Inspection on 12/09/06 for Blackmore House

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Blackmore House 08/09/09

Blackmore House 07/11/08

Blackmore House 06/06/07

Blackmore House 10/11/05

Blackmore House 29/07/05

Blackmore House 06/12/04

Blackmore House 29/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Blackmore House School Drive Bromsgrove Worcestershire B60 1AY Lead Inspector Andrew Spearing-Brown Unannounced Inspection 8:45 12 and 21 September 2006 th st 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 Blackmore House DS0000018462.V294248.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. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blackmore House Address School Drive Bromsgrove Worcestershire B60 1AY 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) 01527 575222 01527 575222 manager.bmhouse@bcop.org.uk asstmanager.bmhouse@bcop.org.uk Broadening Choices for Older People Mrs Paula Georgina George Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28) Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate on a respite basis 1 named service user under the age of 65 years in the category dementia (DE). 10th November 2005 Date of last inspection Brief Description of the Service: Blackmore House was built in 1989 as a care home for older people. The home is single storey and accommodates a day centre that helps to maintain links with the local community. The home provides single bedroom accommodation for a total of 28 residents who are accommodated in 5 bungalows. Each bungalow represents a virtually self-contained living environment with a lounge/dining space, toilets and bathrooms, bedroom accommodation and a kitchenette. Three of the bungalows each accommodate 4 residents, while two bungalows accommodate 8 residents. Emphasis is placed on creating a homely living environment. Blackmore House provides a care service for older people with or without a physical disability and for older people with dementia. Broadening Choices for Older People (BCOP) is the registered provider however, the building is owned by, and leased from Worcestershire County Council. As all beds are blocked purchased by Worcestershire County Council Social Services the standard bed fee applies at £343.00 per week plus the dementia care allowance at £27.00 per week were applicable. Additional charges apply for items such as hairdressing. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of two days. Two inspectors from the Commission for Social Care Inspection carried out the first visit while one inspector undertook the second visit. Prior to the visit a pre inspection questionnaire was posted to the registered person requesting certain information. In addition to the pre-inspection questionnaire a number of questionnaires were also sent to the home, designed to be completed by residents, relatives and visiting professionals. None of these documents or questionnaires were completed and returned to the CSCI prior to the inspection. However following completion of this inspection 3 feedback cards were received completed by local General Practitioners and 1 from a relative. Discussions took place with residents as well as members of staff on duty. Comments from residents are included within this report. Since the last inspection the commission has received a number of complaints regarding Blackmore House, matters relating to these are including within this report. The commission recently received a letter of complement regarding the care provided to a resident, comments regarding this complement are included within the report. Blackmore House is registered to care for a total of 28 residents. At the time of this inspection the home was accommodating 18 residents including one who was in hospital. Out of the 18 residents 8 were receiving respite (short stay) while the remaining 10 residents were receiving long stay care. What the service does well: The design and layout of the home is well suited to older people with mobility difficulties. The relative smallness of the bungalows can assist residents with memory loss to orientate themselves to the toilets and their bedroom from the lounge / dining area, however this could be improved by using visual aids. The kitchenettes within each of the five separate bungalows have recently newly fitting units, a dishwasher and a fridge. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 6 Information regarding advocacy services was available. Other information regarding the service offered is also available although some needs to be reviewed. Care plans are in place and some evidence was noted of advise been sought from professionals such as community nursing staff. Some areas of good practice were noted regarding the management of medication – these took into account the potential high turn over of medication due to the number of respite residents entering the home. Residents are able to join in with the activities available within the day centre, although this is limited primarily to residents receiving respite care. Residents commented that the food provided is good. Prior to this inspection the commission receive a letter commending the staff commitment and the standard of care received at Blackmore House. What has improved since the last inspection? What they could do better: Some care plans as well as risk assessments need improvement, especially in relation to fall prevention. Care plans need to contain sufficient detail to enable carers carry out their job in a consistent manner. Further improvement regarding the terminology on care documents needs attention as well as evidence of action taken in relation to a care concern. Pre admission assessments are not taking place from which initial care plans can be generated. The security of care plans needs to be addressed. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 7 Files were not up to date in that care records were awaiting filing in the office this was also highlighted as part of the last inspection. Although medication management has improved over recent inspection visits shortfalls were identified. These need to be addressed in order to meet the required standard. Areas of poor infection control and elimination of odours were identified and need suitable action. Staffing levels need auditing to ensure that sufficient staff are on duty at all times. As Blackmore House is a unitise care home its layout needs to be taken into account when assessing staffing levels. Some training shortfalls were of concerns especially regarding adult protection and fire A number of health and safety shortfalls were identified including fire records, the storage of dish washer powder, kitchen cleaning, maintaining of freezer temperatures and staff wearing jewellery. 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. Blackmore House DS0000018462.V294248.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 Blackmore House DS0000018462.V294248.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 5. Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available for potential residents and or their representatives in order for them to make an informed decision regarding moving into the home. The lack of pre admission assessments carried out by a representative of the home potentially places residents at risk. EVIDENCE: Blackmore House currently accommodates a number of long stay residents, however the home is currently only admitting persons on a respite (short stay) arrangement; many individuals receive respite on a regular rotational basis. Neither the statement of purpose or the service users guide were viewed on this occasion. The service users guide is not available in any other formats although the registered manager confirmed that she could provide a larger photocopied version should it be needed. In addition the registered manager Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 10 confirmed that she would be willing to record an audio version of the document if needed. The document is not available in any other languages. On the morning of the first visit of this inspection one respite resident was admitted. The file of one respite resident contained a copy of the statement of terms and conditions however this did not contain all the relevant details such as bedroom number. It was also noted to say ‘we are registered with NCSC’ (the former regulatory body) – this needs to be amended to CSCI. The initial assessment of one respite resident was not signed or date. The information on the initial assessments was often scant in detail. The initial assessment of a recently admitted resident contained no details under some headings. Due to the high number of respite placements at Blackmore House the registered manager stated that it was not possible to carry out pre admission assessments, this is not in line with the National Minimum Standards. The registered manager needs to be able to demonstrate that assessed or acknowledged care needs can be meet prior to admission. It was however evident that potential residents as well as their relatives / representatives can visit Blackmore House prior to their admission. The inspector saw no evidence that the registered manager confirms in writing that the home is able to meet identified care needs. Although Blackmore House provides respite care no intermediate care as described under standard 6 is provided. Blackmore House DS0000018462.V294248.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 ,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and associated risk assessments in some instances need to be improved to support the care needs of residents, especially those on respite. The lack of suitable and detailed care plan can place residents at risk. Care planning regarding fall prevention was of particular concern. Previous concerns regarding the management of medication within the home have received action however some areas remain to be a worry. EVIDENCE: As part of this inspection a number of care plans were viewed, these were in relation to a small number of people currently receiving respite care, some who had received respite in the past and some who reside at the home on a long stay basis. Care plans seen partially those regarding long stay residents, covered a range of heath, personal and social care needs. Care plans are on computer with a hard (paper) copy held on file. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 12 Care plans for respite residents were held within the staff room; although this assures accessibility they were not held securely. Some of the care plans viewed contained sufficient detail for example a plan of care regarding a resident with a dementia type illness stated ‘if xx does not understand or won’t cooperate leave xx for a few minutes making sure xx is safe then return.’ It was evident that the care plans regarding the resident concerned were reviewed on a monthly basis containing a description of what had changed during the previous month. Advise sought from the community nurse was included within the care plan and their input regarding pressure care was evident. A pressure-reliving mattress was in place as documented. A care plan covering the nighttime was also seen this was however old information and no longer relevant. Similarly some other notes regarding medication and nursing care were also no longer relevant. It was suggested that these are transferred to another file to prevent confusion. Some risk assessments such as fall prevention and the use or non-use of bedrails needed improvement while others detailed the support required by staff. A similar concern regarding fall prevention or methods to reduce the risk of falling was not held on a care plan relating to a respite resident who fell and fractured a hip. This lack of information was despite the initial assessment stating that she was prone to falling and had limited mobility. Other care plans viewed were not detailed for example the daily notes of one resident showed entries regarding a individual ‘wandering at night’ the care plan failed to give any details as to the action