Inspection on 26/01/09 for Blyford Residential Home

This is the latest available inspection report for this service, carried out on 26th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blyford Residential Home 01/05/07

Blyford Residential Home 23/01/07

Blyford Residential Home 03/04/06

Blyford Residential Home 22/08/05

Blyford Residential Home 17/06/05

Blyford Residential Home 24/11/04

Blyford Residential Home 07/06/04

Blyford Residential Home 09/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

CARE HOMES FOR OLDER PEOPLE Blyford Residential Home 61 Blyford Road Lowestoft Suffolk NR32 4PZ Lead Inspector Julie Small Unannounced Inspection 26th January 2009 09:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blyford Residential Home Address 61 Blyford Road Lowestoft Suffolk NR32 4PZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01502 405420 01502 405429 sharon.hurren@socserv.suffolkcc.gov.uk Suffolk County Council Mrs Sharon Jane Hurren Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Foxfields House may accommodate persons of either sex, over 65 years who require care by reason of a diagnosis of dementia (not to exceed 12 persons). 2 Woodleigh House may accommodate persons of either sex, over 65 years who require care by reason of a diagnosis of dementia (not to exceed 11 persons). 3 The total number of service users accommodated in the home must not exceed 36 persons. 4th February 2008 2. 3. Date of last inspection Brief Description of the Service: Blyford is a residential home, which was purpose built and is owned by Suffolk County Council. It is situated in a quiet area of Lowestoft, to the north of the town. Although it is some distance from the town centre there are some shops and facilities nearby. The building is single storey and divided into three houses, Rosedene, Woodleigh and Foxfields. Each house offers accommodation for twelve residents in single rooms with en suite facilities. The houses all have their own front doors, lounges, dining areas and indoor conservatory space. The gardens are attractive, secure and accessible to the residents. There is a day care service within the same building, which the residents can attend if they choose. During the inspection the fees were from £391 to £709 per week. Following the inspection an e-mail was forwarded to us which stated that an increase in fees would be in place from 1st April 2009 and that they would range from £400 to £709. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced inspection took place Monday 26th January 2009 from 09:10 to 18:10. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present during the inspection. The manager and the staff that were spoken with provided the requested information promptly and in an open manner. Joyce Groves is an Expert by Experience. ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use social care services. The term ‘Experts by Experience’ is used to describe people whose knowledge about social care services comes directly from using them. The Expert by Experience joined the inspector on this site visit. They spoke with four people that lived at the home and made observations of the work practice in the home. The comments and observations made by the Expert by Experience are added to this report. During the inspection six staff recruitment records, staff training records, the care plans and needs assessments of three people that live at the home and accident records were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and five staff members, two visitors and four people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to CSCI (Commission for Social Care Inspection) within the required timescale. Staff, relative, health professional and service user surveys were sent to the home. Four staff, four relative, six service user and seven health professional surveys were returned to us. The health professional surveys had been completed by a GP, two social workers, a consultant psychiatrist and three visitors to the home that provided spiritual support to people that lived at the home. What the service does well: The interaction between the staff and the people that lived at the home was observed to be caring, respectful and professional. The Expert by Experience stated ‘I was impressed with all the interactions that I witnessed between staff and residents, some very short incidents, but all times were friendly, jolly, kind, engaging situations, some of them unaware of my presence, so it was Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 6 not something that was put on for my benefit, but the natural accepted behaviour’ and ‘I left at the end of my visit to Blyford Residential Home with an overall impression of a relaxed atmosphere of friendliness, kindness, warmth and engagement from the staff in their attention to the needs of the residents’. New staff were provided with regular probationary report meetings, which showed that the staff were supported in their roles and provided with opportunities to discuss the ways that they were working and raise issues. Checks were made on new staff to ensure that the people that lived at the home were safeguarded. People were provided with a clean and well maintained home to live in. The health and safety checks in the home, such as fire safety checks and electrical appliance checks, were regularly undertaken to ensure that people were safeguarded. The staff survey asked what the home did well and comments included ‘everything, nice home, good environment, clean, nice staff’, ‘Blyford gives a happy, friendly, homely atmosphere for residents and staff promoting privacy, choice, rights and independence and dignity which all together equal fulfilment for our residents, work together as a team from domestics/care to management’ and ‘medication has excelled and any errors (if any) are rectified and recorded appropriately in the monthly audit. Communicate well with staff, families, residents, health professionals etc’. The relative survey asked what the home did well and comments included ‘very homely and friendly atmosphere’ and ‘very well I have nothing but admiration how it has helped me’. The health professional survey asked what the home did well and comments included ‘care for people with dementia, carers respond well to crisis calls from the older peoples mental health team. Are flexible - always willing to change and consider new ways of working’, ‘Blyford is one of the very best care homes that I visit. They have successfully cared for some very complex cases’, ‘good communication, excellent care, tries to resolve issues before calling me’, ‘I consider the patients are well looked after by caring staff in comfortable and pleasant surroundings’ and ‘the care service takes into consideration the needs of each individual and is patient with all. Any of those who are cared for and that I know speak highly of their treatment by the staff and I know of no case where any has complained. The contentment of those cared for speaks volumes of the quality of the service received’. What has improved since the last inspection? The bathrooms in two of the units in the home had been refurbished and were more accessible to the people who lived in the home. The bathroom in the third unit was due to be refurbished. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 7 The introduction of ‘a day in the life of…’ and ‘a night in the life of…’ documents had been introduced into each person’s care plan. The documents provided information of the support and routines that each person required and preferred to meet their individual needs. Water coolers were provided in each unit, which made drinking water more readily available to the people that lived at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their needs are assessed prior to moving into the home. The home does not provide an intermediate care service. EVIDENCE: The Statement of Purpose was viewed and it was noted it had not been amended to show the recent changes in the home’s registration, which increased the numbers of people with dementia that lived in the home. The manager stated that they were aware of the need to address this, however they had contacted the CSCI registration team to state that Woodleigh accommodated twelve people and not the eleven which was on the new registration certificate. The manager stated as soon as the issue was resolved they would update the Statement of Purpose. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 10 The Statement of Purpose included information that people needed to enable them to make decisions about if the home was the right place for them. The document included details of the registered provider and the management structure in the home, the training and qualifications of the manager and the staff that worked at the home, details about the environment, the support that was provided to people that lived at the home and the complaints and compliments procedure. The Service User Guide was viewed and included details of the service that people could expect when living at the home, such as the roles of key workers, activities that were available, the fees for living at the home, the complaints and compliments procedure, CSCI contact details and details about the environment. The AQAA stated ‘A copy of Service User Guide is given to all customers along with a Blyford information leaflet’. Four service user surveys said that they had been provided with enough information about the home before they moved in so that they could decide if it was the right place for them and two said that they did not. The relative survey asked if they had been provided with enough information about the home to help them to make decisions. Three answered always and one answered usually. The records of three people that lived at the home were viewed and each held needs assessments that were undertaken by the placing authority and by the home’s senior staff. The records included details of their dementia diagnosis and the support that they required. The manager was spoken with and said that they undertook all assessments of prospective residents before they moved into the home and identified if the home was appropriate to meet their needs. They reported that information about the person was gained from the person, their relatives and other professionals who had been involved in their care. The AQAA stated ‘prospective service users are fully assessed prior to moving into the home and have a fully informed choice about where they wish to live. Admission does not take place without the home receiving a Community Care Assessment of need and the home completes their assessment. Assessments are completed to ensure that the home is able to meet the needs of the prospective service user and visits are arranged to the home prior to admission when appropriate to enable them and their families to see where they will be living and meet other residents and staff’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their needs are set out in an individual plan of care, that their health needs are met, to be are treated with respect and to be protected by the home’s medication procedures. EVIDENCE: The care plans of three people that lived at the home were viewed and they included the details of the support that they required to meet their assessed needs and how the needs of people with dementia were to be met. The care plans were updated to reflect people’s changing needs and preferences and the people that lived at the home and their relatives were consulted about the support that they were provided with in regular review meetings. A staff member showed us a document template, which they were planning to introduce into the care plans, which identified the preferences and the life history of people with dementia, when they could not communicate them to staff. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 12 Since the last inspection ‘a day in the life of…’ and ‘a night in the life of…’ documents had been included in the care plans, which showed the support that people needed and preferred on a daily basis to meet their needs. The AQAA stated ‘each resident has a ‘day in the life of’ and a ‘night in the life of’ document which is included in their comprehensive care plan which assists staff to give a quick ‘pen picture’ of the resident’s normal routine’. Each care plan held a ‘spider chart’ which summarised their needs and preferences, such as what they liked and disliked to eat, their preferred form of address and if they wore dentures and/or spectacles. One care plan of a person that had recently moved into the home did not identify the details about their diverse needs, such as the ways that staff could communicate with them and details of their religious observance. Details of their dietary requirements were included in the care plan. Three staff members and the manager were spoken with about how the person