consists of 46 single and 5 twin bedrooms across both sites, some with en-suite facilities. There are communal sitting rooms and separate dining rooms and ample bathroom facilities for the people living there. Access to the upper floor in Broome Park is via stairs and a passenger lift. Chairs placed in the entrance hall give the opportunity to sit and watch the homes comings and goings. Both dwellings are accessible to wheelchair users. The inspector undertook a tour of the main building with the head of care and observed that generally the environment was well maintained and there was evidence to support that further redecoration had taken place since the last inspection and more is planned. The homes AQAA records.....There is a rolling programme of refurbishment and upgrade of all aspects of the physical environment across both Care Homes for Older People Page 23 of 33 Evidence: sites, for example, redecoration of both private and communal areas, including flooring, soft furnishings, furniture, installation of vanity units in bedrooms, redecoration of the main entrance hall in the main house, a conversion of some bathrooms into walk-in showers, improved hairdressing facilities and purchase of new dining room furniture for Stable Cottage. Residents bedrooms were seen to be bright, airy and comfortable. The design of both buildings allows for a variety of shapes and sizes of rooms. Bedrooms are personalised and have space to display the occupants possessions, store clothing, sit and relax and have a comfortable bed. All bedrooms seen evidenced appropriate overhead lighting, but some did not have the provision of bedside lighting. The head of care stated that not all service users require bedside lighting. This information is not however recorded in individual care plans. It was recommended that all bedrooms are audited for minimum content against the requirements of Standard 24.2 and individual need is agreed with the occupant. The information should be recorded in a person centred plan of care to ensure the home can evidence good practice in this area. Aids and adaptations are provided where necessary such as lifting hoists, specialist baths, height adjustable beds, pressure relieving equipment, grab rails and toilet riser seats. A staff call system is available. Service users are protected from the risks of burns or scalds by safe surface radiators and thermostatically controlled hot water outlets. A communal bathroom evidenced stored items of the homes equipment. This practice should be reviewed and suitable storage provided elsewhere in the home. Service users communal facilities should not be utilsed for storage. The home was commendably clean and free from any offensive odours throughout. Where there are aged surfaces in bathrooms and toilets that may compromise the homes infection control measures, it is recommended that advice is sought from the health protection agency to assist in prioritising work that will ensure service users continue to be protected. Survey respondents were largely very satisfied with the accommodation and levels of cleanliness in the home. Survey respondents said....The home is always clean and odour free. A further respondent said.....The home is clean and all the rooms are homely. Another said, when asked what the home could do better.....Carry on with the refurbishments. And....The entrance driveway needs repair, could damage cars. The homes AQAA records that the home employs specialist tradespeople and have Care Homes for Older People Page 24 of 33 Evidence: increased the number of maintenance personnel in order that goals of further refurbishment can be achieved. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Broome Park benefit from a well trained and enthusiastic staff team who know them well and understand their needs and wishes. Staff are being robustly recruited to ensure service users safety and protection. Evidence: The home cares for up to 56 service users across two separate sites. Their AQAA evidences that they employ 44 registered nurses and care staff, together with a further 16 staff who fill ancillary support roles. The Expert by Experience records in her report....The owner states that in the 15 years Broome Park has operated, no agency staff have been employed, thus giving residents continuity of care. Staff spoken with during the inspection stated that they enjoyed working at the Nursing Home. Staff surveyed said....There is no place like Broome Park; we are unique in the amount of support we receive. Another said...It is a pleasure to work for a family business where all staff are equally valued. The staffing numbers on the day of the inspection were observed to meet the needs of the people living in the home. It was evident that the home employs a multi-cultural workforce and equality and diversity issues are being addressed, both for the people living in the home and within the staff group. The home has well maintained training records which provide a clear overview of staff Care Homes for Older People Page 26 of 33 Evidence: training completed, training planned and when training updates are due for staff. The home has a comprehensive induction programme for new staff, which meets the standards required by Skills for Care. Mandatory training for staff is up to date and service user specific training courses are arranged via a comprehensive in house training programme held three times a week and provided by a qualified nurse educator. Programmes cover all aspects of care delivery and NVQ studies (Levels 1-4 and A1 assessor), overseas nursing programmes