to be taken. Similarly no care plan was in place for the management of aggression. Entries on the care plan stated ‘will need full assistance’ but did not indicate what support was required such as bath or shower. A number of files seen contained body maps, these included maps indicating any bruising noted on admission into the home following hospital treatment. No evidence existed of any investigation as to how bruising was obtained if it occurred while at Blackmore House as well as a lack of detail as to who the bruising was reported to. The turning records of a poorly resident were viewed. The recorded plan of care stated that turning was to take place every four hours. The records indicated that turning took place although at times the gap between turns was nearer to 4 ½ hours. The terminology used on the daily notes by carers has greatly improved over recent inspection visits. Despite the general improvement in terminology some written entries continue to be inappropriate such as using nic names when referring to residents. In addition it was noted that some entries on daily Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 13 notes were non-descriptive stated ‘NTR’ meaning ‘nothing to report’ or ‘xx fine’ or ‘slept well’. It was concerning to note that some reported concerns were either not followed up by a professional such as a General Practitioner or closed off as no longer giving cause for concern. The previous report indicated a backlog in filing of residents daily notes, this was also apparent as part of this inspection. This is of concern in case information is needed urgently. Personal inventories regarding residents belongings were held. Prior to this inspection the commission received a letter commending the care provided to a resident on respite care. The letter stated: ‘wish to commend the standard of care and obvious staff commitment at Blackmore House.’ The letter continued with: ‘made to feel valued and cared for’’ One feedback card was received from a relative, which contained the following comment: ‘ as relatives we are very satisfied with the quality of care’ No other comment cards from relatives or residents were received by the commission. Some positive comments were received upon one feedback card returned to the commission from a local General Practitioner. It was noted throughout the inspection that residents appeared suitably dressed taking into account the time of year as well as age, gender and culture. In addition residents appeared to be calm and relaxed. Medication is held centrally rather than on individual units. The storage cupboard where medication is held was warm and in need of cooling down to ensure that medication is held safely – this was actioned immediately and therefore now needs to be monitored for its suitability. A fridge is available for the storage of items such as antibiotic medication, some medication requiring refrigeration was found within the drug trolley. No record of the fridge temperature is maintained. Records need to be commenced regarding both the storage area and the fridge. Recent inspection reports have shown an improvement in the overall management of medication. A number of areas demonstrating compliance with regulations and / or good practice were noted. The supplying pharmacist Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 14 visited the home in January 2006 and prepared a report. No concerns were noted within the pharmacists report. The registered manager and staff at Blackmore are aware of the potential risk for mistakes to take place regarding medication brought into the home for respite residents. It was noted that written information is sent out prior to the stay saying that medication can only be accepted if it is in the original container issued by a chemist. In addition the home seek confirmation from the residents GP of each respite residents current medication. Both of these are good practice and commendable. The date of opening is recorded on boxed and bottled medication thus enabling a full drug audit. The Medication Administration Record (MAR) sheets were generally in good order. It was noted that they contained information regarding allergies or stated ‘none known’ when this was the case. Although some handwritten amendments were not double signed the majority of MAR sheets were completed satisfactorily. Considering the improvement noted in the management and recording of medication it was disappointing to discover one tablet within the blister pack, which was signed as given on the MAR sheet. The inspector recommended that Latin terminology regarding dosages is discontinued and English is used such as ‘twice a day’ rather than ’BD’ No controlled medication was held within the home at the time of this inspection. A register is in place to record the stock and administration of any controlled medication held within the home. A new senior member of staff has not had accredited medication training. A new list showing staff signatures is needed. The previous inspection report brought to the attention of the registered manager (following a complaint) the need to investigate a number of concerns in relation to staff attitude and the need to ensure that privacy and dignity of residents is upheld. The registered manager stated that she is confident that residents have their privacy and dignity upheld by carers. It was noted that a list of residents was held in each bungalow. The names of some residents were however crossed out; it was assumed that this took place once residents were no longer residing at Blackmore House. Concerns regarding this practice were discussed and the lists removed. Fabric covers were in place in one of the units on each of the chairs to ‘protect them’ in case of incontinence; areas around the promotion of dignity were discussed. The registered manager reported that these protective covers are needed due to the number of respite residents accommodated and the uncertainly as to whether such a covering is needed or not. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 15 A public telephone is located in the main corridor of the home; its location is not ideal for personal or private calls. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are provided, however as these are primarily within the day centre this tends to restrict long stay residents and therefore they need to be reviewed and improved upon. Residents spoke highly of the food although the choice available needs reviewing. EVIDENCE: A day centre within the home forms an integral part of the service provided. Day care provision is not, under the Care Standards Act, registered and therefore as a service it does not form part of this inspection. It is however evident that the day centre provision forms part of the overall service especially in relation to persons who are residing within the home on a respite basis. In addition the day centre can be used as a resource during evenings and at weekends. Records maintained within the day centre demonstrated that 2 - 3 respite residents attend the day centre each day while residing within the residential home. Activities recorded as having taken place include music and movement, ball games, quizzes and word games, cooking and handicrafts. The records Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 17 stated whether the activity was successful. The records did not evidence any long stay (permanent) residents taking part in the activities provided within the day centre. Activities for long stay residents appear to be limited, this was confirmed by residents during discussions in the unit. Activities need to be meaningful, purposeful and geared to the care needs of residents. Holy communion was reported to take place on a monthly basis for residents who are Church of England. No Roman Catholics were reported to be residing within Blackmore House at the time of this inspection. Residents who are residing within the home on a long stay basis generally had bedrooms containing personal items as opposed to the bedrooms of residents receiving a respite stay when it is less likely that larger personal items such as furniture will be brought into the home. Visitors are able to visit at any reasonable time. Visitors are able to use communal areas such as the lounge / dining area within the units or the corridor leading to the units as well as resident’s own rooms as they wish. On the first day of the inspection the lunch on offer was either smoked haddock or fish fingers. Although an additional choice of jacket potatoes was available it was recommended that the menu is reviewed to remove having two fish dishes on at the same time. The menu did not show an alternative for each day. Residents are asked to select their choice of menu the evening beforehand. Tea was due to be turkey sandwiches followed by swiss roll with cream. Breakfast is prepared upon individual units. No cooked breakfasts are prepared. One resident commented: ‘The food is really nice.’ While another resident stated ‘ food is good can’t find fault.’ Other favourable comments were overheard. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible and sufficiently detailed to afford residents and others the necessary information. Training and procedures regarding adult protection need reviewing and actioning in order to safeguard residents. EVIDENCE: Prior to the last inspection at Blackmore House the commission received a lengthy complaint regarding a range of issues. Since the last inspection the commission has also received a number of further complaints. One care plan viewed indicated that a respite resident had complained that the night staff had told her that she had to get up at 6.15 am. The registered manager stated that she had no knowledge of the incident. A copy of the complaints procedure was on display. Since the last inspection this has been amended and is now both clear regarding the procedure as well as containing the full and correct address of the commission in Worcester. Some staff members undertook training upon the recognition of adult abuse in December 2004. The records indicated that this training expired in December Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 19 2005. No further training has taken place and some staff have received no training. The lack of training is of concern. Information was available regarding adult protection including a leaflet issued by Worcestershire County Council – ‘Adult Abuse is everyone’s business’. The policies and procedures file contained a document dated September 2003 regarding adult protection. The inspector was informed that this is currently being reviewed. This document needs to mention the CSCI rather than the NCSC who were the former regulator. The document also needs to incorporate the local multi agency guidelines prepared by Worcestershire County Council. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 20 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): Standards 19, 20, 21, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The fabric of the home in relation to the décor needs improvement in some areas. Infection control measures and odour control gave cause for concern for the well being of residents and others. EVIDENCE: The home consists of five family-sized “bungalows” of which, three bungalows accommodate four residents each, and two “bungalows” accommodate eight residents each. Every “bungalow” contains single occupation bedrooms, a lounge/diner and a kitchenette. The bungalow style design promotes homeliness and helps to facilitate a family-living approach and culture. In addition to the communal space cited, each bungalow has a communal bathroom and communal toilet facilities. None of the bedrooms have en-suite facilities; therefore the majority of bedroom contained a commode. One Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 21 commode had dried faeces upon it. As the building is located on a single level, residents who have mobility difficulties can freely access all areas. The kitchenettes within each unit were refurbished about 18 months ago