Inspection on 26/01/06 for Blackdown Nursing Home

This inspection was carried out on 26th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Blackdown Nursing Home 16/12/08

Blackdown Nursing Home 05/06/07

Blackdown Nursing Home 10/05/06

Blackdown Nursing Home 14/09/05

Blackdown Nursing Home 19/10/04

Blackdown Nursing Home 28/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Blackdown Nursing Home Blackdown Mary Tavy Nr Tavistock Devon PL19 9QB Lead Inspector Doug Endean Unannounced Inspection 11:00 26 January 2006 th 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 Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 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. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Blackdown Nursing Home Address Blackdown Mary Tavy Nr Tavistock Devon PL19 9QB 01822 810249 01822 810249 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) Whitchurch Care Ltd. Mrs Maureen Seabrook Care Home 33 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (19), Old age, not falling within any other category (3), Physical disability over 65 years of age (33) Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Registered for max 3 OP Registered for Max 33 PD(E) Service users 65 years and over Registered for max 19 DE(E) service users 65 years and over Registered for max 19 MD(E) service users 65 years and over Date of last inspection 14th September 2005 Brief Description of the Service: Blackdown Nursing Home is a care home that is registered to provide nursing care to a maximum of 33 Service Users male or female, over the age of 65. A maximum of 26 beds may be provided to Service Users who have been assessed as having general nursing needs and a maximum of 19 Service Users who have been assessed as having mental health nursing needs. It is also registered for up to 3 Service Users who have personal care needs only. The manager is a level one trained nurse who heads up the team of other registered nurses that include a Registered Mental Health Nurse, Social Care staff and ancillary staff. Collectively they are able to deal with the various care needs of the current Service User group. Blackdown Nursing Home is arranged on two floors with access to the first floor via a stair lift. A shaft lift is in the process of being built. There are 3 communal areas within the home with an additional conservatory planned. The unit designed for the 19 elderly Service Users with mental health needs (Sunflower) is secured for the protection of the Service Users and benefits from a large day room and extensive views over mainly rural land to Dartmoor. There are large, accessible gardens surrounding the home with some paved areas provided with seating. The home is situated on the edge of Dartmoor in the village of Mary Tavy where there are a number of local amenities. There is the evidence of ongoing building work on the outside of the home. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read along side of the previous report in order to establish the homes performance against the National Minimum Standards during this inspection year. This un-announced inspection began at approximately 11.00 hours and lasted for 3 hours and 15 minutes. The inspector concentrated on the core standards that had not been commented upon in the last inspection. In addition other standards were inspected where issues arose as a result of observations that were made during the tour of the home. The inspector spoke to three staff in total, three clients and met one relative who was visiting during the inspection. The homes policies and procedures were looked at, a sample of two clients records were read, training and maintenance information was also looked at to verify information. In the absence of the Registered Manager who was off duty the staff files were not reviewed on this occasion. What the service does well: What has improved since the last inspection? What they could do better: The internal environment has suffered as a result of what has been very slow progress with planned building work. It appears that the development of one area has a detrimental effect on another such as the building of the conservatory causing problems for the ground floor toilet and bathroom. Better planning and an improved pace is needed. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 6 The other result of the delays is that areas such as the two lounges are now in need of some aesthetic upgrading that would have occurred if the building work had been completed. The exterior of the home has also been damaged by the building work but there are areas that can be used without disturbance once the weather improves. 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. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 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 the following standard(s): 1&2 The Statement of Purpose provides enough information for the reader to make an informed choice regarding admission to the home. The homes contract/terms and conditions of residency is not satisfactory and needs to be updated. EVIDENCE: There is a Statement of Purpose/Service Users Guide at the home that is available to anyone who wishes to see it. It is complimented by the homes “Welcome Brochure” that is also available. These documents collectively meet the required standard having such things as details of the qualifications and experience of the Registered Persons and the Registered Manager as well as information about the services available at the home for the clients. The clients are issued with a contract that includes the terms and conditions of residency when moving into the home. A copy of the contract was seen and it covered almost all the points expected of it such as the fee, the services that will be charged in addition to the fees and rights and obligations of the clients Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 9 for such things as how to complain and the periods of notice required for the termination of the contract. Where nursing is provided it is required that the Funded Nursing Care contribution is shown separately to the personal care contribution. The version of contract that was seen did not have a facility for this to occur. The contract does need to be updated as it still has the name of the previous registering authority and this should be altered to read Commission for Social Care Inspection. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 9 & 10 The arrangements for the storage, administration and disposal of medication are satisfactory. There are also satisfactory arrangements for maintaining the dignity and confidentiality of the clients when they are visited by a health care professional or an advocate. EVIDENCE: The inspector looked at the homes medication management procedures. He found that the medications are stored in a secure place that is locked and that the medicine trolley is securely tethered to the wall when it is not in use within the locked room. The records of administration were satisfactory and there is a record of the signatures of those Registered Nurses that are involved in the administration of medication at the home including the names and signatures of agency nurses that have been used regularly at the home. The home has a British National Formulary dated March 2005 that is used for referencing information about drugs that are used in the home. In addition to this there is also a new copy of the Plymouth Area Joint Formulary that has been supplied by the National Health Services again for the purpose of checking out information on medications that are used in the home. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 11 The clients in receipt of nursing care have this assessed and delivered by the nurses employed at the home. The clients not in receipt of nursing care who have a nursing need have this provided by the District Nursing service. A District Nurse attended to a client during the inspection and left her records of care for the home to store appropriately. The person in charge of the home during the inspection provided evidence as to how the General Practitioners are contacted and visits arranged where there is a need for this to happen. Other health and social care professionals attend the home. The clients see the General Practitioner and District Nurse in the privacy of their own bedrooms. Other advisors such as a solicitor are also given this courtesy when they visit so as to maintain the degree of confidentiality that the client chooses. The clients wear their own cloths that are marked and laundered by the home. The home only provides single room accommodation for the clients. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 14 & 15 The home does provide support and opportunities for the clients to maintain and express their independence in as many ways as is reasonably possible. EVIDENCE: The home does not manage the financial affairs of any of the clients at the home and where it is possible the clients are encouraged to maintain personal control of their affairs or to appoint someone to do this for them. Assisting the clients to maintain independence is an aim of the home. The clients can exercise choice in many ways. They are freely able to express their views about anything such as political events, what’s on the television or what they wish to eat at the next meal. Those that cannot express their wishes due to infirmity are helped along by the staff who have information about past wishes and views that has been collected during the admission process and subsequently during the clients stay at the home. This information is held in the clients file as a history or statement such as in the form of likes and dislikes. The inspector saw evidence of this in the clients files that have been seen during this and subsequent inspections. The clients choices about the food and drinks that they prefer are recorded in there case file and the cook told the inspector that she has knowledge of the individual choices that the clients have made regarding the food they eat. During the tour of the home the inspector saw that the clients do personalise their rooms with their own belongings. Some of the clients choose to spend Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 13 much of their time in their own rooms. This may change when the amount of communal space is increased as it is rather limited at the moment. The conservatory is well underway and the Registered Person told the inspector that the shaft lift has now been ordered. The cook told the inspector that the menu sheets are used to plan the meals that are based on what the clients likes and dislikes are as recorded I their case files. Special diets are also produced by the kitchen again following the menu guide. Food is prepared fresh each day from food purchased from local suppliers. The cook was able to provide evidence of the names of those she purchases good from and the days of the week that she takes delivery of different items. There was also a cleaning schedule, a record of the temperature of foods that have been probed during cooking and the fridge and freezer temperatures. The inspector briefly discussed the new food safety legislation and advised the home to obtain a copy of the Food Standards Agency information if they do not already have this. Hot and clod drinks are provided to the clients on a regular basis during the day between meals. Clients are supervised with drinks and food if this is necessary. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 14 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 the following standard(s): EVIDENCE: These core standards were reported upon during the last inspection and the inspector has nothing to add on this occasion. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 20, 21 & 26 The present level of communal space is limited and building work to increase this is slow. Also there is poor provision of bathing and toilet facilities on the ground floor again due to building work being slow. The infection control level on the ground floor is now not satisfactory. EVIDENCE: The communal space remains as at previous inspections. The work on improving this situation is slow but there is clear evidence that the conservatory is now well underway. The mental health unit has its own lounge and there is a small lounge on the first floor for clients of the general nursing side of the home. On this un-announced inspection both lounges were looking sparse and not very pleasing decoratively although they were clean and warm. The Registered Person told the inspector that the shaft lift has now been ordered. The delivery is generally 12 to 13 weeks on this item. The practice of washing bedpans in a ceramic sluice on the ground floor is not satisfactory due to the risk of airborne infection increasing in the aerosol produced during washing, particularly with the built in water jet. The homes Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 16 infection control policy was read and this supports the inspectors view that the risk is now unacceptable. The new disinfecting sluice on the first floor demonstrates the understanding of the need for enclosed disinfecting sluicing facilities in a nursing home. The problem was discussed by telephone with the Registered Person during this inspection. The disabled toilet facility on the ground floor next to the bathroom is not at present suitable to be used due to its poor decorative order. Where all the tiles have been removed from the wall this possess a risk to the delicate skin of the clients should they fall against the wall. Also the surface is now permeable to liquids and presents a risk to users from the growth of bacteria that may form on the wall surface that cannot be easily cleaned. The window in the disabled toilet and the bathroom next to it on the ground floor has been bricked up as part of the work to create the conservatory. This also possesses issues of adequate ventilation and that the job is incomplete and unsightly. Generally the home is in good decorative order apart from the items remarked upon in this section. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The staff at this home are provided with satisfactory levels of training including National Vocational Qualification training and other mandatory and non mandatory training. EVIDENCE: A number of the care staff employed at the home have nursing qualifications but are not presently registered to practice in this country. There is a consistent drive towards providing training for the staff led by the Registered Person. More than 50 of the care staff, who do not hold a nursing qualification, has a National Vocational Qualification at level 2 or above. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The Registered Manager is suitably qualified in Nursing run the home and meet its aims and objectives. EVIDENCE: The Registered Manager is a first level general nurse and she has a BTEC Diploma in Management. She has considerable experience in running this home both from a care and management prospective. She is responsible for the running of this home supported by her Deputy Manager, who is a first level nurse in psychiatry. The manager and staff have been trained in meeting the needs of the clients and are familiar with the conditions associated with ageing including mental health issues. There are clear lines of accountability within the home and with external management. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 19 and Management to Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 20 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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 2 2 X X X X 2 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP29 Regulation 19(1)(i) Timescale for action The Registered Person should 01/04/06 maintain staff records in accordance with Regulation 19 and Schedule 2 including a recent photograph and proof of the employees address. Not reviewed on this inspection. Where nursing is provided the 10/02/06 contract should show the Funded Nursing Care contribution separately from the personal care contribution. The Registered Person shall 01/05/06 make arrangements to prevent the spread of infection in the home by providing a disinfecting sluice on the ground floor of the nursing home. The ground floor disabled toilet 01/03/06 facility should be suitable decorated to avoid the risk infection from the permeable walls. The ground floor disabled toilet 01/03/06 facility should be suitably decorated to avoid the risk of injury that may occur from the unprotected rough wall surface. Requirement 2 OP2 5A 3 OP26 13(3) 4 OP21 13(3) 5 OP21 13(4)(a) Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 22 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 2 3 4 Refer to Standard OP20 OP2 OP21 OP19 Good Practice Recommendations Extra communal space is to be provided to ensure 4.1 sq m per Service User is achieved. The contract of residency should be reviewed and the name of the registering authority brought up to date to read “Commission for Social Care Inspection”. The wall where the window has been bricked up in the disabled toilet and bathroom should be made good and adequate ventilation provided as soon as possible. The two lounges are in need of some decorative attention as they are now looking rather tired and uninviting. Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Blackdown Nursing Home DS0000029072.V269675.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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