was supported. The staff members explained that they had asked the person’s relatives on several occasions to provide further information, which had been partially provided. However, the staff explained how they had observed the person in the time that they had lived at the home and it was noted that they had gathered a large amount of information about the person’s needs which had not been included in the care plan. The staff could explain areas of good practice, which showed that the person’s needs had been met. The manager agreed that the information of the person’s diverse needs would be included in the care plan straight away to ensure that all staff were made aware of how their needs were to be met. The relative survey asked if the home met the needs of different people. Three answered always and one answered usually. The health professional survey asked if the different needs of people were responded to. Five answered always, two answered usually and comments included ‘home is exploring use of interpreters as required and different diets’ and ‘I have never witnessed any bias from any member of the care service on grounds of ethnicity, age etc. All are treated with impartiality and fairness in respect of faith, there are other services conducted by a variety of different churches and I believe a number attend more than one. This shows the desire on the part of the care service to cater for all and that it has no bias’. The AQAA stated ‘customers have a care plan in place, which includes details about their health and personal care needs and how much help and assistance they require. Each permanent resident has a key worker, whose responsibility is to check that the individuals care plan monthly. All services offered aim to promote independence in health and personal care’. The service user surveys asked if they received the care and support they needed. Five answered always and one answered sometimes. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 13 The relative survey asked if the home met the needs of their relative. Four answered always and one commented ‘lovely happy carers can’t do enough for you’. The survey asked if the home provided the support that they expected or agreed. Three answered always and one answered usually. Four staff surveys said that they were always given up to date information about the needs of the people that they supported. The survey asked if the ways that they passed on information about people who lived at the home worked well. Two answered always and two answered usually. Risk assessments were present in the people’s records that were viewed that included fire evacuation, using a wheelchair and manual handling. The risk assessments identified the assessed risks and methods of minimising the risks in people’s daily living. The care plans and daily records that were viewed detailed the healthcare support that people had been provided with such as, such as visits from the district nurse, chiropodist and doctor. People’s records that were viewed each contained a record of falls, summary of their personal history, dietary requirements, record of family visits, activities which they had participated in, continence management, behaviour incidents which were different form their usual behaviour, weight checks and nutritional screening. The records of one person showed that had lost a significant amount of weight over a period of four months. However, their assessment records that were viewed showed that they had actually gained weight since moving into the home. The manager was shown the records and they stated that it appeared that the earlier weight records might have been recorded incorrectly. They stated that they would check that the scales were accurate and that they would speak to the staff to ensure that all records were accurate. The records of the other two people that were viewed did not show that there was significant weight loss or gain. The AQAA stated ‘residents are weighed monthly and this is recorded on the care plan along with a nutritional assessment. Specialist advice is sought if concerns are raised around weight loss or gain’. The service user survey asked if they received the medical support that they needed. Five answered always and one answered sometimes. The health professional survey asked if staff at the home sought advice and acted upon it to manage and improve people’s health care needs. Six answered always and comments included ‘the staff regularly contact the consultant psychiatrist and community psychiatric nurses when they need advice’ and ‘staff contact GPs and older persons mental health service as necessary, they also liaise with home treatment teams proactively’. The survey asked if the health care needs of people that lived at the home were met. Six answered always and one answered usually and commented ‘the only reason I Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 14 have not ticked always is the fact that some individual’s care are unmeetable in any care situations! However Blyford has always been very flexible and responsive to individuals needs’. The survey asked if the care staff had the right skills and experience to support people’s social and health care needs. Six answered always, one answered usually and one commented ‘training provided, additional staff called in to provide one to one support to unsettled residents as necessary’. The AQAA stated ‘the home has excellent working relationships with health care professionals. District nurses attend regularly and support the home in prevention/reduction of pressure areas by providing advice and specialised equipment, which is recorded on the residents care plan. The specialist advice is also called upon from the psychiatrist and CPN when necessary, as the home has a number of residents with dementia or other recurring mental health problems’. The home’s medication procedures and processes safeguarded people. Two staff members were observed making the monthly medication orders. They explained the procedure for ordering the medication and they were observed to count the remaining medication to ensure that it matched with the MAR (medication administration records) charts. Part of the lunch time medication administration was observed and a staff member explained the procedures for the safe administration of medication. Staff were observed to ask residents if they wished to take their medication, which was placed from the packaging into small