and look domestic in character. Concern regarding the safe storage of items such as cleaning materials within these areas is reported elsewhere within this report. The majority of bedrooms fall below 10m² usable floor space; this is compensated by additional communal space. Bedrooms are lockable and residents are asked if they wish to have a key. Not all bedrooms have a lockable piece of furniture. Two sluices are provided, one on each of the larger units. These sluices are however situation beyond one of the toilets and can only be accessed via the toilet therefore making them less than satisfactory. These areas had an offensive odour about them. One toilet contained a bin, which was overflowing with soiled pads therefore leaving an offensive odour. The inspector was informed that the organisation was seeking a new system of dealing with clinical waste. The registered manager assured the inspectors that the washing machines provided are in line with the required standard however it was not immediately apparent that they had a sluice cycle. It was stated that sluicing is carried out manually within the above areas At the time of the previous inspection it was noted that the bathroom within both of the larger units had recently had an electric overhead hoist fitted. Although the hoist had been commissioned not all staff had received the necessary training to ensure that they could safely operate the equipment. It was evident that these items of equipment are not used as they continued to have packaging on them. Staff consulted stated that residents preferred to use the showers, which are also located within the larger bathrooms. The new shower on Wyrelea continues to look attractive and was reported to be frequently used. Some concerns regarding infection control and health and safety were noted and reported back at the time of the inspection. A range of toiletries including bars of soap were left out or stored within cupboards. A disposable razor was left on the wash hand basin in the shower room. Liquid soap and paper towels were provided within each bathroom and toilet viewed. Bathroom doors displayed a pictorial image of a bath to assist persons with a dementia type illness. Some toilets had a pictorial image while others did not. It was noted that clocks throughout the building showed a variety of different times, on one unit two clocks close to each other were both incorrect. It was stated that the home has experienced problems with electrical clocks due to Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 22 intermittent power failures. During the first visit of this inspection a number of new battery clocks were purchased. A hairdressing room is provided. The roof over the main corridor leading to each of the units is made from glass. Although ceiling fans are in place it was brought to the attention of the commission that this area was extremely hot during the early part of this summer. The registered manager responded to this concern by placing a number of portable fans along the corridor and raising the concern with her line manager. It was noted that information regarding heatstroke and dehydration was displayed within the home. The temperature within the home on the day of the inspection was comfortable. At the time of the inspection one bedroom was out of use, as it required a replacement carpet. One bedroom viewed had a carpet, which had expanded due to frequent shampooing and could become a potential trip hazard. The carpet within the day centre is dirty near to a fire door. Some other carpets were a trip hazard; the inspector requested that they were taped down to reduce the risk prior to a more permanent solution. Some communal areas are in need of redecoration whereby paintwork is damaged due to wheelchairs or the medication trolley knocking against them. A Fire Safety Officer from Hereford and Worcester Combined Fire Authority visited Blackmore House during December 2005. Reference to this letter and other fire safety matters are referred to under the Management section in this report. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An insufficient number of or mix of staff are on duty at certain times. Although recruitment procedures are generally satisfactory some shortfalls regarding training and the staffing concerns can leave residents at potential risk. EVIDENCE: A sample of staff files were viewed, these were primarily those relating to staff appointed since the last inspection visit. It was evident that two references and both a PoVA (Protection of Vulnerable Adults) first check and a CRB (Criminal Records Bureau) disclosure were obtained prior to employment starting. The application forms of two employees lacked sufficient employment history information or were insufficiently completed, which needs to be addressed as part of future interviews for staff. Interview notes are kept and held on file. At the time of this inspection the home had nobody working as a kitchen domestic. Night staff were reported to undertake some cleaning duties. Comments regarding the kitchen are reported elsewhere in this report. It was reported that agency staff were not used due to them not having a suitable CRB disclosure. No domestics were on duty within the home although one was due to be on duty later in the afternoon. No laundry staff are employed therefore carers have to carry out these duties in addition to their other duties as care assistants. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 24 A cook is employed between 9.00 and 5.00 Sunday to Thursday each week. The cook on a Friday was reported to be a regular agency cook while a part time cook works each Saturday. The cook prepares tea ready for care staff to serve. One resident commented: ‘The staff are lovely here.’ The number of carers on duty remains the same as previous inspections. The registered provider must be able to demonstrate that the layout of the home and other duties carers have such as the undertaking of domestic and catering duties are taken into account when preparing staff rotas. According to the documentation seen 50 of carers hold a National Vocational Qualification (NVQ) level 2. Training in particular around health and safety is mentioned later within this report. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of health and safety concerns could potentially place residents, staff and others at risk. Of particular concern was the cleaning of the kitchen and records held within that area and matters regarding fire safety. EVIDENCE: The registered manager reported that she has completed about 80 of her Registered Managers Award and expects to be completed by the end of this year. The standard stipulates that: ‘The registered manager has a qualification, at level 4 NVQ, in management and care or equivalent.’ Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 26 The above training was required by 2005. Therefore the additional training required needs to be achieved upon completion of the RMA. The certificate of registration and a suitable certificate regarding public liability insurance were displayed near to the entrance hall. BCOP need to formally notify the commission of the name of the responsible person. A copy of the hairdressers public liability insurance was out of date; the registered person needs to obtain evidence that suitable insurance is in place. Blackmore House has the facilities to keep in safe keeping a small amount of money on behalf of residents. As part of this inspection the balance held on behalf of two residents was checked and found to match the records held with receipts in place to account for expenditure. No policy is in place regarding the disposal of unknown items held within the safe. Previous inspection reports have highlighted the need under Regulation 26 of the Care Home Regulations for the registered provider to visit the home and prepare a written report. Since the last inspection the commission has received a copy of a couple of visit reports. Although it is not normally necessary for a copy of these reports to be submitted to the commission they must be available within the home. The inspector was informed that no further reports were available. The registered provider must ensure that these visits take place. The registered manager was not able to evidence any quality assurance systems. A quality assurance system is currently being piloted at another BCOP home. No evidence of either resident surveys or residents meeting were in place. Although reported that formal individual supervision is taking place the recording of this does not provide satisfactory evidence that the standard is met. The registered manager or other relevant persons have in the past informed the commission of certain events such as those which adversely affect the well-being or safety of residents. Accident records were in place and matched entries within the daily notes. As part of this inspection one incident was evident whereby the commission were not informed as required. Previous comments regarding the need to ensure that documents are not decanted from the working file and left in trays waiting to be sorted and filed were echoed during this inspection. Temperature records of hot food and fridges and freezers within the kitchen were viewed. At the time of the previous inspection one of the freezers gave cause for some concern as it was regularly reading very high temperatures. Despite this previous requirement it was evident that temperatures as high as – 9 ° C are occurring. Freezers must maintain a temperature of -18° C or lower. The registered manager stated that the need to replace this piece of Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 27 equipment was brought to the attention of the local authority in their role of landlord following the last inspection. It was of serious concern to note that this item of equipment was still in place and still failing to maintain the required temperature. An immediate requirement with a timescale of 48 hours was issued to ensure that freezers maintained the prescribed temperature. The previous inspection report stated ‘Some areas within the kitchen required some cleaning including the top of fridges and behind fridges. The oven was not clean.’ The cleanliness of the kitchen was also included as part of a complaint prior to the last inspection. It was of serious concern to note that the kitchen was not clean during the first part of this inspection. The oven was dirty and greasy as was the top of the grill. The filters over the stove were greasy. Ground in dirt was noted on the waste disposal unit and on the tiles. A cleaning schedule is displayed however it was evident that this is not adhered to. The kitchen was briefly seen on the second visit, which followed a deep clean taking place. The kitchen appeared to be cleaner. The registered person must ensure that this area is kept in a clean and hygienic state in future. Food within the fridge was covered and labelled as required. Risk assessments for food storage and preparation are in place although these were not assessed in any detail during this visit. The food storage area was satisfactory with the exception of a bag of potatoes and some flour that were stored on the floor. It was reported that nobody from Bromsgrove District Council – Environmental Health Department had visited for some time. As reported earlier within this report a Fire Safety Officer from Hereford and Worcester Combined Fire Authority visited Blackmore House during December 2005. Following this visit a letter from the fire officer was written to the registered manager and copied to the commission. The registered manager supplied the commission with a suitable action plan, which was discussed as part of this visit. The registered manager stated that she was still awaiting a fire risk assessment prepared by the fire authority. All areas requiring improvement have now received action by Worcestershire County Council as the landlord of the property. However following the fitting of intumescent seals staff reported that some doors are difficult