Care Home: Broomwood Care Centre

What the care home does well People who come to look round with a view to staying at Broomwood were given information about the home before they moved in. We were told the prospective people would have an assessment of their care needs so they knew their needs could be met before they moved to Broomwood. The internal appearance of the home and the garden area provides a homely and pleasant environment for people to live. People`s bedrooms were personalised and homely. People were positive about the cleanliness of the home. The staff were kind and patient, and one person added, `The carers in nursing are all good, warm and welcoming`. The home has flexible visiting arrangements and encourages people to have regular contact with their families and friends. One relative spoken to said,` We are always made to feel welcome and the people here are friendly and supportive`. Proper employment checks are carried out before new staff start to work in Broomwood to ensure the staff are employed are suitable to work with older people. The company have a system in place to manage complaints and people spoken to during this visit said they felt they could raise any concerns. Health and safety checks were regularly maintained, so that people`s safety and welfare was protected. What has improved since the last inspection? Since the last inspection in December 2009 we have received improvement plans and been informed that quality audits have been carried out particularly in relation to medication and record keeping. It was of concern there are still shortfalls in the management of medication and in information recorded which may lead to people`s needs not being fully met. Some improvements were seen in the care plans and there was evidence of monthly reviews being carried out. Improvements were seen to the choice of food provided at mealtimes and the meal time experience for people living at Broomwood. The menu of the day was displayed and staff were seen to support people appropriately. People who could express a view were positive about the meals provided and the choices made available to them. Since the last inspection the development of a more permanent staff team has led to improvements in communication between staff. Staff commented they felt, communication was better because they know more about the people they are looking after. The company have appointed a new manager and deputy manager since the last inspection. We were told she has started the process to register with the Commission. There have been improvements in the staff training provided. Care staff need training to support them to develop skills in record keeping to give them the confidence to put these skills into practice.There have been improvements to the programme of staff supervision in place. Staff spoken to found this useful in identifying their training needs. What the care home could do better: During this key inspection it was of concern there were still shortfalls in the management of medication identified during this visit. Medication must be given to people as prescribed. Records about medication handling must be accurate and show that people are given medicines properly and all medicines can be fully accounted for. Information provided in the care plans and risk assessments needs to show all the needs of people and record changes in their healthcare needs. Care plans need to be more person centered to show each person`s needs and the support to be provided. Staff must carry out the care in line with the assessments made. Attention must be given to the changing needs of people living at the home to make sure their needs are met. Some concerns were raised during this visit that there were not always sufficient staff as they were always busy and undertaking tasks. People should be provided with drinks and snacks at appropriate times to make sure they are not waiting too long between meals. Although there has been a programme of activites, there was a lack of recreational activities currently being provided to meet the needs of people with a dementia type illness. The manager must make sure the numbers, skill mix and deployment of staff are appropriate and suitable to meet the needs of people living at the home. Now we have been told all the staff vacancies have been filled and use of bank or agency staff has reduced, attention needs to be given to developing the permanent staff team. This will ensure staff can work together to provide quality care to people. Key inspection report Care homes for older people Name: Address: Broomwood Care Centre 53D Mainwood Road Timperley Altrincham Cheshire WA15 7JW     The quality rating for this care home is:   zero star poor 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: Elizabeth Holt     Date: 1 7 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Broomwood Care Centre 53D Mainwood Road Timperley Altrincham Cheshire WA15 7JW 01619808001 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): care@schealthcare.co.uk Southern Cross OPCO Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of people who can be accommodated is:50 The registered person may provide the following category of service only: Care Home with Nursing - Code N, to people of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Broomwood Care Centre is a large, purpose built care home that provides accommodation on two floors. Each floor is run as separate units with the unit on the ground floor designed specifically to meet the needs of people with mental health and dementia type illnesses. The first floor is to support people who need nursing care. Care Homes for Older People Page 4 of 35 Over 65 0 50 50 0 Brief description of the care home Broomwood Care centre offers 50 single bedrooms which have an en suite shower and toliet to provide increased privacy. There are a number of communal lounge areas throughout the home and a pleasant garden area. The home is situated in a quiet area of Timperley and is close to a small variety of shops. The current weekly fees for Broomwood Care Centre range from five hundred and