Care Home: Broomfield

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What the care home does well When we looked at the records of the people living in the home we noted that individuals admitted to the home are fully assessed to ensure that the home is able to meet their needs and are receiving individualised care based on their care needs. It was evident from the staff interaction with the residents` and the records seen that there is a warm relationship between the staff and the residents at the home. The registered manager stated that the people living in the home are regularly assessed and are provided with person centred plans through knowing them well and working with other professionals in order to meet their changing needs. Individuals living in the home are supported to take part in their chosen activities to minimise any risks that are taken, also people living in the home are encouraged to have social links with the community and to take part in recreational activities available. The home provides nutritious meals for the people living in the home. It supports them to have their meal and ensures that those people who are not able to feed themselves are fed in a sensitive and dignified manner. The facilities at the home are adequate for providing personal care and to maintain privacy. Evidence shows that staff are receiving training and are being supervised to ensure that the needs of the individuals living at the home are met. The home has policy and procedure for the Protection of Vulnerable Adults available to ensure that the people are protected from abuse. People who use the service are supported by staff members to complain using the complaint policy, which is provided by the organisation. The Home was found warm, well lit, clean and free from unpleasant odours on the day. People living in the home were found relaxed and looked well cared for in their homely environment. To further help us make judgement about the services provided at the home we sent comment cards to the relatives of people who use the service and also people from the outside who visit the home for various reasons. The comments they sent to us are written below: "Broomfield is good at delivering the added value activities for my relative. For example taking them to hydrotherapy and even taking them out for day trips and for meals in the evenings". "Generally I am satisfied with my relative`s care" "Residents are kept clean and tidy. The food seems adequate". "The home meets my relatives needs and they provide outside stimulation." What has improved since the last inspection? The home has a new registered manager that is proactively developing different methods of communication to enhance the relationship between service users and staff members. For example, Intensive Interaction and new key working system. The manager had secured funding to install an overhead hoist in the living area to create more activities and comfort for the service users. The manager also purchased new chairs and new snack charts for the service users` comfort. It was pleasing to note that all the requirements made at the last inspection have been met. The manager told us in the Annual Quality Assurance Assessment that a new key working system has been put in place and that more staff are involved in Intensive Interaction in order to meet service users` individual needs. We noted that one new sling had been purchased to enhance one service user`s manual handling experience and to prevent potential injury. The manager proactively negotiated with a local charity to purchase two new comfortable chairs for the comfort of two service users. What the care home could do better: To enable the relatives and visitors to the home to make a complaint to the Commission for Social Care inspection if they were not satisfied with the outcome of their complaint to the organisation, it would be better to update the information and ensure it is displayed in an accessible place at the home. In order to promote dignity staff must receive training on report writing and using a language that in not offensive to the individuals living at the home. All staff must receive fire awareness training to ensure that they know what to do in the event of outbreak of fire. It could be better if consent is obtained from relatives/advocates after assessment before bedrails are applied to service users beds. This is so they are aware of the reason for the equipment and the benefit for the individual. Following an unexplained bruise noted on a service user, it would be better to review the individual`s manual handling risk assessment and any other possible cause in order to adequately protect this person. It is recommended that the home obtain a copy of the Bath and North East Somerset Council protocol on Abuse so that staff are aware of what to do if abuse is suspected. CARE HOME ADULTS 18-65 Broomfield 40 Gladstone Rd Combe Down Bath Bath & N E Somerset BA2 2HL Lead Inspector Grace Agu Unannounced Inspection 21th April 2008 09:15 Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomfield Address 40 Gladstone Rd Combe Down Bath Bath & N E Somerset BA2 2HL 01225 830047 01225 830047 julie.snelgrove@Dimensions-uk.org www.dimensions-uk.org Dimensions (UK) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Julie Pearl Snelgrove Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 3 persons aged 22 - 50 years May accommodate up to 3 persons with Physical Disabilities Date of last inspection 5th June 2007 Brief Description of the Service: Broomfield is a care home operated by Dimensions (UK) Ltd, an independent voluntary organisation, to accommodate up to 3 people with profound learning and physical disabilities with varying degrees of sensory impairment. The philosophy of the home is that every person is a unique individual and as a valid member of the society with right to respect and a positive image. It