Care Home: Broxbourne House

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What the care home does well To make sure the service can meet peoples personal and health care needs these are assessed before coming to live in the home. A sample of peoples assessments show they also include their choices and preferences and likes and dislikes. These are reflected in their care plans and show staff how to support people living in the home. Records show that the care plans are looked at regularly and amended if needed to reflect peoples changing care and support needs. The assessments includes peoples social histories or profiles and these reflect peoples cultural backgrounds. They also show peoples hobbies and things they enjoy doing. The record of activities show there are group activities including outings and arts and crafts, religious services and one to one activities based on peoples choices and preferences. People are protected by the way staff are recruited and selected as records show references, police and POVA (Protection of Vulnerable Adult List) checks are taken up before they are employed. People are also protected from abuse as records show there is a Safeguarding Policy and Procedure for staff to follow any allegations of abuse. Records also show staff have Safeguarding training that reflects and includes the Local Authority Safeguarding Protocols. Records show people are cared for and supported by staff that are trained and qualified as nearly all staff have a National Vocational Qualification Level 2 or above. People living in the home said they feel safe and well cared for. One Social Worker writes "I have been extremely impressed a number of times by the care provided by Broxbourne House". and goes on to say "I have observed staff who have supported people with mental health needs, and they have shown empathy and timely skilled intervention in demanding situations, the deserve recognition for this". One relative writes "The home gives my relative the support the need to keep them safe and well". Some others write"We have been very happy with the care Broxbourne House has provided. We have found all the staff and management most helpful at all times. The home is very clean and a lovely place overall". What has improved since the last inspection? To make sure the service can meet peoples personal care and support needs these are now assessed before coming to live in the home. The assessments are now comprehensive and show staff what they need to do to meet peoples care and health care needs. To make sure people enjoy activities of their choice there are now `Residents Profiles` showing peoples likes and dislikes, social history including hobbies and interests. There is now an Activities Coordinator that arrange for and organize group work, individual work, arts and crafts, shopping trips and outings. People were observed enjoying their meals an said they have a choice of menu. The home now has a new cook and all care staff have had training in the nutritional needs of older people. There are also now nutritional assessments showing staff the nutritional needs of people living in the home. To make sure peoples needs are met there are now care plans showing staff how to deal with peoples medicines and now information provided by the District Nurses are also included in peoples plan of care. Records show peoples care plans are looked at regularly and altered if needed to reflect peoples changing needs. To make sure people receive the right care and support peoples records are now up to date and accurate. All the records of everyone living in the home are now kept in good order and make it easier for staff to follow. Staff records have also been changed to protect people living in the home and to make them easier to read as now new staff have to provide a history of where they have worked before and they are now asked upon interview if they have committed any offenses. To make sure peoples wellbeing is promoted and protected the way medicines are dealt with has been reviewed by the acting manager who now audits the medicines regularly to make sure they are kept properly, administered correctly and appropriately recorded. Records also show to further protect people all staff giving medicines have been trained to do so safely. People are cared for and supported by qualified staff as records show nearly all staff now have a National Vocational Qualification at Level 2 or above. To protect people from any kind of abuse the records show nearly all staff have had Safeguarding training provided by the Local Authority. To make sure the home is run in peoples best interests there is now an acting manager that has an application pending with the Care Quality Commission to be registered. It was noted that they are very experienced in caring for older people and also have a Registered Managers Award. Records also show the work staff do is now supervised by the acting manager and supervision notes are now kept in staff files. To keep people safe the maintenance records show the emergency equipment including fire alarms and emergency lighting is now checked regularly. Records also show the water outlets are also now checked to make sure the water temperature is not to hot for people living in the home. A tour of the premises found some areas of the home have been decorated and there are now more pictures displayed in the corridors. For the benefit of people living in the home the garden area has improved greatly and there are now flowers and shrubs and garden furniture provided for them to enjoy in the summer months. The views of people living in the home and those of their relatives is now sought on the quality of care and services provided by the home by using satisfaction surveys. What the care home could do better: The pre admission assessments are not signed by the person wanting the service or their relatives to show their involvement in the assessment process. Not all people living in the home are able to sign their assessments or care plans or reviews but some are, but the documentation doesn`t reflect this. The daily records do not contain many descriptive words to reflect and show peoples choices and preferences or any decision they make about how they live their day to day lives. To protect people living in the home from any kind of abuse, all staff should have Safeguarding training. It is acknowledged and records confirm, that Safeguarding training is planned for those that require it. The acting manager said that to make sure there are enough staff available at all times to meet peoples personal care and support needs they will continue to monitor the staffing levels