CARE HOMES FOR OLDER PEOPLE
Blackburn Lodge LSC The Broadway Sheerness Kent ME12 1TS Lead Inspector
Graham Cummings Announced 13/09/05 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 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. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Blackburn Lodge LSC Address The Broadway, Sheerness, Kent, ME12 1TS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01795 667035 Kent County Council Registered Care Home 35 Category(ies) of Care Home for Older People registration, with number of places Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/10/04 Brief Description of the Service: Blackburn Lodge is a local authority Home which caters for older people needing residential care, the Home also provides recuperative care and there is a day centre on the premises. The service users are accommodated on the first floor of a Social Services building, with the manager’s office, the kitchen, the laundry, a day centre for 30 older people, some facilities used by occupational therapists and several care management offices occupying the ground floor. The premises are located on the seaward side of a busy main road in the centre of Sheerness, with transport and local amenities within walking distance. It provides 35 beds in 33 single and one double room. Eight beds are used by intermediate/recuperative service users. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Graham Cummings carried out the Announced Inspection on Tuesday 13th September 2005. The Inspector arrived at 09:20 and left at 15:00. The Inspector spoke with the Acting Manager Judy Thompson, 3 Residents and 3 staff, the Inspector toured the home and looked at the files of 3 Residents and staff. The Inspector went through the new report layout with the acting manager. A new Manager has been appointed and is due to start on the 1st of November 2005. Staff training was very good and the home has achieved over 50 of it’s staff achieving NVQ level 2. The Residents spoken to were all complimentary about the food and meals served with one Resident saying ‘the food is excellent’ another said ‘the food is good’. The Manager informed the Inspector that they purchase fresh meat, vegetables and fruit daily. The home was clean and well furnished. The majority of the Requirements from the last inspection have been addressed, the Inspector did find that in some of the daily notes the initials P/C were still being used to say personal care had been carried out it did not state what the personal care was, it appeared to be that this was being written by the same 2 staff members and not all staff. Staff files were difficult to fully inspect as a lot of information is held centrally, however on one of the newer employees it was noted that copies of the interview notes were on file. The Inspector noted that formal staff supervision is not carried out as stated in the standards. The staff spoken to were complimentary about the support they received from the acting manager and felt that she had done a good job of running the home, she was approachable and listened to their views. All of the staff were positive about the training they received, however, one staff said that the job was sometimes ‘frustrating’ when they were short staffed and could not spend as much time with the Residents as they would like, another said that they would like to spend more 1 – 1 time with the Residents but they did get a ‘good quality of life’. The home is registered for 35, at present there are 7 recuperative care beds, 1 enhanced care bed and 27 care beds, it is anticipated that the number of recuperative care beds may need to be increased in the near future. The Inspector left the home with no major concerns for the health, welfare or safety of the Residents. What the service does well:
The home provides a good service to the local community with good support and backup from Kent County Council. Staff training is good and centrally provided by the county. The home has fresh fruit, vegetables and meat delivered daily with cooks working 7 days a week. The rotas are adapted wherever possible to meet staff needs but only if Residents needs are not compromised in any way. Care plans are improved and further work is being carried out on them. The communication within the home is good, with the minutes of Seniors and Management meetings being put on the staff notice
Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 6 board, no items relating to individuals are included in this, there are handover sheets for seniors and staff so that the shift senior is fully informed of the situation within the home. What has improved since the last inspection? 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. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,6 Residents have a contract with the home. Residents needs are assessed prior to placement. Residents referred for intermediate care are helped to maximise their independence and return home. EVIDENCE: The Inspector spoke to the manager who informed the Inspector that the cost of staying at Blackburn Lodge was now in the Residents contract as a maximum cost they would pay, the Inspector looked at 3 Residents files and found that all had a cost in them. Prior to admission the home receives a care managers assessment and this is followed up by a home assessment visit by the Manager or suitably qualified person to ensure the home can meet the needs of the prospective resident, if all is agreeable then a care plan is formulated and the person admitted to the home, some residents or family visit the home prior to placement but not all. Blackburn Lodge has an intermediate care provision where Residents can stay for a maximum of 6 weeks, the home provides the main meal but it residents are encouraged to be as self sufficient as possible and make their breakfast and tea, there are 2 Occupational Therapists available to residents to help with the program of returning home.
Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Residents have their health, personal and social care set out in individual care plans. Residents health needs are met and where appropriate they are responsible for their own medication, residents are protected by the homes policies and procedures. EVIDENCE: All 3 of the care plans seen by the Inspector set out the individuals health, personal and social care needs. The Inspector found that there had been an improvement in the information available on the care plans, however, the information around how the plan was to be carried out and the proposed outcomes still required more detail. All of the Residents have been registered with a local G.P and the recuperative care residents, if they are local remain with their G.P, if they live out of the local area they are given temporary registration with a local doctor. Medication for the Residents who self medicate is kept in a locked cupboard in the Residents room, the medication is checked on a regular basis and a risk assessment is on file that has been signed by the care Manager, Resident, Team Leader and relative. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents find their lifestyle meets their needs. Residents are encouraged to maintain contact with their families. Residents are helped to exercise choice and control over their lives. Resident receive a wholesome and nutritious diet. EVIDENCE: All 3 of the Residents spoken with informed the Inspector that they were happy with their lives at Blackburn Lodge, one Resident told the Inspector that ‘the staff were very helpful’ another said that ‘they had all they needed’. The Manager told the Inspector that Residents family or friends were welcome to visit at any time, one Resident told the Inspector that they had received 3 visitors that morning. The Inspector was informed that 2 of the Residents attended church every Sunday, the monthly Salvation Army service on a Sunday was also available for those who wished to attend. The local Round Table also invite the Resident out to different activities or visits. The care plans are written with the input of the Resident wherever possible, other input is from the Care Manager and relatives if required, one of the care plans seen was signed by the resident. All 3 of the Residents spoken to said that the food they received was ‘really good’ one said that there was ‘always plenty of food’. The Manager informed the Inspector that they purchased their vegetables, fruit and meat fresh on a daily basis. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents and family are confident complaints will be listened to. Residents are protected from abuse. EVIDENCE: There have been no complaints received regarding the residential care of the Residents, there has been 1 complaint received from the day-care service, this was dealt within the appropriate time scales, a meeting was held with all concerned and agreements reached to all parties satisfaction. There were 3 responses from the Service User comment cards but nothing received from Relatives or Visitors to indicate there were any concerns or complaints. The Inspector was informed that new staff have attended Adult Protection training, 2 in January and 2 in May. The Commission has received no complaints since the last inspection. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26. Residents live in a safe and well maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Residents have access to sufficient and suitable lavatories and washing facilities. Residents have the specialist equipment they require to maximise independence. Residents rooms suit their needs and they live in safe, comfortable surroundings that are decorated with personal possessions where individuals require. The home is clean and hygienic. EVIDENCE: The home is well maintained and there is a general handyperson employed to carry out daily repairs and decoration when required, if the repair requires specialist expertise then this is brought in to carry out the required repair. The home does have access to a small garden area but the living accommodation is all on the first floor and access is gained via the stairs or lift. The home does have a balcony area with table and chairs that Residents can access on the first floor. The home has 4 bathrooms and 8 toilets, 1 shower and 1 en-suite room, all rooms have a wash hand basin, specialist equipment is available for Residents use that enables them to be as independent as possible, the
Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 13 manager has recently had a Parker bath made available to them and this is now in the process of being fitted and risk assessed. The Residents rooms were adequately furnished and although not all had soft comfortable chairs in them the Inspector was informed that where this occurred a written risk assessment was on the individuals file to say they did not require a soft chair, this was confirmed when the Inspector saw an individuals file and a risk assessment was in place. Residents rooms seen were personalised, some more than others, the Inspector was informed by the Manager that this was the Residents choice. The Inspector was shown a room that was unused at present but did have an unpleasant odour, the Manager confirmed that this room was not being used until the odour had been eliminated. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30. Residents needs are met by the numbers and skill mix of staff. Residents are supported and protected by the homes recruitment policies and practice. Staff are trained and competent to do their jobs. EVIDENCE: The home employs 29 care staff, 17 of them have achieved the NVQ level 2 qualification. Staff have access to appropriate training to carry out their care duties, over the last 6 months staff have had access to training in Manual Handling, Induction, HIV and AIDS, Fire protection, Infection Control, NVQ 2 and 3, and Adult Protection. The Manager informed the Inspector that training had been booked for Health and safety, Manual Handling Risk Assessment and First Aid. The Inspector looked at 3 staff files and was informed that some of the documentation is kept centrally at the HR office, the home, via the local authority does have a thorough recruitment procedure and the Inspector did see copies of interview notes on a new employees file as requested in the last inspection report. Staff spoken to were complimentary towards the manager and the running of the home, one member of staff said ‘we get could support from the manager and seniors’. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36,38 Residents live in a home that is competently managed and run in their best interest. Residents financial interests are safeguarded. Staff supervision needs to be carried out at regular intervals. The Residents health, safety and welfare are promoted and protected. EVIDENCE: The home is managed appropriately and in the best interests of the Residents and in line with the Statement of Purpose. The Inspector was informed that Residents finances procedure required 2 staff signatures for any transaction, this was usually the member of staff and an administrator, only one Resident kept there own credit card and cash point access, this was kept in a locked draw in the Residents room. The Manager and staff agreed that formal supervision is not carried out 6 weekly as required by the Care Homes Regulations, one staff member said ‘we may not get regular supervision but senior staff and managers are always available to advise and guide us’.
Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 2 x 3 Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 17 Are there any outstanding requirements from the last inspection? 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. 1. Standard 36 Regulation 18(2) Requirement The Registered person shall ensure that persons working at the care home are appropriately supervised - in that staff are supervised at least 6 times a year. Timescale for action 1st November 2005 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 29 Good Practice Recommendations That the home has all the documentation or copies of the origanal information required in Schedule 2 of the Care Homes Regulations 2001. Blackburn Lodge LSC H56-H05 S37875 Blackburn Lodge V240032 130905 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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