to close or are difficult to open. This has been brought to the attention of the landlord and requires urgent attention. It was apparent that the annual testing of fire fighting equipment (extinguishers and fire blankets) had not taken place. Furthermore it was noted that a number of extinguishers checked showed the pressure gauge on or close to the red zone as opposed to the green safe zone. The lack of servicing and the lack of suitable systems to identify problems regarding Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 28 pressure were of serious concern and posed a potential risk to the health, safety and welfare of residents, staff and others. As a result of the serious concerns an immediate requirement with a timescale to 48 hours was issued to make arrangements to have all equipment serviced. A table blocking a fire extinguisher within the central corridor was moved upon bringing it to the attention of the registered manager, however this extinguisher was once again blocked on the second visit to the home. Easy access to fire fighting equipment needs to be assured at all times. The previous inspection report concluded that the weekly testing of the fire alarm was ‘well organised’ and that the records regarding this test ‘were well maintained’. Some other records were in need of improvement while others could not be sought. As part of this visit the fire records were viewed and were found to be in need of improvement. A new handyperson is in place and therefore it is essential that the registered person provide sufficient training to ensure that the necessary testing takes place. The fire alarm is tested weekly however this was not in sequential order, therefore missing some break glass points for example the boiler room was last tested in November 2005 (10 months ago). No records were in place regarding a monthly visual check of the fire fighting equipment. Other records such as the means of escape and the emergency lighting were unsatisfactory. Since the fitting of smoke seals to doors a number are not closing properly; this has been brought to the attention of the landlord. The lack of sufficient fire training was of serious concerns and in need of urgent attention; the inspector was assured that training is due to take place. Fire safety will be re assessed as part of a forthcoming inspection due to the range of concerns identified. At the time of this inspection no member of staff at Blackmore House has attended any infection control training; this lack of training is of concern. The inspector was informed that this training is scheduled for January 2007. As reported earlier within this report each of the units contains a kitchenette. Concern was expressed regarding the storage of dishwasher powder especially as the lid was not secure in one unit and therefore potentially affording easy access to the substance. The substance was clearly marked as an ‘Irritant’. A tin of paint was held in another cupboard. Items were located within the laundry, which needed to be secured. As all items hazardous to the health safety and welfare of residents must be held securely at all times an immediate requirement was issued regarding this matter. Suitable locks were in place within each kitchenette by the time of the second visit. The plate covering the mechanism on one toilet door was missing resulting in some exposed sharp areas Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 29 Information attached to one of the overhead hoists evidenced that it was last serviced during May 2006. The testing of portable electrical equipment was taking place during the first visit of this inspection. One wheelchair was seen without footrests in place. The previous inspection report brought to the attention of the registered persons the need to review the practice within the home of staff wearing jewellery while at work. The inspector does not know what review took place however it was of concern to note that some staff were wearing excessive amounts of jewellery. Items such as rings with stones or bracelets and necklaces can be hazardous to both residents and staff members in certain circumstances. Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 30 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 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 2 2 2 1 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 31 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 OP2 Regulation 5 (1) (b) Requirement The homes terms and conditions document must be reviewed in line with the associated regulations. A full assessment of prospective residents must be undertaken prior to them moving into the home and must include all aspects of their care needs. A letter confirming the homes assessment and the ability to meet care needs must be sent to potential residents or their representative. Each resident must have a comprehensive and detailed care plan in place which is regularly reviewed and updated and reflects all aspects of their care needs. Timescale for action 30/11/06 2. OP3 14 31/10/06 3. OP4 14(1)(d) 31/10/06 4. OP7 15 (1) (2) 31/10/06 5. OP7 OP10 12 (3) The registered manager must 31/10/06 ensure that the terminology used on care documents takes into account residents wishes and DS0000018462.V294248.R01.S.doc Version 5.2 Page 32 Blackmore House preferences. 6. OP8 13 Risk assessments must be carried out and reviewed on a regular basis. The information from the risk assessment must form part of a comprehensive care plan 31/10/06 7. OP9 13 (2) The registered manager must ensure that any handwritten amendments to the medication administration record (MAR) sheets are checked dated and counter signed by a second member of staff. (Previous timescales of immediate and on going not met issued during recent inspections not met. This requirement must be met in full). 