and adjust the rotas to reflect the needs of the current population. To make sure the home runs in the best interests of those using the service the Acting Manager said they will progress their application to be registered with the CQC. The information gathered as part of quality assurance monitoring and in particular satisfaction surveys has not been collated or a report provided showing what people said about the quality of services provided or any changes to the way the home runs as a result of their comments. Key inspection report Care homes for older people Name: Address: Broxbourne House 57 Barnsley Road Wakefield West Yorks WF1 5LE     The quality rating for this care home is:   one star adequate 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: Tony Railton     Date: 2 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Broxbourne House 57 Barnsley Road Wakefield West Yorks WF1 5LE 01924370004 01924201016 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr M Seeratun Name of registered manager (if applicable) Mr Nigel Edwards Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Broxbourne House provides residential care for 21 older people who may also suffer with mental health problems. The home is situated just outside the centre of Wakefield on the main Barnsley Road. Set in its own grounds, there is a garden area to the front and side and car parking to the rear. The main entrance is to the rear of the home where there is an office and corridors leading to the lounges, dining room and bedrooms. A passenger lift is provided for those who require it and there are assisted bathing and showering facilities. Shared and single accommodation is provided and most bedrooms, although not en-suite, are personalised and comfortable. The home is Care Homes for Older People Page 4 of 27 Over 65 21 21 21 0 0 0 1 3 0 5 2 0 0 9 Brief description of the care home on a main bus route and is only a few minutes from the centre of Wakefield and all services and amenities. The provider informed the Commission for Care Quality Commission in November 2009 that fees are £396 per week. Additional charges include hairdressing, private chiropody, newspapers and some selected activities. Information about the home and the services provided are available from the home in the statement of purpose and service users guide, copies of which can be obtained by contacting the home. Care Homes for Older People Page 5 of 27 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: one star adequate 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: Following this visit the service has been given a One Star rating which means people living in the home experience adequate quality outcomes. Although the service has shown many improvements since the previous inspection visit these improvements must be sustainable and demonstrated over a longer period of time. This visit started at 08.30 and ended at 13.00. During the visit there was the opportunity to speak to people living in the home, the service provider, the new acting manager, all care staff and a visiting District Nurse. Other information considered included information sent to us from the service and in particular the Annual Quality Assurance Assessment (AQAA) and the Action Plan telling us about the improvements made to the service. Also considered were the returned CQC surveys showing what people living in the home and their relatives and two visiting professionals think about the home and the services provided. A sample of three peoples records were seen and included Pre-admission assessments, assessments, including risk assessments, care plans, reviews, daily and medical records. A sample of staff records were also seen and included, application Care Homes for Older People Page 6 of 27 forms, interview notes, police and POVA (Protection of Vulnerable Adults List) checks, references, induction, training and supervision notes. The medication systems were looked at and some medicines checked. This was a very positive unannounced visit where lots of improvements were noted. The inspector would like to take the opportunity to thank the people living in the home, the acting manager and the staff team for their hospitality and cooperation throughout the visit. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? To make sure the service can meet peoples personal care and support needs these are now assessed before coming to live in the home. The assessments are now comprehensive and show staff what they need to do to meet peoples care and health care needs. To make sure people enjoy activities of their choice there are now Residents Profiles showing peoples likes and dislikes, social history including hobbies and interests. There is now an Activities Coordinator that arrange for and organize group work, individual work, arts and crafts, shopping trips and outings. People were observed enjoying their meals an said they have a choice of menu. The home now has a new cook and all care staff have had training in the nutritional needs of older people. There are also now nutritional assessments showing staff the nutritional needs of people living in the home. To make sure peoples needs are met there are now care plans showing staff how to deal with peoples medicines and now information provided by the District Nurses are also included in peoples plan of care. Records show peoples care plans are looked at regularly and altered if needed to reflect peoples changing needs. To make sure people receive the right care and support peoples records are now up to date and accurate. All the records of everyone living in the home are now kept in good order and make it easier for staff to follow. Staff records have also been changed to protect people living in the home and to make them easier to read as now new staff have to provide a Care Homes for Older People Page 8 of 27 history of where they have worked before and they are now asked upon interview if they have committed any offenses. To make sure peoples wellbeing is promoted and protected the way medicines are dealt with has been reviewed by the acting manager who now audits the medicines regularly to make sure they are kept properly, administered correctly and appropriately recorded. Records also show to further protect people all staff giving medicines have been trained to do so safely. People are cared for and supported by qualified staff as records show nearly all staff now have a National Vocational Qualification at Level 2 or above. To protect people from any kind of abuse the records show nearly all staff have had Safeguarding training provided by the Local Authority. To make sure the home is run in