Broomfield Court Care Home Service 751 Broomfield Road Barmulloch Glasgow G21 3HQ Telephone: 0141 558 2020 Type of inspection: Unannounced Inspection completed on: 28 June 2017 Service provided by: Larchwood Care Homes (North) Limited Service provider number: SP2011011695 Care service number: CS2011301132
About the service we inspected Broomfield Court is situated in Barmulloch, north Glasgow, and has been registered with the Care Inspectorate since 2011. The service provides care and support to a maximum of 60 older people and has a specialised unit for people who have a diagnosis of dementia. The home is purpose-built and is designed on one level which makes it easy for residents to access different parts of the home. The residents have toilet/sink en-suite facilities in their bedrooms, with sufficient communal bathrooms and toilets across the home for residents' use. The home has several sitting rooms, conservatories, and dining areas. Residents and their families can see and access the garden area from the sitting rooms. How we inspected the service We compiled this report following an unannounced visit over two days, by two inspectors, from 27 June 2017. We gave feedback to the management team on 28 June 2017. During the inspection, we spoke to several residents in the two units of the home to find out their views about the care and support provided. We spent time observing how staff supported and interacted with residents. Directly observing care is an important way to help us judge whether a service complies with the regulations and meets the outcomes for people. We used the Short Observational Framework for Inspection (SOFI) to help gather information on the experience of people who were unable to tell us their views. We spoke with the home manager, nurses, senior care staff and care staff. We also spoke with the cook, activities coordinators and housekeeping staff. We looked at the service's improvement plan, care plans and key documents. Taking the views of people using the service into account Residents we spoke with said that the staff were kind. One resident told us 'the staff look after me when I'm not well.' Residents were complimentary about the meals and one person said 'the food is lovely; I like the cakes.' We saw that residents looked comfortable in the presence of staff and were able to move freely around the units. People we spoke with told us there a good range of activities in the home to keep them busy. Residents said they particularly liked going on trips out of the home. On the day of inspection, some residents were being supported to visit a local community lunch club and to attend an afternoon tea dance. page 2 of 15
Taking carers' views into account During the inspection visit there were no opportunities to speak with carers. We saw that the home had scheduled regular meetings for relatives to meet with the manager and take part in the development of the service. What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must make proper provision for the health, welfare and safety needs of service users in line with best practice, the principles of the National Care Standards, the codes of conduct of the Nursing and Midwifery Council and the codes of practice of the Scottish Social Services Council. In order to do this, they must ensure: - That all staff receive training regarding the care of people living with dementia including management of stress and distress reactions. - That the personal plans for all residents who can become distressed contain information regarding the management of their distress in line with the principles of the National Care Standards and best practice guidance from the Mental Welfare Commission. - That all staff are made aware of the need to maintain residents' dignity and adhere to the codes of conduct of the Nursing and Midwifery Council and the codes of practice of the Scottish Social Services Council regarding the use of written and verbal language. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). This requirement was made on 1 May 2017. Action taken on previous requirement The service was progressing well with the Promoting Excellence Framework for dementia learning and development. We saw that staff skills and knowledge about supporting residents living with dementia had improved. This was particularly evident when staff were supporting residents who were distressed. The service should continue with this training programme to support development with staff skills. We noted that staff demonstrated a better understanding of making sure they maintained residents' dignity when they were supporting them with care. page 3 of 15
We noted an improvement in the language and terminology staff used in their spoken and written communication. We sampled several personal plans for residents who could become distressed. We saw that the quality and detail of the information in the plans had improved. This provided clearer guidance for staff about how to help minimise distress for individual residents and specific strategies to support the person when they were distressed. Met - within timescales Requirement 2 The provider must put in place and implement systems which will ensure that the nutrition and hydration needs of those residents identified as being at risk of malnutrition or dehydration are being regularly assessed and adequately met. In order to do this, the provider must ensure the following: - There are sufficient snacks and drinks made available for all residents to meet their nutrition and hydration needs. - Prescribed dietary supplements are given as directed by the GP. - Staff have training to ensure they have the necessary skills to identify and support residents at risk of malnutrition and dehydration. - A review of the meal time experience for residents is undertaken. - Meal times are managed effectively including designated table/room management and closer attention to those residents who require prompting and supervision or direct physical assistance with eating and drinking. - Outcomes of food and fluid monitoring must be used to inform support with nutrition and hydration needs for individual residents. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). This requirement was made on 1 May 2017. Action taken on previous requirement There had been training for staff regarding the care and support of residents at risk of not eating and drinking enough to maintain their health. Staff told us that the training had helped improve their knowledge on how to best support these residents with eating and drinking. We saw that mealtime management had improved with staff being well deployed to support residents with eating and drinking. There was an improvement in team working during mealtimes and clearer guidance from the person in charge regarding staff duties. This resulted in an improvement of the experience for residents and made sure that residents were supported with their nutritional needs. page 4 of 15
We saw that between meals, residents had access to a range of drinks and snacks. There was evidence that residents were receiving the dietary supplements prescribed by the GP. This helped to maintain the weight of those residents who were at risk of losing weight. Some residents needed to have the amounts of what they ate and drank monitored for health reasons. We saw an improvement in the completion of these charts. This meant there was better information available to help staff plan day-to-day support for residents at risk of not eating of drinking enough. Met - within timescales Requirement 3 The provider must make proper provision for the health, welfare and safety needs of service users in line with best practice regarding the management of residents' continence needs and minimising risks of pressure ulcer development. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). Timescale for compliance: 23 June 2017. This requirement was made on 1 May 2017. Action taken on previous requirement We saw an improvement regarding the support of residents who needed full assistance with their continence needs. There was evidence that residents who were at risk of developing pressure ulcers were receiving appropriate care to minimise this risk. Met - within timescales Requirement 4 To safeguard vulnerable people and meet legal requirements, the provider must improve the reporting systems and procedures when incidents happen. In order to do this, they must: - Demonstrate practice is in line with legislation. - Provide training so that staff follow policy and best practice about reporting incidents aware of their legal responsibility in keeping accurate records and retaining records. - Ensure all staff are made aware of the provider's policies and procedures regarding Adult Support and Protection. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). Timescale for compliance: 23 June 2017. page 5 of 15
This requirement was made on 1 May 2017. Action taken on previous requirement We noted that staff had received training and one to one support to improve their awareness of the provider's policies and procedures regarding Adult Support and Protection. Staff we spoke with demonstrated an improved level of awareness regarding their responsibilities to maintain the safety of the vulnerable people they cared for. We looked at completed reports of accidents and incidents that had happened in the home. We noted an improvement in the information within the reports and details about the actions taken to minimise reoccurrence. There was a system to regularly audit the accidents and incidents in the home for patterns and trends. This helped to protect the safety of the people using the service. Met - within timescales Requirement 5 In order to make proper provision for the health, welfare and safety of service users, the provider must ensure that staff are subject to appropriate recruitment procedures and pre-employment checks. In particular, the provider must: - ensure appropriate references are in place to inform recruitment decisions about the employment of individuals in the care service - ensure applicants are interviewed by appropriate personnel in line with the best practice guidance from the Scottish Government - Safer Recruitment through Better Recruitment - fully evidence interviews of applicants and how decisions to employ them are made. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). Timescale for compliance: 23 June 2017. This requirement was made on 1 May 2017. Action taken on previous requirement We sampled recruitment information for two new members of staff recruited since the last inspection. We noted that the files contained sufficient information to establish that the service had followed best practice guidance regarding the safe recruitment of care staff. Appropriate pre-employment checks had been carried out to make sure that staff were safely recruited to protect the interests of the residents in the home. Met - within timescales Requirement 6 In order to make proper provision for the health, welfare and safety of service users, the provider must implement a system to ensure that regular checks of the validity of registration of staff are carried out. page 6 of 15