pots. The staff member signed the MAR charts, when medication had been taken. The MAR charts were viewed and it was noted that there were no unexplained gaps. The medication was stored in secure trolleys in MDS (monitored dosage system) blister packs or in the original packaging. Stocks of medication were stored in secure cabinets in the medication room. There was a refrigerator where medication that needed to be refrigerated was stored. The records of regular temperature checks were viewed to ensure that the medication was stored at the correct temperature. The records of regular medication audits were viewed, which were regularly undertaken by senior staff. At the hand over of each shift the senior staff checked the medication records. Staff training records were viewed and evidenced that staff were provided with medication training and Skills for Care medication knowledge sets. The AQAA stated ‘staff who handle medication have all completed in-house training in accordance with Suffolk County Councils medication policy and procedures. New staff will also complete the Skills for Care knowledge set on medication before taking on this responsibility. The senior team leader ensures all procedures adhere to the relevant legislation i.e. the Medicine Act, the Misuse of Drugs Act 1971 etc. and she is responsible for in-house training’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 15 The health professional survey asked if the home supported individuals to administer their own medication or manage it correctly when this is not possible. Four answered always, one answered sometimes and two did not answer. Comments included ‘my customers would not be able to administer their own medication but to the best of my knowledge they ensure that the customers receive their correct medication and administer it correctly’ and ‘most of my patients at the home have Alzheimers disease and are not capable of administering their own medication’. The privacy and dignity of the people that lived at the home was respected. All bedrooms in the home were of single occupancy. During the inspection staff were observed to knock on bedroom and bathroom doors and they waited to be invited in before entering them. Two staff members were observed supporting a person to show a visiting health professional to their bedroom to ensure that they were examined in the privacy of their own room. Interaction between staff and people that lived in the home was observed to be respectful and professional. Staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks and if they were comfortable. People that were spoken with confirmed that the staff treated them with respect. The Expert by Experience reported ‘I was impressed with all the interactions that I witnessed between staff and residents, some very short incidents, but all times were friendly, jolly, kind, engaging situations, some of them unaware of my presence, so it was not something that was put on for my benefit, but the natural accepted behaviour’ and ‘I was impressed by the smooth, cheerful, respectful interaction between (the person) and the staff member, they were completely at ease with each other’. The health professional survey asked if the home respected individual’s privacy and dignity. Six answered always and one answered usually. Comments included ‘staff are always observant and treat residents as individuals’, ‘own room, knock before entering etc.’ and ‘yes the staff always treat the residents with dignity’. The AQAA stated ‘privacy and dignity are respected throughout and is part of the ethos of the home. Questions pertaining to this are part of the recruitment process, Common Induction Standards sessions/paperwork and shadow shifts. Residents and customers have easy access to a telephone and some may have one in their room at their request. Medical examination and treatment are provided in the residents bedroom and staff will remind health professionals of this if need be. On admission, the resident is asked their preferred term of address and this is recorded on the care plan. All rooms are single and have en-suite toilet and wash basin. The Home’s Manager is a Dignity Champion and the senior team are encouraged to do this also’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 16 It was noted that the people that lived at the home were clean and tidy, which showed that the staff had supported people with their personal care to a good standard, which maintained their dignity. The Expert by Experience reported ‘the person) was beautifully coiffured and groomed (the member of staff with (the person) had told me that hairdressing and manicure was readily available)’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to be provided with activities, which are of interest to them, to be supported in maintaining contacts, to be supported to exercise control over their lives and to be provided with a healthy and balanced diet. EVIDENCE: People were provided with the opportunity to participate in activities that were of interest to them. The care plans of three people that lived at the home were viewed and they included a record of what activities they had participated in. The activities included watching a DVD film, completing puzzles, singing, bingo, quizzes, listening to music, religious services and memory and reminiscence activities. The care plans detailed people’s individual interests. People’s spiritual needs were observed by religious services held in the home from various denominations in the Lowestoft area, such as Christian and Catholic. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 18 In each unit in the home there was a notice posted on the wall which showed what activities were available each day. During the inspection people were observed undertaking various activities, which included reading a newspaper, watching television, listening to music and chatting to staff and each other. The Expert by Experience stated ‘I had seen a nearby resident with that days Daily Express’ ‘(the person) said that (the person) watched a lot of TV. I tried to discover whether (the person) was able to take part in any entertainments provided by the home, but (the person) could not understand what I was asking, and at this point a very pleasant member of staff, who had overheard the difficulty I was having in explaining what I meant, came over and told me about all the various activities that did take place on a weekly basis, mostly in the afternoons, immediately after lunch. (The staff member) reminded (the person) that the previous afternoon a volunteer had come in with (the volunteer) collection of records and had played them to the residents for about one and a half hours, and how many of the residents had enjoyed it, although of course (staff member) recognised that the music was not to everyone’s taste’. The Expert by Experience reported ‘…during this conversation that another young member of staff knocked on the door and came into the room carrying a volume entitled WW11, and with great excitement showed me a photograph of (the person) with a group of Lowestoft lads as a soldier in Berlin. It was (the person’s) book, and (the person) had given it to the staff member to show the picture to another resident, and (staff member) was returning it to (the person). The fact that I was present to witness this small episode was entirely accidental, but it showed me how engaged the staff were with (the person), joining in with (the person) happiness and excitement with warm and good humour’. The manager was spoken with and stated that there was an activities coordinator in the home that provided activities each day after lunch. They also reported that a volunteer attended the home on a weekly basis and provided a music club for people to participate in if they chose to. Since the last inspection pet rabbits and guinea pigs had been purchased. The manager explained that they had been purchased at the request of people that lived at the home and that they had competitions to name the pets. People that lived at the home had volunteered to help to care for the pets. A person was spoken with and stated that they loved the rabbits and explained how they looked after them. People said that they had plenty to keep them busy, that staff in the home listened to them and that they felt that their choices were respected. The service user survey asked if there were activities that they could take part in at the home. One answered always, three answered usually and two answered Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 19 sometimes. Five service user surveys stated that the staff listened to them and acted upon what they said and one said that they did not. The AQAA stated ‘the residents can attend the day centre activities and entertainments if they wish. Clothes, jewellery and shoe sales now take place on a regular basis, so residents can make their own choices if unable to visit shops in the community. Entertainment is also offered on the units. Regular fund raising events and activities take place all the year round’. The minutes of a recent home meeting were viewed, where the people that lived at the home were provided with information about the home and the opportunity to discuss their choices in areas such as meals and activities. Records of people’s review meetings, which included the person and their relatives, which showed that they were consulted with regarding the care that they were provided with. The health professional survey asked if the home supported individuals to live the life they chose. Four answered always, three answered usually and comments included ‘customers are given person centred care, unfortunately due to their deteriorating mental health it is not always possible for them to live the life they choose but staff help them to accept it as second best’ and ‘recently set up an enclosed garden to allow someone who smokes to do so as they wish without risk of wandering onto the main road’. The relative survey asked if the home supported people to live the life they chose. Two answered always and two answered usually. The care plans of three people that lived at the home that were viewed included the details of the contacts with their relatives and friends that people maintained. Two relatives of a person that lived in the home were spoken with and stated that they were always made welcome at the home and that they were kept informed of any changes to their relative’s condition. The Expert by Experience reported ‘(the person) said that (the person) family visited and sometimes took (the person) out in the wheelchair in good weather. Did (the person) family visit often? “Oh yes! They come frequently; I am expecting someone later today”.’ Three relative surveys stated that the staff at the home always helped their relative to keep in touch with them and one did not respond to the question. The survey asked if the staff at the home kept them up to date with important issues affecting their relative. Three answered always and one answered usually. The AQAA stated ‘visitors are welcomed to the home (if the resident so wishes). Residents can receive visitors privately in their room or in one of the many sitting areas throughout the home’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 20 People were provided with a well balanced diet. People that lived at the home that were spoken with said that they were provided with a good diet and there was sufficient food. Staff were observed to provide people with their choices of hot and cold drinks throughout the day. Since the last inspection water coolers had been provided in each of the home’s units, which ensured that people could help themselves to cold drinking water as they wished. A staff member was observed to help a person to use the cooler after they had asked for a drink. The service user survey asked if they liked the meals at the home. Two answered always, two answered usually, one answered sometimes and one answered never and commented ‘I don’t like the food I would prefer to cook the food myself’. The care plans that were viewed included people’s likes and dislikes regarding food and any specific dietary requirements that they had. The menus were viewed and provided a healthy, varied and balanced diet. There were three choices for each meal, including a vegetarian option. There was a supplementary menu, including salads, jacket potatoes and sandwiches, which people could choose if they did not want what was offered on the main menu. The cook showed us the notes that they were provided with on a daily basis, which showed the meals that each person had chosen for that day. The Expert by Experience reported ‘I had seen the menu for lunch that day and there were three choices of first course’. One person had told the Expert by Experience that there was no choice of meals. The Expert by Experience reported an observed incident of good practice, which showed that