and distance learning courses. The homes AQAA records that in relation to their continuing efforts to attain and retain nationally recognised quality standards, which set a level of good practice for developing an organization.....In the last 12 months we have been successful in the retention of our Investor in People Status, following post recognition review in March 2009, where we exceeded the evidence requirements. Staff confirmed that they have regular staff meetings and receive supervion and annual appraisal. One survey respondent records....We have regular training sessions and staff meetings where I feel my involvement and opinion is always valued. CRB and POVA checks for staff were clearly in evidence and the home follows a robust recruitment process designed to protect service users from any potential for harm. Care Homes for Older People Page 27 of 33 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 receiving services benefit from a registered manager that provides clear leadership and is qualified and competent and whose aim is to consistently improve and develop the service and the outcomes for people who live in the home. Evidence: The owner and registered manager of the nursing home are both suitably qualified nursing professionals. They have considerable knowledge of the service user group accommodated and relevant experience of nursing home provision. They are able to discharge their duties fully and have a good understanding of regulation. Throughout the inspection Mr and Mrs Choy and the homes head of care were open and transparently honest. The views of people who use the service and staff are listened to, and valued. Survey respondents consistently spoke highly of the senior staff, saying....There is an open door policy throughout the management structure. They seek to inform relatives very efficiently and overall create a delightful atmosphere. And....They provide a supportive environment for everyone and make people feel part Care Homes for Older People Page 28 of 33 Evidence: of a large extended family. There have been improvements in the home since the last inspection in line with statutory requirements and good practice recommendations made in the last key inspection report. The home has retained the Investors in People Award. This is a national quality standard which sets a level of good practice for improving an organisations performance through its people. A member of staff said....The organization is improving in every aspect. The service sends out quality assurance surveys to residents, relatives and other associated professionals annually. The responses are collated and a written report is produced for people to see. Results inform the homes business plan. The registered manager could also evidence a completed catering survey with largely good outcomes for service users. The home does not hold resident or relatives meetings but the fund raising body, The Friends of Broome Park consist of some relatives of the home. The home has efficient systems to ensure the effective safeguarding and management of resdients money, including record keeping. Written guidance is available on issues relating to health and safety. Records submitted by the home state that all the necessary servicing and testing of health and safety equipment has been undertaken, including regular internal health and safety checks. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The head of care reported that a fire risk assessment has been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The Fire Officer was said to be visiting the home the week following this inspection. The homes AQAA contained relevant information, although there were areas where more supporting evidence would have been useful to evidence the homes good practice. The home has a comprehensive range of polices and procedures to promote and protect service users health and safety. Despite this, the last two completed AQAAs failed to provide any review date for these documents, even when this situation was highlighted in the homes last Annual Service Review report. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS), assessments of capacity and decision making for service users are being undertaken in a way that complies with the published codes of practice. All senior staff has received relevant training from the local authority to raise their awareness of the Care Homes for Older People Page 29 of 33 Evidence: new legislation and to ensure that any restriction of movement or liberty in place for service users can be clearly evidenced as legal and ethical. Care Homes for Older People Page 30 of 33 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 31 of 33 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 2 1 It is recommended that the homes information documents be reviewed and further developed to ensure people of all capacities accessing the service have all the information they need prior to moving in and later for reference. It is recommended that service users communal bathrooms are free of the homes stored items of equipment and suitable provision is made for storage for the purposes of the home. It is recommended that service users bedroom accommodation is audited against the requirements of National Minimum Standard 24.2 and individual need is agreed with the current occupant. The information should be clearly recorded in their person centred plan of care to ensure the home can evidence their good practice. 3 22 4 24 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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