peoples best interests there is now an acting manager that has an application pending with the Care Quality Commission to be registered. It was noted that they are very experienced in caring for older people and also have a Registered Managers Award. Records also show the work staff do is now supervised by the acting manager and supervision notes are now kept in staff files. To keep people safe the maintenance records show the emergency equipment including fire alarms and emergency lighting is now checked regularly. Records also show the water outlets are also now checked to make sure the water temperature is not to hot for people living in the home. A tour of the premises found some areas of the home have been decorated and there are now more pictures displayed in the corridors. For the benefit of people living in the home the garden area has improved greatly and there are now flowers and shrubs and garden furniture provided for them to enjoy in the summer months. The views of people living in the home and those of their relatives is now sought on the quality of care and services provided by the home by using satisfaction surveys. 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 Older People Page 9 of 27 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 10 of 27 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 11 of 27 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. To make sure peoples personal and health care needs can be met by the service , these are assessed before coming to live in the home. The home does not provide a specialist intermediate care service. Evidence: To make sure the service can meet peoples personal and health care needs these are now assessed before coming to live in the home. The information sent to us by the providers before the visit show also shows and confirms there are now comprehensive assessments completed before they come to live in the home. A sample of three peoples records show there assessments completed by the acting manager showing staff how people need to be cared for and supported.The records show the assessments include peoples personal care and physical wellbeing, their diet and weight including likes and dislikes, peoples sight, hearing and communication, peoples oral health needs, foot care and mobility needs. The assessments also include any history of falls, peoples continence care needs, the , medicines they are taking. The Care Homes for Older People Page 12 of 27 Evidence: assessments also include any problems with their mental health and a social history that includes peoples religious and cultural needs. The acting manager said the assessments are completed with the help of people wanting to use the service and their relatives. However, some of the assessments and social histories are not signed by the person themselves or their relative to say they agree with what is written. Care Homes for Older People Page 13 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are set out in their plan of care and they are treated with dignity and their wishes respected. People are also protected by the way medicines are dealt with. Evidence: People living in the home are protected by the way medicines are dealt with as there is now a Medication Policy and Procedure for staff to follow that includes the Royal Pharmaceutical Guidelines on the administration of medicines. People are further protected as the staff records show those giving medicines have been trained to do so safely. To further protect people using the service the acting manager now audits the medicines regularly and checks then to make sure they are correct. To make sure people receive the medicines and health care support they need and require , these are set out in a plan of care. A sample of peoples records and medicines were checked on the day of the visit and found to be safely stored and recorded. The signatures on the record of medicines given and the lack of gaps suggests that people are receiving the medicines they need and require. To make sure peoples health care needs continue to be met the plan of care is now looked at regularly and amended to reflect Care Homes for Older People Page 14 of 27 Evidence: peoples changing health care needs. To make sure information regarding peoples health is up to date and correct information held by the District Nurses is now included in peoples care plans. This is to show staff how people need to be supported and cared for. The daily records reflect the care and support given on a day to day basis. One visiting District Nurse said they have never had any problems supporting people in the home and the staff are always helpful and there is a homely and friendly atmosphere. A sample of three peoples records show they are supported by local General Practitioners, District Nurses, Opticians and Chiropodist. On the day of the visit people said they are happy living in the home. The fifteen returned CQC satisfaction surveys show people living in the home and their relatives are happy with the care and support provided. One relative writes the homes gives my relative the support they need to keep them safe and well. Another writes, The home provides a friendly caring environment. One relatives says they have been Very happy with the care provided, we have found all the staff and management most helpful at all times. Another says Broxbourne look after the residents well, and treat them all with respect and dignity. One staff member says The carers do their job very well and will go above and beyond their duties, care plans are always up to date and information about all residents is passed on. When asked what the home does well, one Social Worker writes Staff listen to the needs and wishes and requests of service users and hopes to meet those needs, the care provided is person centered, The feedback I receive from service users is positive and people comment they are made to feel welcome and are kept informed, The home communicates well with professionals including Social Workers and District Nurses. On the day of the visit people were observed being treated with dignity and having their wishes respected. There was enough staff observed to be available to meet peoples personal and health care needs in a relaxed and unhurried manner. Care Homes for Older People Page 15 of 27 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. The lifestyle experienced by people living in the home matches their expectations and they are offered a choice from a varied and balanced menu. Evidence: On the day of the visit people were observed relaxing in the lounges, dining room and in their own rooms. Some were enjoying each others company