ten pounds to six hundred and sevent eight pounds. There are additional charges for toiletries, haidressing, chiropody, newspapers and outings. Care Homes for Older People Page 5 of 35 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection included a site visit. The manager and staff at the home did not know the visit was going to take place. During the course of the visit the key standards were assessed. Information was taken from various sources including an analysis of information received by the Care Quality Commission prior to this site visit. The visit lasted for 8.5 hours on the 7th May 2010. People living at the home and staff were asked to complete survey forms to gather their views of the service. We received three surveys from people living at the home. Comments from these surveys have been included in this report where possible. Since the last inspection there have been changes to the management arrangements for the home, a new manager had been in post since February 2010 and a deputy manager had just completed his induction. Care Homes for Older People Page 6 of 35 At the time of writing this report a number of concerns, allegations being investigated under Trafford Councils Adult safeguarding procedures have progressed, however some of these have not yet been concluded by other agencies. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Since the last inspection in December 2009 we have received improvement plans and been informed that quality audits have been carried out particularly in relation to medication and record keeping. It was of concern there are still shortfalls in the management of medication and in information recorded which may lead to peoples needs not being fully met. Some improvements were seen in the care plans and there was evidence of monthly reviews being carried out. Improvements were seen to the choice of food provided at mealtimes and the meal time experience for people living at Broomwood. The menu of the day was displayed and staff were seen to support people appropriately. People who could express a view were positive about the meals provided and the choices made available to them. Since the last inspection the development of a more permanent staff team has led to improvements in communication between staff. Staff commented they felt, communication was better because they know more about the people they are looking after. The company have appointed a new manager and deputy manager since the last inspection. We were told she has started the process to register with the Commission. There have been improvements in the staff training provided. Care staff need training to support them to develop skills in record keeping to give them the confidence to put these skills into practice. Care Homes for Older People Page 8 of 35 There have been improvements to the programme of staff supervision in place. Staff spoken to found this useful in identifying their training needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Information about the service was available and Broomwood has a system in place for assessing the needs of people moving into the home to ensure the service can meet their needs. Evidence: A Statement of Purpose and a Service User Guide were on display in the reception area on the day of this visit which tells people about the service and the type of support they can expect to receive. Since the last key inspection there have been no new admissions to the home but the care plans looked at included an assessment of need. There has been no new evidence to suggest that people would not receive an assessment of need. The manager told us about the procedure for new admissions to the home and this included plans to gather as much information about the prospective person, complete a pre admission assessment and involve family members where possible. Care Homes for Older People Page 11 of 35 Evidence: A requirement made at the last inspection was for the manager to ensure the needs of prospective people to have been appropriately assessed and a copy of the care management assessment to be obtained so an accurate decision can be made as to whether the persons needs can be met by the service. As there had been no new admissions since the last visit the requirement has been made again in this report. Broomwood does not provide intermediate care. Care Homes for Older People Page 12 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some improvements in care planning were seen, peoples specific needs were not always clearly recorded and monitored. This has the potential of their personal, health or social needs not being met. Improvements were needed in the procedures for dealing with medication to fully protect people living at the home. Requirements made at the last visit by the pharmacist inspector had not been met and these are now subject to our enforcement processes. Evidence: A visit to Broomwood by a Pharmacist Inspector in February 2010 showed a number of concerns in relation to poor medication administration practices. During this visit we monitored compliance with the requirements made in February and found that no significant improvements had been made in medication practices or outcomes for people having their medicines given to them by staff. These requirements are now subject to our enforcement processes. We looked at a sample of medication records and stock and we found it was still very difficult to account for medicines. This meant that we could not be sure they had been Care Homes for Older People Page 13 of 35 Evidence: given to people correctly, or if the right amount of stock was left. Stock count sheets were being completed, but these were often inaccurate, and we found numerous entries where the amount recorded did not match the actual stock recorded. We looked at records of medicines that had been received into the home, brought forward from previous months and/or disposed of. We found that these were incomplete, inaccurate and many items had been disposed of without being recorded at all. The health and well being of people living in the home is at risk