This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulation 4(1)(a). Timescale for compliance: 23 June 2017. This requirement was made on 1 May 2017. Action taken on previous requirement The service had implemented a new procedure to ensure that regular checks of the validity of registration of staff are carried out. This safeguards residents by making sure that staff have up to date registration appropriate to their role. Met - within timescales Requirement 7 The provider must make proper provision for the welfare and safety of service users to ensure a satisfactory quality of service is consistently provided. To help achieve this, they must fully implement a quality assurance system which includes but is not restricted to the following: - Use of internal audits to check key areas to ensure that policies and procedures are being followed, this should include but not be restricted to mealtime audits, monitoring and assessment of risks, analysis of accidents and incidents, staff development and practice and verification of Adults with Incapacity section 47 certificates. - That any issues found through the audit process are highlighted and an action plan made with timescales for any actions required taken to address those issues. This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210), Regulations 4(1)(a). This also takes into account National Care Standards for care homes for older people, Standard 5 - Management and staffing arrangements. Timescale: Within four weeks of receipt of this report the provider must send the Care Inspectorate details within an action plan specifying how they will meet this requirement. This requirement was made on 1 May 2017. page 7 of 15
Action taken on previous requirement The provider had implemented a range of audits to assess and monitor the quality of service provision. The manager of the service used the audit tools on a regular basis and developed action plans to address any issues identified. This helped to develop and improve the service. Examples of this included improvement in record keeping, development of the environment of the home and improvement in identifying training and development needs of staff. We saw that the outcomes for residents had improved through the use of the quality audits and action plans. This included improvements in the availability and quality of meaningful activities for residents to take part in and more pleasant mealtimes. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 To ensure safe administration of medication, the provider should ensure the following: - All handwritten entries in medication records are clearly written - All residents have an up to date photograph in the medication records for identification purposes. National Care Standards for care homes for older people: Standard 15 - Keeping well - medication. We looked at medication records and saw that there were photographs in place to identify residents. The handwritten entries for medication followed best practice guidance. This ensured that medication was being managed safely for residents. This recommendation had been implemented. Recommendation 2 The provider should further develop residents' personal plans to include details about individuals' preferences over all aspects of care and support National Care Standards for care homes for older people: Standard 6 - Support arrangements and Standard 19 - Support and care in death and dying. page 8 of 15
We sampled several personal plans. We saw that there was an improvement in the detail of information in the plans and that they were more reflective of individuals' preferences. The home planned to enhance the information further with individual life histories. This helped to guide staff to deliver care taking residents' wishes and preferences into consideration. This recommendation had been implemented. Recommendation 3 The provider should undertake to ensure that areas accessed by residents have appropriate signage to guide residents. National Care Standards for care homes for older people: Standard 4 - Your environment and Standard 5 - Management and staffing arrangements. We saw that the signage in one unit had improved, the other unit was being redecorated and signage was to be replaced to the same standard. There was an improvement in the signage to help guide residents and visitors around the home. This recommendation has been implemented. Recommendation 4 The provider should ensure that provision is made to carry out the health and safety checks throughout the year. This should include evidence that regular checks are carried out on the mini bus used to transport residents. National Care Standards for care homes for older people: Standard 4 - Your environment and Standard 5 - Management and staffing arrangements. We had asked that safety checks continue when the maintenance worker was on leave and not be missed. The service has appointed appropriately skilled staff to attend to this. There was evidence that regular checks were now being carried out on the safety of the mini bus used to transport residents. This recommendation has been implemented. Recommendation 5 The provider should ensure that records are kept to document the assessment and consent for the use of equipment which may restrain. This should be completed in line with best practice guidance from the Mental Welfare Commission for Scotland - Rights, risks and limits to freedom. page 9 of 15