and socializing, others watching television and some having their breakfast. People were comfortable and having their support needs met in a relaxed and unhurried manner. Discussion with the acting manager found that there is now an activities coordinator that works in the home five days a week. Discussion with the activities coordinator found they provide group activities, outings and one to one activities of peoples choices. The records show and the activities coordinator confirmed that they are currently completing residents Profiles. The profiles are designed to identify peoples choices and preferences, social history and background and any hobbies they previously liked and would like to take up again. This practice is to be commended. The records show people can choose from a range of activities arranged regularly. One person said they enjoyed the trip to Bridlington and would like to go again. The photographs displayed show people enjoying a trip to the coast. On the day of the visit people were observed painting some decorations for the planned Halloween Party and celebrations. Care Homes for Older People Page 16 of 27 Evidence: People were observed throughout the visit being treated with dignity and having their wishes respected and in particular at mealtimes. To make sure people have a choice the menu is displayed in the dining room. People were also observed being asked which menu they would prefer. Some people needing assistance to eat their meals were supported by staff in a relaxed and unhurried manner. The training records show that all staff have now had training regarding the nutritional needs of older people. The records show people now have nutritional assessments telling staff what they need and require nutritionally. The records show that now a complete record is kept of the meals provided and what people chose to eat. Discussion with the acting manager and service provider found that the home now has a new cook. The returned satisfaction surveys show people and their relatives are happy with the meals provided. On the day of the visit one person said they can choose what meals they have. Another said they are very happy with the meals provided. Throughout the visit people were observed making decisions about how the live their day to day lives. However, the daily records do not contain many descriptive words to reflect and show that people have a say in what they do and what happens to them. Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. What people say is taken seriously and acted upon and people are protected from any kind of abuse by the Safeguarding Policy and Procedures. However, people will be further protected once all staff have had Safeguarding Training. Evidence: People living in the home said they know how to make a complaint but said they have never had to do this. A visiting District Nurse said they have always been happy with the services and support offered by the home and never had to make a complaint. To make sure people know how to make a complaint, the complaints policy and procedure forms part of the Service User Guide given to everyone living in the home. To make sure relatives and visitors know how to complain the Complaints Policy and Procedure is displayed in the home. To make sure staff know how to deal with complaints it is included .as part of their induction training. To make sure people are protected from any kind of abuse there is a Safeguarding Policy and Procedure for staff to follow. To make sure people are protected the policy includes the Wakefield Local Authority Safeguarding protocols. To further protect people from abuse all staff have Safeguarding training provided y the Local Authority. On the day of the visit it was noted that some staff are waiting to have Safeguarding training that is planned for them to attend the coming months. Care Homes for Older People Page 18 of 27 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 clean and pleasant environment that is homely and safe. Evidence: On the day of the visit people were observed relaxing in warm and pleasant surroundings. A tour of the premises found it to be clean and free from any unpleasant odors. For the benefit and comfort of people living in the home all bedrooms now have lampshades fitted. To make sure people are safe the maintenance records show the fire equipment and fire alarms are checked regularly. Records also show to further protect people the passenger lift and hoists are serviced regularly. To make sure people dont scald themselves the temperature of all hot water outlets are now checked regularly to make sure the waters not to hot. To protect people living in the home and prevent cross infection there is now a key pad lock on the sluice room door. On the day of the visit people said they like living in the home. A visiting District Nurse said there is always a homely atmosphere and people seem happy. The returned satisfaction surveys show people and their relatives are very happy with the services provided. One relative writes The home gives their relative the support they need to keep them safe and well. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs are met by the numbers and skill mix of staff that are trained and qualified. People are also protected by the way staff are recruited and selected. Evidence: One relative satisfaction surveys says Broxbourne House provides a friendly caring environment, another writes the staff provides the care and attention to individual needs. Other relatives write We have been very happy with the care provided, We have found all staff and management most helpful at all times. The home is very clean and a lovely place overall. Another writes Staff look after residents well and treat them all with respect and dignity and privacy. Another relative comments,The carers do their job very well and will go above and beyond their duties, care plans are up to date and they pass on information . One Social Worker says staff at Broxbourne House are always friendly and approachable. The staff rota shows there are enough staff planned to be on duty to meet the needs of people living in the home. On the day of the visit there was enough staff available to meet peoples care and support needs in a relaxed and unhurried manner. The Acting Manager said they have reviewed the staffing levels provided and will continue to do so and change them if needed to reflect the needs of the current population. People are protected by the way staff are recruited and selected as records show Police and POVA (Protection of Vulnerable Adults List ) checks and references are taken up before they are employed. It was Care Homes for