of harm if records are not complete and accurate. We found that some people had not received their prescribed medicines because the home had no stock available. It was of serious concern to note that one person did not have a nutritional food supplement for 19 out of 22 days. There was no evidence of this being ordered before stock ran out and none had been given for 4 days after new stock had been received. We found that almost all the painkillers that were prescribed to be taken only when required were out of date. Medication may not work properly and can be dangerous if it is administered after it has expired. The health and wellbeing of people living in this home is at serious risk of harm if their prescribed medication is not ordered in a timely fashion, is out of date or is allowed to run out. Some medicines have to be taken at specific times, for example an hour before food, in order to work properly. There were numerous examples of medicines prescribed to be taken before food being given at the same time as other medicines that should only be taken after food. People are unlikely to get the best from their medication if it is not given at the correct time in relation to food and drink. The manager told us that new systems had been introduced for nurses to check stock balances, note any discrepancies and take action to make improvements. These systems were clearly not effective as numerous inaccuracies were found in the paperwork and there were concerns that had not been identified. There was still no effective overall audit (check) of the medicines handling system in place, despite this having been discussed in detail at the last visit. This meant that mistakes were not being found and acted upon to help prevent them happening again. We looked at how staff were trained. The manager told us that staff had received training from the supplying pharmacy, but this had clearly had little effect on practices in the home. There were still no assessments of staff competence in place to show that staff were capable of performing medication tasks safely. We asked the manager about the action they had taken to address the concerns raised about care practices and care planning following our visit in December 2009. Care Homes for Older People Page 14 of 35 Evidence: We were told that all care plans had been reviewed and in the updated improvement plan sent to us in April 2010, we were told that all records had been reviewed and were now monitored to address any shortfalls. The manager stated they were still working at improving care plans and making them more person centered. We were told there has been increased support provided at a senior level to make sure that peoples care needs are carried out and recorded. The manager stated she had introduced handover sheets to improve communication and to highlight changes in peoples health, personal and social care needs. Two staff commented they felt, communication was better because they knew more about the people they were looking after. We looked at four peoples care plans in detail and these showed that some improvements were seen. One care plan was for a person who had received End of Life care. This care plan was detailed and person centered so the staff could closely monitor the care provided. The care plans showed some examples of the personal preferences in the way people liked to be supported but this was not consistent. Records did not always give staff the information they needed to properly monitor the changing healthcare needs of the person and their progress. The following issues were identified: The care plan for a person who had been in hospital had not been updated following their return to the care home. A discussion with the Registered Nurse showed that whilst they knew the persons needs, specific information in relation to the person being quite weak in the morning and stronger and more able to weight bear as the day progressed, had not been recorded in their care plan. There were shortfalls in the detail about a persons personal preferences and some of the information was confusing. The record showed that this person had only had one shower in the month of May. One care plan stated, Needs assistance of care staff but the personal hygiene record stated they were self caring. For another person one record stated they needed help with continence products, however this persons care plan did not mention they used these products. For another person the risk assessment stated they needed two hourly night checks. The manager stated these were recorded in the night book but it was not stated in the care plan that these checks were to be carried out. Care plans were not always updated, for example, one persons care plan stated that they were on antibiotics from the hospital, but it was not clear if this treatment had been completed or whether it had been effective. Care Homes for Older People Page 15 of 35 Evidence: The records were not always an accurate and up to date record of a persons needs. Shortfalls in information may lead to their healthcare needs not being met in full. For one person the evaluation recorded a person showed changes in their behaviour when slightly constipated. This persons care plan had been re written in the last three months and the information had not be carried forward into the care plan. On the day of this visit we looked at the persons elimination chart. The care worker stated this was not a proper account because she was not really sure how to fill this in properly. The care plan asked for a description of the stool and these details were not recorded. The GP had been requested to visit this person for the second time in three days due to ongoing healthcare problems. Shortfalls in the level of detail recorded may lead to peoples healthcare needs not being met in full. For another person, the elimination records were confusing and one chart showed the person had not had their their bowels opened for thirteen days. When asked, staff stated That cant be right. For one day the record showed this person visited the toliet twice and on another day