21/09/06 8. OP9 13 (2) The registered manager must ensure that records are maintained regarding the room temperature where medication is stored and the fridge temperature used for storing certain medication. The registered manager must ensure that medication is administered as prescribed and that the Medication Administration Record (MAR) sheets are completed correctly. The registered provider must ensure that all persons who have responsibility for the management or administration of medication undertake accredited medication training. DS0000018462.V294248.R01.S.doc 21/09/06 9. OP9 13 (2) 21/09/06 10. OP9 13 (3) 30/11/06 Blackmore House Version 5.2 Page 33 11. OP12 16 (2) (n) The registered manager must ensure that meaningful and purposeful activities, taking into account the care needs of residents are available within the home. (Part met - extended timescale given) 31/12/06 12. OP18 13 (6) The registered provider must ensure a review of the corporative document regarding adult protection takes place to comply with local guidance issued by Worcestershire Social Services. (Timescale of 30/09/05 not met. A new and revised timescale is given by which time this must be met in full). 30/11/06 13. OP18 13 (6) All staff must receive suitable 31/12/06 training to prevent residents being placed at harm or suffering abuse. The registered provider must 30/11/06 ensure that all areas of the home are well maintained. (Timescales of 30/11/05 and 31/01/06 not met. This timescale is extended). 14. OP19 23 (2) (b) 15. OP22 23 (2) (n) Opportunity must be taken to provide appropriate visual signage for residents to assist in the location of areas and rooms within the building. Opportunity must also be taken to use colour and décor for orientation DS0000018462.V294248.R01.S.doc 31/12/06 Blackmore House Version 5.2 Page 34 purposes. This should be undertaken from the viewpoint of residents who may possess a form of visual impairment and/or possess short-term memory loss. (Timescale of 30/11/05 and 31/01/06 not met. This timescale is extended). 16. OP26 13 (3) Review infection control measures within the home including ensuring the washing machine meets the required standard. The registered manager must take appropriate action to eliminate offensive odours from the home. 30/10/06 17. OP26 13 (3) 30/11/06 18. OP27 18 (1) (a) The registered manager must 31/10/06 ensure that sufficient staff are on duty at all times to meet identified care needs of residents as well as the layout and purpose of the care home. Quality assurance and monitoring systems must be developed to comply with NMS 33. Specifically;· Effective quality assurance and quality monitoring systems, based on seeking the views of residents must be in place to measure success in meeting the aims, objectives and statement of purpose of the home.· 30/11/06 19. OP33 24 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 35 There must be an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for residents and· Feedback must be sought from residents about services provided. (Previous timescale of 30/04/05 30/09/05 and 31/01/06 not met. A new an extended timescale is given for full compliance). 20. OP35 17 (2) Schedule 4 (9) The registered provider must develop suitable policies and procedures in relation to items held in safe keeping which are unclaimed by the rightful owner. (Previous timescale of 31/03/05 30/09/05 and 31/12/05 not met – a further extension is given). 21. OP37 17 (1) The registered manager must ensure that care records are appropriately stored. (Previous timescale of 10/11/05 not met – a new and revised timescale is given for full compliance) 31/10/06 31/12/06 22. OP38 13 (4) (c) The registered manager must ensure that the use of jewellery amongst staff is in line with the health, safety and welfare of residents. (Previous timescale of 31/12/05 not met – a new and revised timescale is given for full compliance) 31/10/06 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 36 23. OP38 13 (3)16 (2) (j) The registered manager must ensure that all areas of the kitchen are kept in a clean and hygienic state and that suitable records are maintained. (Previous timescale of 10/11/05 not met – an immediate requirement was made at the time of this inspection regarding areas of the kitchen identified as unclean) 12/09/06 24. OP38 13 (3)16 (2) (j) The registered manager must ensure that suitable action is taken regarding the freezer with consistently high temperature readings. (Previous timescale of 10/11/05 not met – an immediate requirement was made at the time of this inspection regarding the need to ensure that safe temperatures are maintained) 12/09/06 25. OP38 23 (4) (c) The registered manager must ensure that the required fire safety test records are up to date and maintained. (Previous timescale of 10/11/05 not fully met – an immediate requirement was issued on 12/09/06 in relation to some aspects of this requirement. Additional shortfalls were noted as part of the inspection held on 21/09/06. The date given is therefore taking into account all shortfalls noted. This requirement must be met in full) 21/09/06 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 37 26. OP38 23 (4) The registered provider must ensure that staff receive the required level of fire safety training. 31/12/06 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 OP9 Good Practice Recommendations The registered manager should review the use of Latin terms upon the Medication Administration Record (MAR) sheets. The registered manager should review the use of ‘kylie pads’ on all chairs. The registered manager should review the practice of crossing residents names off upon lists within each unit. The registered manager should review the current menu to ensure that a real choice is available. The registered manager should carry out an audit upon the brakes fitted to bed legs to ensure they are suitable. This recommendation was not assessed as part of this inspection and therefore remains in place. 2. 3. 4. 5. OP10 OP10 OP15 OP19 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Blackmore House DS0000018462.V294248.R01.S.doc Version 5.2 Page 39 - 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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