Older People Page 20 of 27 Evidence: noted that all the staff records have been reviewed and updated and are much more accessible. People in the home are cared for be staff that are qualified as records show nearly all staff have a National Vocational Qualification. This practice is to be commended. To make sure people receive the support they need and require records show staff have received Health and Safety,Moving and Handling, First Aid and Infection control training.To further meet peoples needs records show staff have Mental Health and Dementia Awareness training. They also show those giving medicines have been trained to do so safely. The minutes of the staff meetings show they have the opportunity to comment on the running of the home and the quality of services provided. Care Homes for Older People Page 21 of 27 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. People now live in a well managed home that is run in their best interests and where their health , safety and well-being is promoted and protected.However their views and the views of their relatives on the quality of care and services provided are not published. Evidence: To make sure people living in the home receive the care and support they need and require an Acting Manager has been appointed who has an application pending with the Care Quality Commission to be registered. The Acting Manager says they have previously been a registered care homes manager and has recently completed the Registered Managers Award. They said they have improved the care management systems within the home including the pre-admission assessments, updating personal details, reviewing peoples care plans and including medical information provided by the District Nurses. A sample of peoples records confirmed this. To protect people living in the home, they also said they have improved the staff recruiting and selection process to include completed application forms with an employment history and Care Homes for Older People Page 22 of 27 Evidence: interview notes. A sample of staff records confirmed these improvements. To further protect people living in the home the acting manager says the medicine administration systems are now checked and audited regularly. The medicine administration records confirmed this. The views of people living in the home and their relatives are sought through satisfaction surveys. However, this information has yet to be collated and a report provided reflecting the views of people living in the home on the quality of care and support provided or any changes to the way the home runs as a result of their comments. The records show this was an outstanding Requirement following the previous inspection visit. The maintenance records show that proper checks are carried out on the emergency equipment in the home. To further promote the health and safety of people in the home the passenger lift and hoists are checked regularly and there are risk assessments completed. Staff training records also show they receive Health and Safety and Moving and Handling, Infection Control and First Aid training. To make sure people receive the care and support they need and require the staff supervision notes show the work they do is supervised. Records also show the acting manager appraises staff work. The returned Care Quality Commission satisfaction surveys show people and their relatives and other visiting professionals are happy with the quality of services provided. One Social Worker writes I am are that improvements have been made to the service users files and documentation. I feel this has been an area that has let Broxbourne House down, and unfortunately has not evidenced or reflected the standard of care provided. Care Homes for Older People Page 23 of 27 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 33 24 What people say about the 01/09/2009 home and the services provided must be sought formally and a report provided showing what they , their relatives and other stakeholders say about the quality of care provided and the results published. To make sure people have a say in how the home is run and to reflect any changes to the way the home operates as a result of their comments. Care Homes for Older People Page 24 of 27 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 33 24 The service provider shall collate the information gathered through quality assurance and provide a report. The report will reflect the views of people living in the home and their relatives on the quality of the services provided and show any changes to the way the home runs as a result of their comments. 01/01/2010 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 3 As a matter of good practice people should be asked if they would like to sign their assessments to show their involvement and to make sure they agree with the information recorded. To make sure peoples needs can be met by the service they should continue to make sure everyones personal and health care needs are assessed before coming to live in the Page 25 of 27 2 3 Care Homes for Older People 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 home. 3 7 People and their relatives are involved in developing and reviewing their care plans, however, they do not sign the assessments, care plans or reviews to show their involvement o to show they agree with what is written in them. People were observed throughout the visit making decisions about what they do and how they live their lives on a day to day basis, however the daily records do not contain many descriptive words to reflect this. Although it is acknowledged that training is planned. To make sure people are protected from any kind of abuse those staff requiring Safeguarding training should have this as soon as is practicable. To make sure peoples care and support needs continue to be met the acting manager should monitor the numbers of staff available and amend them if needed to reflect the care and support needs of the current population of the home. The new Acting Manager should continue to monitor the care management and staff management systems within the home to make sure the care and support they need and require is provided. The information gathered through satisfaction surveys should be collated along with any other quality assurance information and published to reflect and show what people and their relatives and other visiting professionals say about the quality of services provided and also reflect any changes made to the way the home runs as a result of their comments. 4 14 5 18 6 27 7 31 8 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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