National Care Standards for care homes for older people: Standard 5 - Management and staffing arrangements and Standard 9 - Feeling safe and secure. We saw that there were systems in place to assess the use of equipment that may be seen as restraining. The personal plans contained details regarding the use of this equipment for individual residents. However, the evidence of the consent for the use of the equipment was variable. There was a continued need to fully implement best practice guidance from the Mental Welfare Commission for Scotland - Rights, risks and limits to freedom to protect the rights of residents. This recommendation has not been fully implemented and will continue. We will monitor progress with this at the next inspection. Recommendation 6 The provider should review the format of recording accidents and incidents to ensure that all information about the follow-up of events is evidenced. There should be a review of the monthly audit of accidents and incidents within the home to ensure that an analysis of patterns and trends is carried out and follow-up actions are detailed. National Care Standards for care homes for older people: Standard 5 - Management and staffing and Standard 9 - Feeling safe and secure. The home had started to carry out audits of accidents and incidents for patterns and trends to inform action to minimise reoccurrence and improve safety for residents. We saw that the accident and incident records contained an improved level of detail. There was a continued need for the provider to review the form to assist staff with recording follow-up actions. This recommendation had not been fully implemented and will continue. We will monitor the review and implementation of an improved format for recording accidents and incidents at the next inspection. Recommendation 7 The provider should implement systems to ensure that therapeutic chairs used by residents are regularly cleaned and that the cleanliness of this equipment is maintained. National Care Standards for care homes for older people: Standard 4 - Your environment and Standard 5 - Management and staffing arrangements. page 10 of 15
We noted that the therapeutic chairs used by residents were cleaner than at the previous inspection. This should be seen as an important aspect of infection control in the service to protect residents. This recommendation has been implemented. Recommendation 8 The provider should continue to introduce a system to formally evaluate the training staff had undertaken and the impact it has on staff practice. National Care Standard for care homes for older people: Standard 5 - Management and staffing arrangements. There were informal methods used to observe staff practice. However, the development of staff practice and skills would be enhanced with a formal system to assess the impact training has on practice and the delivery of care and support of residents. This recommendation had not been fully implemented and will continue. We will monitor progress at the next inspection. Recommendation 9 The provider should ensure that staff have access to regular meaningful supervision sessions. National Care Standards for care homes for older people: Standard 5 - Management and staffing arrangements. We saw that there was a schedule in place to ensure that regular supervision for staff was planned. There were records of supervision sessions that had taken place. Staff confirmed that they had received regular supervision from senior staff and that they felt supported in their role. This recommendation has been implemented. Recommendation 10 The provider should ensure that staff are made aware of the need to manage information about residents in a confidential manner. National Care Standards for care homes for older people: Standard 5 - Management and staffing arrangements and Standard 10 - Exercising your rights. We observed an improvement regarding the way staff managed confidential information about residents. This helped to ensure that residents' privacy and dignity was being maintained. This recommendation had been implemented. page 11 of 15
Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 11 Apr 2017 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 27 Feb 2017 Re-grade Care and support 2 - Weak Management and leadership 2 - Weak 21 Dec 2016 Unannounced Care and support Management and leadership 24 May 2016 Unannounced Care and support Management and leadership 1 Dec 2015 Unannounced Care and support Management and leadership page 12 of 15
Date Type Gradings 8 Jun 2015 Unannounced Care and support 4 - Good 4 - Good 4 - Good Management and leadership 4 - Good 30 Oct 2014 Unannounced Care and support 4 - Good 4 - Good 5 - Very good Management and leadership 4 - Good 30 Apr 2014 Unannounced Care and support 4 - Good 4 - Good 4 - Good Management and leadership 4 - Good 23 Oct 2013 Unannounced Care and support Management and leadership 23 May 2013 Unannounced Care and support Management and leadership 9 Jan 2013 Unannounced Care and support Management and leadership 14 Sep 2012 Re-grade Care and support Management and leadership 27 Apr 2012 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory page 13 of 15
Date Type Gradings 23 Feb 2012 Unannounced Care and support 2 - Weak 2 - Weak 2 - Weak Management and leadership 2 - Weak page 14 of 15
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 15 of 15