people’s choices were respected. ‘(The person) was having a late breakfast -11.30am when I encountered (the person) at the table, just finishing a bowl of grapefruit’, ‘a young member of staff came by and apologised for keeping (the person) waiting for (the person) cup of coffee, but (staff) had been delayed’ and ‘when I asked (staff) about the timing of breakfast (staff) explained that (the person) did not like getting up early, but this morning (the person) was later than normal, and so (the person) had just had grapefruit, instead of (the person) normal Porridge and other things, because it was so near to lunchtime, served at 12.30pm. Again I was impressed by the smooth, cheerful, respectful interaction between (the person) and the staff member, they were completely at ease with each other’. The AQAA stated ‘the menus offer great choice to the residents and they are regularly consulted The diet is suited to each individuals requirements i.e. soft, diabetic, low fat, high protein etc. Meals offered are breakfast, lunch, tea and supper as well as coffee/tea, juice and squash’. Records were viewed, which were maintained by the kitchen staff at the home showed that safe and hygienic procedures were routinely undertaken, such as fridge, freezer and probed food temperatures. The home used the ‘safer food Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 21 better business’ log book in the kitchen, which showed when the kitchen had been cleaned. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their complaints are acted upon and to be protected from abuse. EVIDENCE: The home’s complaints procedure was viewed and clearly explained how people could make a complaint if they were unhappy with the service that they were provided with. People that lived at the home and visitors to the home were provided with details how they could raise complaints, compliments and concerns in the Service User’s Guide and the Statement of Purpose. The complaints, compliments and comments book was viewed. There were several compliments received from visitors to the home, people that lived at the home and their relatives. The records of complaints and concerns included clear details of how the issues were resolved and support provided to the person that had raised the concerns. There had been no formal complaints made since the last key inspection. Four staff surveys said that they knew what to do if a person had concerns about the home. Five service user surveys said that they always knew who to speak to if they were not happy and one said that they did not. Five service user surveys said that they knew how to make a complaint and one said that Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 23 they did not and one stated ‘I don’t have any complaints’. Four relative surveys stated that they knew how to make a complaint and three said that their concerns were always responded to appropriately and one did not answer. Seven health professional surveys stated that concerns were always responded to appropriately. The AQAA stated ‘residents are encouraged to make comments/complaints and compliments so that the home can continue to improve the standard of care given. Suffolk County Council policies and procedures are followed and a Complaints, Comments and Compliments book kept in the team leaders office. All are recorded and how the complaint was investigated, dealt with, action taken and by whom’ and ‘each complaint is taken seriously and documented. During regulation 26 visits the resident has the opportunity to make comments or complaints to an independent person from outside the home’. Staff were informed of their responsibilities in safeguarding people who lived at the home in training, in the local authority safeguarding guidelines and in the home’s detailed safeguarding procedure. Training records that were viewed showed that staff were provided with safeguarding training. Staff spoken with were aware of their roles and responsibilities in the safeguarding of people that lived at the home. The manager had informed us of one safeguarding referral that they had made, which showed that they were aware of the local authority procedures for safeguarding. The AQAA stated ‘all staff have training in Safeguarding Adults and No Secrets as part of their induction and annual refreshers. Suffolk County Council has a whistleblowers policy and all staff are made aware and are fully supported if an incident occurs. Staff are aware of when incidents need external input and who to refer the incident to’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to be provided with a safe, well maintained, clean and hygienic environment to live in. EVIDENCE: The home was clean and well maintained. The communal areas were clean and attractively furnished. The grounds were attractive and well maintained and were available for people’s use. There were no offensive odours in the home. A staff member and the manager explained the plans that they had to ensure that the environment was accessible to people with dementia. They showed us signs that had been developed for toilet and bathroom doors. Each bedroom door held a sign with the person’s name on it, the staff member stated that Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 25 these would be changed to include something that each person would recognise, such as a picture of something that they enjoyed, to ensure that they could identify their bedroom doors. People that lived at the home and visitors to the home that were spoken with stated that the home was clean, comfortable and that it was always warm enough. The service user survey asked if the home was fresh and clean. Three answered always, two answered usually and one answered never and commented ‘it could be cleaner’. A comment made in a relative survey was ‘very homely and friendly atmosphere’. A comment made in a health professional survey was ‘I consider the patients are well looked after by caring staff in comfortable and pleasant surroundings’. The AQAA stated ‘the home strives to provide a homely atmosphere and residents encouraged to bring their own items to have around them. All residents are encouraged to help carry out domestic tasks in the home if they so wish e.g watering plants, washing and wiping up’. The AQAA stated that the imropvements made in the last twelve months were ‘replaced carpet in four lounge areas to alleviate the smell of urine and we have re-decorated four bedrooms, planted flowers