Care Home: Broomhill Lodge

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What the care home does well Support service users to make decisions that positively impact on their lives. The management and staff continued to work closely with service users and external professionals, to ensure that they maintain stability, while improving their self esteem and motivation. Support service users to engage in a wide range of activities that brings fulfilment to their lives. Have good arrangements in place for enabling service users to maintain their friends and family networks. Staff work flexibly to enable service users to fulfil their personal and social objectives. Closely work with service users to integrate them into their community. What has improved since the last inspection? An accurate record was maintained of medication used in the home. Sleeping-in arrangements for staff were more appropriate. Recruitment practices were more robust. An internal audit of the service was carried out and an annual development plan was in place for the service. Risk assessments for safe working practice topics were mostly completed, with the one for food hygiene being completed. The registered manager achieved the Registered Managers Award qualification. Safeguarding training and protocols have been reviewed and implemented. The home achieved its highest award for Food Safety i.e. `Five Star` award from the London Borough of Redbridge. What the care home could do better: They should ensure that reports arising out of monthly provider monitoring visits are available for inspection at all times. They should provide written confirmation to the Commission about the arrangements that are in place for the supervision and appraisal of the registered manager. Key inspection report Care homes for adults (18-65 years) Name: Address: Broomhill Lodge 1 Broomhill Road Goodmayes Ilford Essex IG3 9SH     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: Stanley Phipps     Date: 1 8 1 2 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 Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Broomhill Lodge 1 Broomhill Road Goodmayes Ilford Essex IG3 9SH 02085903427 02085904308 Jon@roselock.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Alan Philp Name of registered manager (if applicable) Mr John McGillick Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Broomhill Lodge is a residential care home for eight younger adults, both male and female with a learning disability. The home is run by Alpam Homes, an organisation with a number of other similar schemes in which the service users may exhibit various forms of challenging behaviour. The building is situated in a residential street close to public transport and other local amenities. All bedrooms are single with all other facilities - shared. There is a large garden to the rear of the property and the premises Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 8 Brief description of the care home are furnished in a way that values homely living. There are parking spaces to the front of the building as well as street parking to the front, which is not currently a controlled parking zone. The organisation also runs a day centre (Highview House) that is regularly attended by service users from the homes in the group. Broomhill Lodge is staffed on a twenty-four hour basis to ensure that service users needs are met as and when required. A statement of purpose is made available to all service users in the home and is kept in the main office. This document is also made available to relatives and stakeholders, as they may be important in referring service users to the home. A service user guide is also given to each service user upon admission to the home. Fees start from £1,100.00 per week and may vary dependent on individual levels of need. Fees are charged extra for personal effects, which are variable. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We carried out an unannounced site visit on the 18/12/09. The focus was on the key minimum standards and the improvements made since the last inspection. In doing this we took feedback from service users, staff and the registered manager. We also considered outcomes arising out of safeguarding matters since the last inspection. An assessment was made of all the records required by regulation, that related to service users, staff, complaints, health and safety, activities, the environment and the general operations of the service. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 7 of 28 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 Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Service users have the benefit of being part of a thorough assessment prior to deciding to live at Broomhill Lodge. This ensures that their needs and aspirations are thoroughly assessed, which is critical to meeting their needs. Evidence: At the time of the visit, there was one newly admitted service user in the home. The process of his admission was case tracked and found to be detailed and in line with the homes admissions protocols. The service user concerned came from one of the sister homes owned by the company, however, the process of admitting the individual was the same. He had the benefit of viewing the service before making a decision about wanting to live there. In a brief discussion with him, he was pleased with the process of moving in at Broomhill Lodge. There was evidence that pre-assessment information was provided from the previous establishment as part of the initial assessment process. From the records seen, a full range of needs were identified, including the specialist needs of the service user. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Service users are actively supported to take part in planning their lives, based on their individual aspirations. They get good opportunities to take control of what they wish to pursue in their lives, which is enabled by good risk planning and management. Evidence: There was good evidence that all service users had the benefit of an individual plan of care, which detailed their needs and aspirations. This was strengthened by the fact that person centred planning was developing in the home and staff were much more familiar with the concept. They involved service users in the process and each plan detailed their personal, health, social and specialist needs. A key-working system remained in place to support service users, and monthly key-worker reports were compiled on each individual. Daily monitoring of a wide range of service users personal goals were carried out, some of which included; hygiene, mood, activities, behaviour, clubs attended, medication, diet, incidents or accidents and sleeping patterns. Service users are involved in developing their care plans and reviews were carried out with external professionals and relatives. This is strong area of the homes Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: operations. Service users continued to get good support to enable them to make decisions about their lives. In some cases relatives are involved and this is widely encouraged by the home. Advocacy information is made widely available to all service users and their relatives. Advocacy services were actually used in one case, since the last inspection. As part of the assessment process, staff develop a good understanding of the communication needs of each service user, which is useful in engaging with them. One good example of decision making is where a service user attending a college, found the second year more challenging than the first. Support was provided by the registered manager who went to the college and had appropriate support arrangements put in place for the individual. This is also a strong area of the homes operations. Risk assessments were carried out with each service user and risk management plans were developed and linked to the care plans. At Broomhill Lodge, most of the service users are actively engaged in a wide range of activities, which are mostly external to the home. These risk assessments were designed to promote service users independence, while making them safe in the least restrictive manner. In all cases seen they were updated and regularly reviewed. It was useful to see that risks associated with behaviour had a sound basis, in that triggers were identified and recorded. This information was then used to plan for minimising the risk of reoccurrence of any undesirable patterns of behaviour. A missing persons procedure remains in place for the safety of all service users. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Service users enjoy high levels of participation in activities that are best suited to them. They also have a high level of engagement with their community and are wellsupported to maintain their personal and social networks. Their rights and responsibilities were respected by the staff and they enjoy a variety of meals that were reflective of their cultural and nutritional needs. Evidence: All service users have the experience and opportunity to participate in age, peer and culturally appropriate activities. Most, attend a day centre with at least one attending college. As a result of this they are out almost every day in the week where apart from making new networks, they get opportunities to develop their skills and knowledge, and basically to have fun. Six of the seven service users clearly indicated that they do look forward to getting out and enjoying themselves. It should be noted that their interests were varied as were their attendance to events and engagements. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: One individual attended college four days per week, and went out socially at least three evenings per week. He stated; I love it here because I get the support to do things I enjoy. Another stated: I enjoy doing things out with my key- worker, which sums up the experiences of most individuals living in the home. Each service user had a plan of activities that were best suited to them. There was strong evidence again to confirm that service users are a part of their local community. They regularly visit: shops, cafes, post offices, cinema, theatre and indeed social clubs. Staff were rostered flexibly to ensure that each service user uses the facilities available to them. Good arrangements were also in place to support service users who did not wish to go out on a given day. From observation service users using the community were well presented and displayed an air of confidence as they made their way in and out of the home. It must be stated that service users did get further afield to places such as the Shraftsbury theatre in London, Hampton Court Palace and Brick Lane. This remains a strong area of the homes operations. Although there are service users without family networks, the registered manager and staff worked extremely well in enabling service users to maintain their family and friends networks. Where possible relatives are invited to reviews and kept updated on the progress and developments of service users. In one particular case, contact was made with the brother of a service user, resulting in them going out and spending quality time together. In another case a service user had good contact with his mother and previous guardian, which he expressed a high level of satisfaction with. A visiting policy remains in the home accessible to service users friends and relatives. This is a strong area of the homes operations. From observation during the inspection, staff were treating service users with dignity and respect. All service users spoken to confirmed this observation. These important values are instilled at staff induction and reinforced in staff meetings. One of the observations made, which demonstrated how service users were respected came about when a group of three, expressed their concern for staff in relation to the adverse weather conditions. The point of interest was that it was the staffs party later on that evening, however staff did not marginalise or trivialise their concerns, which was positive to see. In discussion with some of the staff, they demonstrated a good understanding of the importance of promoting dignity and respect during their engagement with service users. This is particularly important as at times, they had to deal with some challenging aspects of service users behaviour. Lunch was observed during the course of the visit and the service users choice demanded beans on toast with a variety of fruit drinks. Menus were planned in Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: advance with service users, who were generally satisfied with the meals provided by the home. The menus were assessed and found to be varied with a good nutritional balance. Meals consumed were recorded to ensure that service users nutritional intake was in line with their individual plan. It was important to note that alternatives were available, should an individual change their mind. There was a good supply of dry and frozen food, and fresh fruit and vegetables were available. The meals provided were in line with the cultural preferences of the service user group. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Service users continue to receive personal support that are in line with their needs. The management and staff worked well to ensure that the physical and emotional needs of service users were met. The support provided with medication ensures that service users health and welfare is promoted. Evidence: There was good evidence from the care plans seen, to confirm that service users preferences were identified and recorded. Staffing interactions with service users indicated that they had a good understanding of how individual service users were to be given their support. The care plans were used as working tools and clear action points were in place for supporting service users with their personal care, activities and personal tasks. Staff worked closely with the guidelines to ensure consistency, although there was evidence that they also worked in flexible manner. This was important as the mood of any one service user could change, bringing a different challenge to the staff. This was managed effectively. Service users prided themselves in what they wore and how they presented, which was extremely important to them. In all cases seen, there were sound arrangements were in place to promote service Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: users health and welfare. They were all registered with a GP with varying inputs from the Community Learning Disability Team. Most of the service users had their their flu jab, while one individual enjoyed the protection of having a swine-flu jab. Health action plans were in place for all service users and from the records seen staff worked well in ensuring that service users received appropriate health care if and when a health problem arose. In one case, there was evidence that an individual needed the support of a psychologist, which was being arranged. This decision was taken at the service users review in which he took an active part. Service users physical and emotional needs were well-provided for at Brooomhil Lodge. At the time of the visit, an updated medication policy and procedure was in place and available to staff. It was noted that none of the service users were able to manage their medication independently. In this respect staff that were suitably trained provided the support required with medication. This was integral to maintaining the health and well-being of all service users in the home. Medication storage, recording and its administration was assessed and there was an overall improvement in how drugs were recorded. In just one case, a short course of medication should have been initialled upon completion and this was pointed out to the registered manager. It was acknowledged that this would be monitored more closely in the future. The inspector was satisfied with the support given to service users with their medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have the assurance that a system is in place for dealing with their complaints. Improved protocols are in place to ensure that they are safeguarded from the risk harm or abuse. Evidence: Service users continued to have access to an updated complaints procedure, which was also widely available to staff, relatives and external professionals. In discussion with some service users, they demonstrated an understanding of their right to complain. It was just as important that the staff showed a sound awareness of their role in supporting service users to complain. The complaints record was examined and thete were no complaints on record at the time of the visit. There has been one safeguarding matter since the last inspection, in which the allegations made were substantiated. As a result disciplinary action was taken against the staff concerned and a referral made to the Independent Safeguarding Authority. The registered persons also took supplementary action to prevent recurrence to include; refresher training in safeguarding for staff, reviewing the reporting procedures in relation to dealing with out of hours emergencies and discussing the key learning outcomes in a staff meeting held in July 2009. It must be stated that the registered persons were cooperative and demonstrated their commitment to keeping service users safe. An updated safeguarding policy was in place at the time of the visit. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. At Broomhill Lodge, service users enjoy living in a clean, homely environment that is suited to their needs. Sound hygienic practices and protocols ensure that they remain safe in the home. Evidence: On the day of the visit, the home was clean, bright and airy with service users going about their routines in comfort. This included having lunch in the communal dining area, which remained pleasantly decorated with art and craft works made by the service users. Following lunch, service users were observed later on either enjoying a game of snooker, watching their favourite television programme, while one or two were chatting. They were observed accessing all parts of the building relatively easy. The building was in a good state of decorative repair, and the fixtures and fittings were of a good standard. There was a good system in place for dealing with daily maintenance, which is carried out by a dedicated maintenance officer. Arrangements were in place for cyclical repairs, which were outlined in the homes annual development plan. The front garden was clean and accessible, which was important, given the adverse weather conditions at the time. The registered manager informed that more appropriate arrangements were in place for staff to sleep in at nights. The home did have a cosy feel to it and all Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: service users spoken to were happy to be living there. The premises were clean and hygienic throughout the course of the inspection, which included the laundry facilities. Updated health and safety policies and procedures were in place for the protection of service users and staff. Health and safety signs were appropriately posted throughout the home, as were the facilities for handwashing. The laundry floor was suitable and the equipment used was appropriate for cleaning soiled/foul linen. Staff have the benefit of health and safety training to include, infection control. The home complies with the Water Supplies Regulations 1999. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 benefit from having a staff team that is committed and generally skilled to meet their needs. Improvements in the recruitment practices ensure that service users remain safe from coming into contact with staff that may be unsuitable to work with them. Training is provided to prepare staff to meet the needs of the service user group. Evidence: On the day of the visit, staff were observed engaging with service users in a positive manner. Throughout the course of the visit, service users were happy and at ease with the staff on duty. The staff spoken to demonstrated a good understanding of the service users needs and from the records seen, were making appropriate interventions with them. Feedback provided by the service users were extremely complimentary about the staffing input in working with them. Most knew their keyworkers, which was a testament to how well the staff engaged with them. Over fifty per cent of the staff team had achieved at least an NVQ Level 2 in Care, with one starting their NVQ Level 3. The staffing skills and knowledge enabled them to provide a good level service to service users with a learning disability. The recruitment files of two of the most recently employed staff were assessed and there was evidence of: completed application forms, Criminal Records Bureau (CRB) Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: checks, two written references, medical declarations and the verification of staffing identification. Staff had access to the General Social Care Councils code of conduct which, provides them with the key principles of providing good care. They also have to undergo a probationary period to ensure that they are capable of carrying out their roles. Although service users are not yet involved in the selection of staff, the recruitment practices ensure that unsuitable staff would not come into contact with them. It was noted that all staff had the benefit of a structured induction, to ensure that they had the key essentials to provide safe and efficient care to service users. They also had the benefit of mandatory training in fire safety, infection control, health and safety, first aid, manual handling and food hygiene. Specific training was also provided to include: autism, medication, control and restraint, safeguarding and training in the Mental Capacity Act. The registered manager provided a training schedule for the staff team and this included refresher training. In general staff receive training that enables them to carry out their roles at Broomhill Lodge. However, the registered manager may wish to target additional training that would give staff a better understanding of service users with more specific needs for e.g. where an individual may have mental health needs, which may be combined with their primary needs. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 were some good systems in place to provide a quality service at Broomhill Lodge. This includes systems for quality assurance, financial planning and health and safety. However, some improvements could be made to quality assurance and the support systems in place for managing the service. Evidence: The registered manager has been running the home for a number of years and so he has managed to maintain a fair amount of stability within the service. He has good professional relationships with the staff and service users alike and both groups were quite happy with his ability to manage the home. He has done some intensive front line work with service users, particularly with external agencies and in some cases, with relatives. This demonstrated his commitment to the service he runs. Since the last inspection, he has completed the Registered Managers Award and has undertaken training that is relevant to the service he provides. There were some improvements in this standard, which would have a positive impact on the overall service provision. They included carrying out an internal audit of the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: service and producing an annual development plan for the home. This plan was comprehensive and measurable covering all aspects of the service. Monthly provider monitoring(Regulation 26) of the service continued, although, a number of reports were not returned to the home. Service user surveys were carried out at the end of November 2009 and feedback from external professionals about the service is gathered at service users reviews. It is fair to conclude that quality monitoring systems were in place for developing the service. although reports arising out of Regulation 26 monitoring visits should be available for inspection. There was evidence that key steps were taken to maintain and promote health and safety in the home. Accessible policies and procedures, the monitoring of staff practices, as well as staff training in health and safety, all contributed to the maintenance of a safe environment. There were risk assessments now in place for all safe working practice areas, apart from food hygiene, which was in process. A number health and safety records were assessed and found to be in order. Accidents and incidents were appropriately recorded and reported. It was noted that the home achieved a five star rating for food safety in April 2009 from the London Borough of Redbridge, which is positive. At Broomhill Lodge service users and staff remain relatively safe. In most cases clear systems were in place for running the service. Staff spoken to have a good understanding of the organisational structure and who they should report to. The responsible individual also has systems in place for financial planning and quality monitoring of the service. However, the system for the supervision and appraisal of the registered manager remains unclear. There was evidence that he is provided with training and although he manages the service effectively, the systems in place for his support and development were unavailable at the time of the inspection. This should be addressed by the registered persons. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 39 The registered persons should have complete and have available for inspection, reports arising from their monthly provider monitoring (Regulation 26) visits. The registered persons should set out in writing to the Commission the arrangements for the supervision and appraisal of the registered manager. 2 43 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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