four times in thirteen hours. The identified needs and risks were not always clear for the staff to follow. During this visit staff stated that they took one person to the toliet before lunch and that the person could weight bear for some transfers. This persons moving and handling risk assessment had been updated the previous month and stated they were no longer able to weight bear. For a transfer from chair to chair the record showed the appropriate handling method was two staff and use of the trixie hoist. Following lunch staff were seen to use the hoist with this person to transfer them from chair to toilet. If information is not clearly recorded and communicated to staff, the staff will not have clear information about how to meet peoples specific needs, potentially putting the person at risk from inappropriate or unsafe moving and handling practices. Staff were not always aware of how to record information in the care plans. Two staff received scratches from a person whilst attending to their needs. We asked had they filled in the challenging behaviour chart but they stated they were not particulalry clear about using the care plans and how to do this. Both people stated they had not received an induction on using the care plans, they stated they Filled in what bits they could on the charts at the beginning in relation to hygiene and bowels. We spoke to the manager who stated staff were due to receive some training in care planning and recording. We talked to the manager about some of the daily statements. These were general and did not always show information about the persons day. The manager stated she had identified this as an area for development in her care plan audit. Care Homes for Older People Page 16 of 35 Evidence: Although there was evidence of some improvement, the requirement made at the last inspection to ensure each person has an up to date and detailed plan of his or her care needs has been reiterated. We discussed the recording of fluid and diet charts for people, staff were seen filling these charts in just before lunch recording what people had eaten and drank at breakfast time. A care worker was asked if they are allocated named people to care for so they could monitor them closely. The care workers spoken to said, We just remember what people have eaten and drank and we all care for everybody. We would not always have the time to record the charts straight after a meal or a drink. The time delay in the recording potentially leaves people open to forgetting and has the potential to lead to shortfalls in the monitoring of a persons dietary and fluid intake. For one person their assessment stated they can get confused and show challenging behaviour. There was no care plan in place for confusion or challenging behaviour although there were some records of entries where staff had recorded episodes of challenging behaviour. We were told there was one person with a hospital acquired pressure sore at the time of this visit. Records showed there were signs of improvement in the wound but the detail provided in the care plan did not give clear instructions for the staff to follow in relation to the type of dressing to be applied. It was of concern this person had gone without their wound being re dressed over a weekend due to the home running out of the required dressings. A requirement was made at the last inspection for risk assesssments to be completed for all identified risks for individuals. Improvements were seen for the record keeping of body maps and any bruising. Other risk assessments were seen in place for falls, moving and handling, prevention of pressure sores, nutrition and bed rails. During the visit staff were seen to be kind and attentive to peoples needs. Staff were friendly in their approach and appeared to know people well as individuals. Observations throughout the visit showed staff gave attention to peoples personal needs. The care plans provided evidence that access to other health care professionals and services were provided to people. Three people returned surveys to share their views about the service they received. All Care Homes for Older People Page 17 of 35 Evidence: three said they always, sometimes or usuallyget the medical care they need and two of the three said staff usually act on what they said. One person added, Communication between staff could be better sometimes, carers need to know the history (medical) of patients which would help them understand their behaviour too. In response to the question, What could the home do better, one persons relative wrote, read the care plans properly to see what residents actually need. A discussion with three care workers showed they felt, Care plans are not really useful to me on a daily basis, they are for the qualified staff really. The care plan should be the written guide to show the staff how to support a person to meet their personal care needs. A recommendation was made for staff to read these and follow the persons care needs. On the day of this visit some relatives spoken to said they were happy with the improvements seen in the home and the level of care provided. One relative expressed some concern that, We hear some staff are leaving and this is a worry because things are generally getting better. care plans showed evidence of the person themselves or their representative being involved in the care planning process and the information had been shared with them. Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to engage in social activities and a varied menu is provided which people enjoyed. Evidence: The care plans looked at included information about a persons background or a social profile which included information about their past experiences, interests, family life and their work life experiences. One staff member stated, Learning about what someone used to do and their family life helps me to understand them better. From observations made on the day of this visit there were no formal activities in place and a recommendation was made to develop the activities. One person said, It would be better if there was more to do. A discussion with the manager showed she was hopeful to introduce more activities, particularly for people with a dementia type illness to meet the needs of the people living at the home more fully. We were told the activities organiser was on a period of extended leave from the home at the time of this visit and people spoken to said, We miss our activities organiser. We saw a list of some planned activities including keep fit and details of events in the local community. We were told that regular events included celebrating peoples birthdays, visiting entertainers and staff encouraging people to sing and one Care Homes for Older People Page 19 of 35 Evidence: person was seen to enjoy having a dance with one of the care workers. We noted that some people chose to continue to follow their religious beliefs, as a result several people received Communion from a local priest. The three surveys returned from people who use the service showed that the home usually or sometimes arrange activities people can take part in if they wanted to. One person added, There are virtually no activities or stimulation happening on a daily basis, residents are just left to sit in the lounge, the other person stated, The activities are good, always something going on to mark an occassion. They accomodate for all diets and the meals have improved since mother went into the home. People who use the service were encouraged to maintain contact with family and friends and some visitors were seen during the day. Visitors said they had a choice of where they could spend time with their relative and could meet in private. At the last inspection we reported that the lunch was served late and the menu did not reflect the meal provided. This site visit showed the meal time experience had been reviewed and people saw this as a positive experience. For one person, their care plan showed they preferred finger foods as opposed to big meals. During lunch time this person was seen to eat sausages which had been cut up as finger food and the staff member was sitting at the dining table enouraging them to eat this. The lunch on the day of the visit was sausage and onions, potato and vegetables or scrambled eggs on toast. The menu on display reflected the meal of the day. Two people who expressed a view stated the food was good and they received a choice at mealtimes. One person stated, The food is quite nice. I always get what I have ordered and there are plenty of drinks. The staff make it feel like home as best they can and I feel my need for privacy is respected as much as possible. Since the last visit the meal time experience was seen to be more positive for people. Staff were seen to be more aware of the need to support people during lunchtime and people were seen to enjoy their dessert in the lounge area because they had wandered away from the dining room. A discussion with the catering manager showed that the number of sandwiches provided had been reduced. One person commented that,The meals are better than they were. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives were confident that issues they raised would be dealt with. Staff would be confident to pass on any information about potential allegations of abuse. Evidence: The complaints procedure was available and we we looked at the complaints record made directly to the home since the last inspection in December 2010. the three people who returned surveys said they knew how to make a complaint and felt any concerns they raised would be dealt with appropriately. Three staff spoken to were aware of what they would do in the event of an allegation of abuse. the records showed staff had received some training about the protection of vulnerable adults. There have been a number of investigations safeguarding concerns/allegations investigated under Trafford Councils adult safeguarding procedures. Concerns raised have been in relation to poor record keeping and shortfalls in care practices. Concerns raised in some of these referrals have been addressed by the home, others are not yet concluded by the other agencies involved. Care Homes for Older People Page 21 of 35 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. People live in a spacious, homely, clean and comfortable environment which meets their needs. Evidence: A partial tour of the home was carried out that included some bathrooms, communal areas and lounges. all rooms are single with ensuite showers and are accessible for wheelchairs and hosits. Specialist baths were available to ensure the physical care needs of people accommodated could be sent. The home was clean, homely and free from any unpleasant odours. The lounge dining room had doors that opened out into the garden and patio area, The garden areas were well kept and people said they enjoyed the benefit of the pet rabbit outdoors and budgies indoors. We looked at some peoples bedrooms which were personalised to peoples own tastes and preferences including family photographs. People wrote in the surveys that the home was always clean. Some staff had received training in infection control practices in the last twelve months and there were plans in place for new starters to undertake this training. We were told the home currently provided one domestic and one laundry staff member each day. Staff spoken to said they did have to go the extra mile to keep Care Homes for Older People Page 22 of 35 Evidence: the home as clean as it is. We were told a new housekeeper was due to start in the next few weeks to support the current team. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The skill mix, number and deployment of staff should be reviewed to make sure the care, health and safety needs of people living at Broomwood are met in full. Evidence: On the day of the site visit there were twenty-four people accommodated at Broomwood. The last inspection raised concerns about there being enough suitably qualified, competent staff to meet peoples needs. This visit showed some improvements in the staffing arrangements although there is still a need for these to be reviewed. There were two registered mental health nurses on duty who were both new to the service since the last inspection one of whom told us they were working their period of notice. On the ground floor the three care workers were permanent staff who knew the people and their needs well. From observations made and from discussion with the care workers we had some concerns in relation to the number, qualification or deployment of the staff to meet in full the needs of the people accommodated. We were told in the improvement plan that all vacant posts have now been recruited to. During the visit we had some concerns in relation to the number, skill mix and deployment of staff on duty. The lounge area, on the ground floor was left unsupervised for periods of time on a number of occasions. The housekeeper stopped her work at one point to observe the lounge and wait for staff to reappear. This raises Care Homes for Older People Page 24 of 35 Evidence: concerns that the people were being left unsupervised by appropriately trained staff. On the day of this visit one of the nurses was still giving out medicines at 11.25 am, this person said, I dont get job satisfaction because we are doing tasks all day. The medicines can be time consuming because some people need alot of time spending with them to get them to take their tablets and liquids. A staff member on the first floor stated, We do not always have the chance to give people the baths and showers they would like because it is too busy, we are always answering the call bell. The nurses are kept bust doing the drugs and other things so we are left to get on. On the day of this visit people did not receive their mid morning drink until 12pm immediately before lunch and some people were asked to wait to have their needs met until a staff member was free to provide assistance. During the visit a relative commented that,The staff are always busy here but they are kind. Staff were concerned about trying to take their breaks because they did not want to leave people in the lounges without supervision. A review of some of the duty rotas showed there was a reduction in the use of agency staff and where possible we were told bank staff covered shifts because they knew the people accomodated. The way in which staff are recruited at Broomwood was assessed by looking at the staff files for four staff who had started working at the home since the last inspection. Information included a completed application form, two written references, criminal records bureau checks (CRB). There were photocopies of bank statements, passports, driving licence, these were not signed or dated to evidence the these copies were taken from original documents. There was a training plan in place and a computer training matrix showed the training that had been carried out. Staff files looked at included a list of staff training that the individual had done. Examples of training carried out included moving and handling, fire safety, infection control, health and safety and nutrition. Two staff said they had an induction and thought it was satisfactory. Another care worker who had been at the home for six months stated that I had some training but not an induction , I just shadowed one of the other care workers. Following the shortfalls in the staff recording in the care plans and the comments in relation to induction, a recommendation was made for staff to receive a thorough induction to include record keeping. From the three surveys returned two of the three people said the staff usually listen and act on what they say, one person said, sometimes. One person added ,The carers in nursing care are all good , warm and welcoming, and a person living at Broomwood said, The staff are good, they are gentle and kind. Care Homes for Older People Page 25 of 35 Evidence: Discussions with senior management and from observations made there have been attempts made to develop a staff team and provide continuity of care. Care Homes for Older People Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work is needed to ensure the systems in place are effective to monitor care practices, staff competencies and record keeping in order to safeguard the interests and well being of the people at Broomwood. Evidence: Since the service opened there have been changes in management. The manager in post at the time of this visit was appointed in February and she told us she was waiting for her Criminal Records Bureau check before she submitted her application to be the as part of the registration process. The manager has a number of years experience at a senior level of nursing older people. A deputy manager, a mental health nurse was new in post on the day of this visit. the new manager had received on going support from a relief manager over recent months. Staff and visitors were positive about the new manager and one person added, Vicki is good for this home, she lets us know what she wants from us. We spoke to the manager and senior management about the areas of concern shown in this report following our visit. It is of concern that although audits have been carried out regularly on care practices, for Care Homes for Older People Page 27 of 35 Evidence: example care plans and medication, a number of shortfalls were identified. The manager created an open and friendly atmosphere within the home and was seen on more than one occasion to stop what she was doing to meet the individual needs of people living at the home. People living at the home, relatives and staff said they found the manager approachable and she knew the needs of people at the home well. We saw some improvements in a number of areas since the last visit which the manager does believe will continue as she continues to develop a permanent staff team. We were told there have been no changes to the policy and procedures in place for the management of peoples money since the last visit. The records are audited by the company on a regular basis. A system was in place for the recording and reporting of accidents and incidents that occured. The manager was looking at these on a regular basis and looking at ways to make any changes to peoples risk assessments to minimise the risk of further accidents. We discussed there appeared to be a high number of accidents and incidents during the previous month, which the manager stated may in part be due to the staff being more focused about recording and reporting anything. A sample of maintenance records were looked at which showed equipment in the home was checked and appropriately maintained, for example hoists and fire extinguishers. A maintenance person was spoken to who was responsible for the day to day repairs and for monitoring the health and safety of the home. A quality assurance survey had not been sent out since the last inspection. We were told there have been meetings with relatives and people living at the home to update them of their plans to improve the service for the people living at Broomwood. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14 The manager must ensure 11/01/2010 that the needs of prospective people for whom accommodation is provided have been appropriately asssessed and a copy of the assessment has been obtained. This is so that an accurate decision can be made as to whether the persons needs can be met by the service. 2 7 15 You must ensure that each 11/01/2010 person living at the home has an up to date and detailed plan of his or her care needs. The plans must include comprehensive details of the needs of service users relating to their health and welfare and clear instruction to staff in how to meet those needs. So that staff have clear guidance how to meet peoples assessed needs and provide them with appropriate support. 3 7 17 You must ensure that records 11/01/2010 are kept up to date and are accurately recorded. This is to ensure the information provided is Care Homes for Older People Page 29 of 35 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 accurate and up to date to reflect changes in a persons health care needs. 4 8 12 Where people are at risk of poor nutrition, due to poor health or dementia, you must ensure that diet and fluids is provided in accordance with nutritional guidance and at reasonable intervals throughout the 24 hour day. Records must be kept up to date to monitor this. This is to ensure peoples health and well being needs are being met. 5 9 12 Medicines must be given at the correct time of day, particularly with regard to food and drink intake in order for medicines to work properly and/or reduce side effects. previous timescale of 30/04/10 not met which means this requirement is subject to our enforcement processes 6 9 12 All medication must be administered/used only as prescribed in order to safeguard the health and well being of people who use this service previous timescale of 30/04/2010 30/04/2010 08/01/2010 Care Homes for Older People Page 30 of 35 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 30/04/2010 not met, which means this requirement is subject to our enforcement processes 7 9 24 There must be an effective 30/04/2010 system for regularly auditing (checking) the standard of handling and recording medication within the service so that standards can be monitored and improved where necessary. previous timescale of 30/04/10 not met, which means this requirement is subject to our enforcement processes 8 9 13 1.All medicines must be 11/01/2010 administered as prescribed in a timely manner. 2. All records about medicines must be clearly recorded. 1.To make sure that peoples health is not at risk. 2.So that all medicines are shown they are given as prescribed. previous timescale of 11/01/10 not met, which means this requirement is subject to our enforcement processes 9 9 18 There should be a system in 30/04/2010 place for checking and recording the competence of all nurses and care staff involved in administering and/or handling medication Care Homes for Older People Page 31 of 35 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 in order to ensure these tasks are performed safely previous timescale of 30/04/2010 not met, which means this requirement is subject to our enforcement processes 10 27 18 The registered person must make sure there are enough suitably qualified staff to meet peoples needs. This is to make sure that there are enough staff available at all times to meet the health and social care needs of people living in the home. 11 33 24 Systems must be in place to monitor and check the care practices in the home. This is to make sure shortfalls are identified and improvements are made particualrly in relation to care plans, medication and staffing. 29/01/2010 31/12/2009 Care Homes for Older People Page 32 of 35 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 1 3 14 The manager must ensure 30/07/2010 that the needs of prospective people for whom accommodation is provided have been appropriately assessed and a copy of the assessment has been obtained. This is so an accurate decision can be made as to whether the persons needs can be met by the service. 2 9 13 There must be a robust system in place for ordering medication and dressings so that supplies do not run out so that supplies do not run out and people therefore receive the treatment they need at all rimes 30/06/2010 Care Homes for Older People Page 33 of 35 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 3 7 8 12 Care plans should include information about peoples likes and dislikes so they can be supported appropriately. Staff should plan in advance so they have the appopriate dressings in place to maintain a persons dignity. Social activities should be reviewed and developed to meet the needs of people with a dementia type illness to keep people mentally stimulated. Documents taken as proof of identity should be signed and dated to show that the originals have been seen. Staff should have a thorough induction that includes record keeping so they are competent to complete records appropriately. 4 5 29 30 Care Homes for Older People Page 34 of 35 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. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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