recognises that the individuals have the right to make choices about their life and lifestyles. The individuals have the right to the support they need to participate in community life. There is a staff team comprising of full and part time support workers. The organisation recognises that in order to develop skills for the employees and to ensure that they are equipped to undertake their roles and fulfil their responsibilities, the provision of appropriate training is an absolute priority. Training ranges from induction for all new employees to development programmes for senior managers. It is a continuous programme starting with induction, leading into foundation and followed by NVQs. The home is a large bungalow situated in a quiet cul-de-sac in Combe Down, on the outskirts of Bath. It has access to local amenities such as shops, pubs, local surgery and a post office. The city centre of Bath is approximately 3 miles away. The home has three single bedrooms; two comply with the space standards for wheelchair users, as set out in the national minimum standards. The third bedroom is a smaller room. Two of the bedrooms share en-suite bathroom facilities. The third has easy access to a specialist shower for wheelchair users. There is also a spacious lounge, kitchen, utility, two staff sleep in rooms and a conservatory. The current fee for this service is £1511.52 per week. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 5 Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit which was undertaken as a part of a key inspection over eight hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. At the last inspection seven requirements were made in relation to care planning, environment, staff training and ensuring that the risk assessments of safe working were undertaken at the home. It was pleasing to note that the home has made efforts to ensure that the requirements were met. Information about care of the individuals living in the home and the services provided at the home were obtained through review of records, including policies and procedures, care files, staff training and staff recruitment. We met with Ms Julie Snelgrove also spoke with people who use the service and one staff member. No relatives were seen at the home during the inspection. What the service does well: When we looked at the records of the people living in the home we noted that individuals admitted to the home are fully assessed to ensure that the home is able to meet their needs and are receiving individualised care based on their care needs. It was evident from the staff interaction with the residents’ and the records seen that there is a warm relationship between the staff and the residents at the home. The registered manager stated that the people living in the home are regularly assessed and are provided with person centred plans through knowing them well and working with other professionals in order to meet their changing needs. Individuals living in the home are supported to take part in their chosen activities to minimise any risks that are taken, also people living in the home are encouraged to have social links with the community and to take part in recreational activities available. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 7 The home provides nutritious meals for the people living in the home. It supports them to have their meal and ensures that those people who are not able to feed themselves are fed in a sensitive and dignified manner. The facilities at the home are adequate for providing personal care and to maintain privacy. Evidence shows that staff are receiving training and are being supervised to ensure that the needs of the individuals living at the home are met. The home has policy and procedure for the Protection of Vulnerable Adults available to ensure that the people are protected from abuse. People who use the service are supported by staff members to complain using the complaint policy, which is provided by the organisation. The Home was found warm, well lit, clean and free from unpleasant odours on the day. People living in the home were found relaxed and looked well cared for in their homely environment. To further help us make judgement about the services provided at the home we sent comment cards to the relatives of people who use the service and also people from the outside who visit the home for various reasons. The comments they sent to us are written below: “Broomfield is good at delivering the added value activities for my relative. For example taking them to hydrotherapy and even taking them out for day trips and for meals in the evenings”. “Generally I am satisfied with my relative’s care” “Residents are kept clean and tidy. The food seems adequate”. “The home meets my relatives needs and they provide outside stimulation.” What has improved since the last inspection? The home has a new registered manager that is proactively developing different methods of communication to enhance the relationship between service users and staff members. For example, Intensive Interaction and new key working system. The manager had secured funding to install an overhead hoist in the living area to create more activities and comfort for the service users. The manager also purchased new chairs and new snack charts for the service users’ comfort. It was pleasing to note that all the requirements made at the last inspection have been met. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 8 The manager told us in the Annual Quality Assurance Assessment that a new key working system has been put in place and that more staff are involved in Intensive Interaction in order to meet service users’ individual needs. We noted that one new sling had been purchased to enhance one service user’s manual handling experience and to prevent potential injury. The manager proactively negotiated with a local charity to purchase two new comfortable chairs for the comfort of two service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The policy and procedure for admission of a prospective service user is robust to ensure that the individual(s) make positive choice of moving to the home with assurance that their needs will be met. EVIDENCE: There have been no new admissions to the home since the last inspection and the individuals have lived together in the home for several years. The manager stated in the Annual Quality Assurance Assessment that if a vacancy arises the home has a brochure in place, policies and procedure which promotes opportunities for the individual to have visits and stay over night to ensure that they are able to live with the existing service users. All three service users’ care plans viewed evidenced measures in place to meet specific assessed needs, the staff member that we spoke with on the day was aware of their roles and responsibilities and how to support the individuals living in the home. The home has a Statement of Purpose, which has information about the services provided at the home, for example, how to make a complaint and any support that would be given in relation to the individuals’ health. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 11 Each individual had a tenancy agreement in the care file; this document was written and contained fees to be charged. The inspector noted that the documents were signed by the peoples’ representatives/advocate. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are supported to participate in making decisions at the home. Individualised care plans are followed and residents are confident that information about them will be kept confidential. EVIDENCE: We reviewed in detail the care documentation of three individuals living in the home. The care files contained person centred plans to reflect the changing and complex needs of people using the service. The care files also contained personal information to include next of kin and social and other health care support. Records noted on the care file contained information to include ‘About me’ this gives specific information about the person’s, likes and dislikes, hopes and fears, valued options and relationships including speech and language therapy programme. Other information noted in the records include care review notes and the details of how staff can interpret the non-verbal communication of the Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 13 resident and more importantly when the resident is unhappy or dissatisfied with any aspect of the services or their care. Staff were seen adding and referring to the care records during the inspection demonstrating that they are using the documents as a working tool as expected. Staff were also noted interacting with residents and one staff member spoken with stated that through body language and facial expressions staff are able to obtain consent or disapproval from a service user. The staff member described a typical morning with a particular individual and how the person is enabled to make choices. Whilst it was difficult to involve the service users in the decision making process due to their profound learning disabilities the interaction between staff and the people who use the service was service user focused. Staff were able to acknowledge the service users individual abilities and needs. At a discussion with a staff member met on the day, we were informed that through observation such as facial and/or vocal expression staff enable the people to make choices. There are risk assessments with regards to various areas of health and personal care and these were reviewed regularly. The registered manager and one staff member spoken with were able to demonstrate awareness of risk for individual service users in the home, which includes the balance between maintaining the safe environment and enabling people who use the service to express choice. We observed staff feeding the people who use the service during the course of the afternoon. The manager was able to discuss the physical and mental wellbeing of the individuals and confirmed that the General Practitioners and other health professionals would visit the home whenever required. In order to demonstrate this practice one service user was taken to the Doctor’s Surgery to consult a doctor about a condition noted on the finger. However we noted that one individual using a special bed with bedrails had no evidence of consent to confirm that they were consulted before the bedrails were installed. It was agreed that the home should obtain consent from this person or their representatives to ensure that their right to make a decision is not compromised. This consent has now been obtained. The Home maintains an individual daily diary for each individual. This diary is written from the service user’s perspective. The manager told us that the people living in the home are supported to attend regular house meetings and the inspector gained the clear impression that Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 14 everything that occurred in the home was done with the involvement of the people who use the service. Service users information and other records were securely locked away. The registered manager demonstrated awareness of ensuring that all information relating to people who use the service is kept confidential and what actions to take in the event of a breach. The home has a confidentiality policy. None of the residents is likely to go missing as total support is required for all the individuals and staff always accompany the service users on all external activities. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are encouraged and supported to engage in leisure activities and maintain links with the community, family and friends. Healthy diet is provided for the individuals at their chosen times ensuring that their individual rights are respected. EVIDENCE: The home has a large secluded garden, which can be accessed in a wheelchair from the front of the house. Each service users’ care files contain details of their likes and dislikes and provides a list of activities enjoyed by the service user. These include aromatherapy, music, massage, foot spa and sensory equipment. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 16 Individuals living at the Home were attending various routine activities away from the home first thing on the day of inspection. When they returned at different times were found to be relaxed in a positive atmosphere. Staff were noted interacting with residents in informal, however, sensitive and respectful manner. This is a demonstration of good practice and shows that the home includes the residents in the daily routines. There was evidence that service users have regular contact with families. Relatives told us in the survey sent to them that they are satisfied with the care provided at the home. The manager told us that one service users family visits every Friday to see their loved one. We noted from discussion with the registered manager and reviewing the care files that people who use the service are supported to lead active lifestyles based on their level of understanding and choice. The manager stated that all the service users have a planned activities programme, which is supported by staff in the home. Activities noted in the individual care files include going out for walks when the weather is good, going out pubs and individual interactions. The manager stated that service users were supported to visit Chew Valley Lake and Minehead. There was evidence of one’s individual holiday to Cornwall with staff support. Through observation and discussion with staff, it was evident that people living at the home are treated with respect and dignity when receiving personal care. However we noted that some of the statements on the daily dairy lacked sensitivity in relation to the dignity of the individual due to their behaviour. We discussed this with the manager and have required that this issue be addressed though supervision and training. The manager told us that staff are aware of the needs and preferences of the individuals and despite the fact that it is difficult to establish the level of understanding of each individual due to profound learning disability, staff continue with normal conversation and are often able to expect responses based on knowledge and experience of caring for the individuals. The manager also told us that there is no set menu however, there was a record of meals offered that showed a varied menu; records also indicated individual choices. There are no specific dietary needs but food needs to be liquidised. The manager stated that service users have a healthy appetite and that staff know individuals’ preferences. There was documentation regarding assistance Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 17 required with eating and drinking, a speech and language therapist had reviewed this recently. There was a record of procedures to be followed. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive preferred personal support as required, their emotional and physical health needs are met also respect is given to their wishes in the event of death, Appropriate care planning is in place along with medication practices to protect service users. EVIDENCE: The people who use the service are dependent on the care staff to meet their care needs with the care documentation in place to guide staff. Personal care is provided in private and respects the dignity of the individual service user. Staff were noted knocking at the door before entering to provide the individuals with personal care. There is specialist equipment and technical aids in place to support individuals’ needs. Specialist health professional support is provided including Psychologist, Speech Therapist, Occupational Therapist and Physiotherapist. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 19 The manager told us that a key-working system has recently been reintroduced in the home following recent staff recruitment due to staff turnover and that this operates well in the home. Whilst the people are not able to contribute due to their learning and physical disabilities, staff ensure that they are included in the review meetings. One staff member we spoke with gave a detailed account of how personal care is given to an individual with very complex needs. The staff member stated that they are aware of the individuals’ facial and vocal expressions, which would normally indicate how the individual is feeling. The care files showed evidence of regular GP and other professional visits including reviews. There are clear procedures and appropriate arrangements in place for the receipt, storage, administration and disposal of medication in the home. The system was found generally satisfactory. However we noted that there had been two notifications sent to the Commission relating to medication discrepancies. We are satisfied with the action taken by the manager to resolve the identified issues to ensure adequate protection of the service users. The care files viewed showed evidence of risk assessments in relation to the care needs. Individual needs with regards to specialist equipment are clearly met and regularly reviewed. Risk assessments in relation to using the equipment was provided for all transfers. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents are enabled to complain with the confidence that their views will be listened to and acted upon and that they are protected from abuse. EVIDENCE: There is a complaints procedure available in the home. The document contains information about the Commission for Social Care Inspection and is in an appropriate format relevant to the service users group. It was agreed that the details of the Commission must be updated to reflect the recent move to a new address. The complaints policy should also be displayed at the home to enable the service users representatives and visitors to make a complaint to the Commission if they were not satisfied with the outcome of their complaint to the organisation. Individuals living in the home would not be able to complain due to their profound learning disabilities however the manager and one staff spoken with were able to demonstrate how they might know that an individual is not happy through facial and vocal expression and changes in their behaviour. Relatives told us in the comment cards sent to them for their views about the care provided at the home that they would complain to the management on behalf of the people who use the service. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 21 The home has a new concerns, complaints and compliment book in place. Evidence seen suggests that recorded complaints had been satisfactorily resolved. Staff spoken with demonstrated awareness of the Whistle-blowing policy. There is a ‘Dimensions’ policy and procedure in regards to the Protection of Vulnerable Adults. It is recommended that the Home also obtain a copy of Bath and North East Somerset policy and procedure for the Protection of Vulnerable Adults from Abuse to ensure that staff are aware of the protocol to follow if abuse is suspected or occur. Staff records viewed evidenced that staff have attended training on the above subject. One staff spoken with was well aware of abuse issues and would report any suspected abuse to the manager regardless of who was involved. One resident’s money was reviewed. The individual’s money in the purse was correct and balanced with the record. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The relationships between staff and those living at the home are good, and this creates a warm, supportive, homely environment, which promotes a good quality of life for the individuals living at Broomfield. However some areas of the building need attention. EVIDENCE: Broomfield is a large bungalow situated in a quiet cul-de-sac in Combe Down, on the outskirts of Bath. It has access to local amenities such as shops, pubs, local surgery and a post office. The city centre of Bath is approximately 3 miles away. The home has three single bedrooms; two comply with the space standards for wheelchair users, as set out in the national minimum standards. The third bedroom is a smaller room. Two of the bedrooms share en-suite bathroom facilities. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 23 The manager informed the inspector that the two individuals’ privacy is maintained and that sharing the facilities is managed well. The third has easy access to a specialist shower for wheelchair users. There is a spacious lounge, kitchen, utility; two staff sleep in rooms and a conservatory that is used as a dining room and office space. The manager stated that the home is proposing to convert one sleep in room into a proper office for general use and to provide better security for all confidential information. The home had various equipment available for assisting service user’s mobility. The bedrooms were homely, in a good decorative order and colour coordinated. The carpets were found to be clean and in good condition. The home was found in good decorative order, clean and tidy. There were no offensive odours. The hallway has been decorated with perplex to protect the walls and decoration from wheelchair damage. It was pleasing to note that the requirement issued at the last inspection in relation to providing sufficient ventilation facilities had been actioned however it appears that the work was not satisfactorily completed. The manager stated that the company that did the work would be back to remedy the problem. We have issued a requirement to ensure that this work is completed. The registered manager also told us that the Occupational Therapist had visited and assessed the shower room and that a new shower would be installed, following the requirement issued at the last inspection, in order to meet the needs of one of the service users. The Building Manager for Dimensions was at the home on the day assessing the building for repairs including the cracks noted in walls around the kitchen and laundry. There is a small laundry with one washer and one dryer. All service users’ laundry is done in-house. The kitchen was clean and in good order. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents enjoy a good and warm relationship with competent staff, the home’s recruitment procedure offers protection to residents living in the home. EVIDENCE: On the day of inspection there were three staff members on duty to support three residents. It was evident from the staff/residents interactions that there is a good relationship between the residents and staff within the home. One new staff member spoken with stated that there is a good team spirit amongst staff and that this has resulted in the high quality care provided to the residents at the home. Staff training records viewed showed that staff have attended various training including Food Hygiene, Health and Safety, First Aid and Manual Handling training. The manager stated that three staff members have attended a four day training developed by ‘Dimensions’ termed “Our Approach” which includes learning on Person Centred Planning. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 25 The manager stated that the home recently had discussion with the Learning Disability nurse about providing training on Epilepsy and administering Bucca Medazolam (medication for epilepsy that is applied to the gums for quick absorption). The manager has also arranged for staff to attend training on eating, drinking and swallowing with people with learning difficulties to enable them to support one service user’s swallowing difficulty. The manager has been booked to attend Mental Capacity Act training to provide her with knowledge of how to support people with little or no capacity to make decisions. The staff in the home are supported by the manager to receive regular supervision. This is to ensure that they are able to perform their duties effectively. Staff are also good at supporting each other. Regular staff meetings take place. Issues discussed at the last meeting include clients accidents for, training, person centred training, recruitment, privacy and dignity and individual service user care. The home has a recruitment policy to ensure that suitably qualified staff are recruited at the home. Staff records seen contained the required information to include two satisfactory references, proof of identity and Criminal Record Bureau (CRB) disclosures. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well run by a competent manager who ensures that residents are adequately protected through appropriate health and safety measures. EVIDENCE: Ms Julie Snelgrove was recently registered as the home manager of Broomfield following a successful Fit Person’s Interview with the Commission for Social Care Inspection. Ms Snelgrove has completed National Vocational Qualification (NVQ) levels 2 and 3, D32/33 NVQ assessors’ qualification and is currently undertaking NVQ level 4 in care management. She has attended courses in safe working practices, supervision and appraisal. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 27 She has also attended courses in Autism Awareness, Medication protocol and four day training in Dimensions’ ‘New Approach’ to care which includes Person Centred Planning, peoples’ right and the Protection of Vulnerable Adults from Abuse. The staff member spoken with told us that Julie was an approachable manager and was ready to support and give advice if needed. It was demonstrated by staff through their interaction that there is an understanding in the team of the manager’s enthusiasm to raise and maintain a high level for the people living in the home. Evidence from observation led us to believe that the team are supportive to each other. There were recent records of annual gas safety inspection, portable electrical equipment testing and the testing of fire equipment. The manager stated and there is evidence of this that the Five Yearly Electrical Installation Safety inspection had been undertaken however, the certificate had not been issued. This will be reviewed at the next visit. The home’s quality assurance system was reviewed. During a discussion the Manager stated that the service users plans are regularly reviewed and discussed at staff team meetings. Other ways used to monitor the quality of service includes 6 monthly management audits, checking residents personal allowance once a day, residents care plan reviews and the statutory monthly visits by the organisation. The home’s policies and procedures reviewed included whistle blowing, missing persons Medication, Protection of Vulnerable Adults from Abuse and accident reporting. Those records in respect of each service user as set out in Schedule 3 have been looked at in the relevant standards of this report. The home has a visitor’s book. The accident book showed that all accidents were well documented and followed up and when required a Regulation 37 notification form is used to inform the Commission for Social Care Inspection of serious injuries to the service users. We discussed the recorded entry on 28/02/08 in relation to a bruise noted on one service user’s knee. The manager was unsure how the individual sustained the injury however; she had contacted the doctor to review the individual’s medication in relation to agitation. It was agreed that the manager raise staff awareness regarding possible causes and review the individual’s risk assessment in regards to agitation. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 28 The fire logbook is up to date and in order. The record shows that the inspection of fire fighting and fire alarm systems had been carried out. The manager stated that two staff members have attended fire safety training in February and four staff members are waiting dates to attend. We have issued a requirement to ensure that this is undertaken in order to adequately protect the service users. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 2 X Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 13 Requirement Ensure there is risk assessment before bedrail is installed and obtain consent from the individual or their representative. Ensure that service users dignity is respected in the way reports are written. The home must satisfactory resolve the issue of insufficient ventilation in the home’s communal shower room. All identified staff must be provided with training on fire safety to ensure that people living at the home are protected. Ensure that complaints procedure contains updated of information for the Commission for Social Care Inspection. Ensure an individual’s risk assessment is reviewed following an injury to minimise further risk of injuries. DS0000008196.V361361.R01.S.doc Timescale for action 21/05/08 2. YA18 12 21/05/08 3. YA27 23 21/05/08 4. YA42 18 21/05/08 5 YA22 22 21/05/08 6 YA7 13 21/05/08 Broomfield Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 Good Practice Recommendations To ensure that relatives and visitors are aware of how to contact CSCI if they wanted to complain, it is recommended that the complaints procedure be displayed prominently at the home. It is also recommended that the home obtain a copy of the Bath and North East Somerset Council protocol on Abuse so that staff are aware of what to do if abuse is suspected. Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broomfield DS0000008196.V361361.R01.S.doc Version 5.2 Page 33 - 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. 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