outside in the garden and worked on the internal planting in the conservatory. Replaced curtains in the foyer and gazebo areas’. At the time of the inspection a programme to modernise and refurbish the communal bathrooms was underway. The communal bathrooms in two of the home’s units had been refurbished to make them more accessible to people and work was due to be undertaken on the remaining bathroom. A staff member that was spoken with stated that there had been no problems when the work was being done, they said that there was sufficient bathrooms in the home to ensure that people’s personal care was maintained. Two staff members were spoken with and they reported that the refurbished bathrooms were much better for supporting people with their personal care. The bathrooms were large and spacious and each provided an assisted bath and a walk in shower. The AQAA stated ‘each room is single occupancy and has toilet and wash basin en-suite’. Maintenance records that were viewed showed that repairs were undertaken in a timely manner, to ensure that people were provided with a safe and well maintained environment to live in. The laundry was viewed and the laundry staff member was spoken with. There were two industrial and one domestic washing machine, and there were drying facilities such as two drying machines and outside washing lines. The laundry was clean and tidy and hand washing facilities were provided for people who used the laundry to minimise cross infection. A staff member that was spoken with clearly explained the infection control processes in the laundry to ensure that cross infection was minimised. They stated that people’s clothing was Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 26 labelled with their names to ensure that they were provided with their own clothing. The AQAA stated ‘we have recruited three new domestic assistants and three kitchen assistants that have been able to highlight some additional cleaning in the units’. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and laundry. Staff were supported to complete Skills for Care infection control knowledge sets, which included the completion of work books and had recently been provided with training on hand washing. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to have their needs met by staff that are trained to do their jobs and to be protected by the home’s recruitment procedures. EVIDENCE: During the inspection there were two staff working on each of the home’s units and there were three team leaders on duty. The rota was viewed and it showed that the home was adequately staffed twenty four hours each day. During the night there was one waking night staff on each unit and one team leader. The manager reported that there were two ‘floating’ staff, who assisted in the units as required. The manager said that there was one staff vacancy, that six staff had been recruited in the last six months. Staff spoken with said that there was sufficient staffing at the home. The staff survey asked if there were sufficient staff to meet people’s needs. Two answered always and two answered usually. The service user survey asked if staff were available when they needed them. Four answered always, one answered usually and one answered sometimes. One relative survey stated ‘lovely happy carers cant do enough for you’. One health professional survey stated ‘any of those who are cared for and that I know speak highly of their Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 28 treatment by the staff and I know of no case where any has complained. The contentment of those cared for speaks volumes of the quality of the service received’. The AQAA stated ‘the home has a very committed staff in all teams, who on the whole, work in a flexible and positive manner’. The Expert by Experience stated ‘I left at the end of my visit to Blyford Residential Home with an overall impression of a relaxed atmosphere of friendliness, kindness, warmth and engagement from the staff in their attention to the needs of the residents’. The recruitment records of five staff members were viewed and they held evidence that the required checks had been made to ensure that people were safeguarded by the home’s recruitment procedures and processes. The recruitment records included CRB (Criminal Records Bureau) checks, their work history that was included in application forms, forms of identification, terms and conditions of employment and two written references. The records included probationary reports for newly recruited staff, which showed that their strengths in their work practice and areas that further support or training was required. Four staff surveys stated that their employer carried out checks, such as CRB and references, before they started work. The AQAA stated ‘the home operates a thorough recruitment procedure’. Staff training records viewed evidenced that newly appointed staff were provided with an induction, which included the Skills for Care Common Induction Standards. The AQAA stated ‘new residential carers receive training to support and complete the Common Induction Standards, manual handling training, ongoing inhouse training and regular staff meetings and supervision and Skills for Care’. The staff survey asked if their induction covered everything they needed to know to do the job when they started and four answered very well, one commented ‘3 days induction, 2 days manual handling, hand washing training’. A newly recruited staff member was spoken with and they stated that they had completed their NVQ (National Vocational Qualification) in their previous employment and that they were waiting for the date of their induction training course. They stated that they were supported in their role and had been provided with probation meetings and supervisions meetings with senior staff, which provided them with the opportunity to discuss the ways that they worked. Staff records that were viewed showed that staff were provided with regular supervision meetings. The minutes for recent team meetings were viewed and showed that staff were advised of their roles and responsibilities and they were provided with the opportunity to discuss issues. The training records were viewed, which included training certificates in staff records and a training matrix. It was noted that staff were provided with the Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 29 training that they needed to enable them to do their jobs and to meet people’s needs. Training included safeguarding, manual handling, Unisafe, medication, food hygiene, fire safety, health and safety, first aid and dementia. Staff were also supported to undertake Skills for care knowledge sets, which included infection control, medication and dementia. Staff spoken with confirmed that they had received sufficient training at the home to support them in their work role. Four staff surveys said that they were provided with training which was relevant to their role, helped them to understand and meet the needs of individual people and that kept them up to date with new ways of working. Comments included ‘I feel the training opportunities at Blyford are very good, I am given the opportunity to apply for training’ and ‘I ensure that my training is up to date and also that of other staff members. I am able to access training that develops and promotes my role. I am willing to take on extra tasks and responsibilities’. The AQAA stated ‘90 of staff trained at NVQ level 2. All team leaders have now gained NVQ level 3 except one who is working towards this goal and the senior team leader undertaking level 4. Kitchen assistant completed NVQ level 2 in catering and the assistant cook has completed NVQ level 2’. The trainng matrix that was viewed confirmed the NVQ achievement of staff in the home, which showed that they had been assessed as competent in their work roles. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to live in a home that is managed by a person who is fit to be in charge, that the home is run in their best interests and that their health, safety and welfare is protected. EVIDENCE: The manager had achieved the qualifications that were required for their job and they had regularly updated their knowledge to ensure that they were aware of their roles and responsibilities in managing the home. The AQAA stated ‘the manager has qualifications as follows: NVQ Level 4 in Care, Diploma in Management in Care Services, Honours Degree in Community Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 31 Studies, currently studying ILM Level 5 and is also a qualified Dementia Care Mapper. Three members of Staff, including the Manager, are about to start NVQ Level 2 in Infection Control. The Manager is a Risk Assessor and has attended training on variety of subjects including, Changes in Culture for Dementia Care, Dignity, MCA (Mental Capacity Act) & DOLS (Deprivation of Liberty) and Infection Control’. The manager’s qualifications and training were confirmed in the home’s Statement of Purpose and in discussion with the manager. They had been successful in their registered manager application with CSCI. The manager reported that they received regular support in their role. The AQAA stated ‘the manager promotes a positive and open atmosphere for residents, staff and relatives maintaining good links with the community and partnership working with other professionals. The home deals positively but realistically with the changing needs of customers and residents’. Staff that were spoken with reported that the manager was approachable and fair. It was noted that the manager kept us informed of any issues within the home. The records of people that lived at the home that were viewed held minutes of review meetings, where the people and their relatives were consulted with regarding the support that they were provided with. The minutes of recent house meetings were viewed, which showed that people were provided with the opportunity to make choices about the support that they were provided with, such as with food and activities. Regulation 26 visit reports were viewed and were undertaken on a monthly basis. During the Regulation 26 visits people that lived at the home were spoken with regarding their satisfaction with the service that they were provided with. Previous inspection reports identified that the safeguarding of people’s financial interests was positive. There were clear records of the balance of the individual’s finances and records of ingoing and outgoing money. The AQAA stated ‘the home has robust procedures for handling and safe keeping and access to residents finances following Suffolk County Councils procedures’. Staff records that were viewed showed that staff were provided with regular supervision meetings and team meetings. The minutes for recent team meetings were viewed and showed that staff were advised of their roles and responsibilities and they were provided with the opportunity to discuss issues. Four staff surveys stated that the manager met with them to provide support and discuss the ways that they were working and comments included ‘we can ask to meet with Sharon the manager if we need to, but we have regular supervision with our team leaders who support us and we can discuss work’ and ‘ we have regular team meetings and supervision we discuss issues as and when required’. The AQAA stated ‘staff have regular supervision and staff meetings’. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 32 People’s health and safety was protected. Health and safety records were viewed and evidenced that regular safety checks were routinely made, such as water temperature, legionella, fridge and freezer temperatures, food temperatures and electrical appliance safety. Fire safety records were viewed and evidenced that regular checks were undertaken. The home had a fire risk assessment and the records of people that lived at the home that were viewed, held a fire risk assessment, which identified methods of supporting the person if there was need for evacuation of the home. There were fire safety notices posted around the home, which provided information of actions to take in case of a fire emergency to staff, visitors and people that lived at the home. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling, COSHH (control of substances hazardous to health) and infection control. The manager and a staff member were spoken with and they reported that all senior staff had undertaken appointed first aid training and that there was always a staff member on duty who were trained, which ensured that peole were safeguarded. Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans are developed further to include specific details of people’s divers needs Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blyford Residential Home DS0000037146.V373960.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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