Inspection on 06/06/07 for Blackmore House

This inspection was carried out on 6th June 2007.

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 12/09/06

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 6th June 2007 08:35 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.V334932.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.V334932.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 F/P 01527 575222 manager.bmhouse@bcop.org.uk www.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.V334932.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). 12th September 2006 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 £381.00 per week. Additional charges apply for items such as private chiropody, toiletries, magazines, newspapers and hairdressing. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector based at the Worcester office of the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection over two part days. This inspection takes into account any information received by the CSCI in relation to the home since the previous inspection as well as the visits to the home. The last inspection at Blackmore House took place during September 2006. Prior to this inspection a pre-inspection questionnaire (PIQ) document was posted to the home for completion. This document was returned to the commission before the start of the inspection. A number of questionnaires were sent to the home for residents and their relatives to complete. A small number of completed questionnaires were returned to the commission. The contents of the completed questionnaires are taken into account as part of this inspection. The registered manager was on a day off on the day of the first visit to the home but was present throughout the second visit. During this inspection discussions took place with the registered manager, the assistant manager, a visitors, some senior carers, some care assistants and a number of residents. A partial look around the home took place which included a number of bedrooms as well as communal areas. The care documents of a number of residents were viewed including care plans, daily notes and risk assessments. Other documents seen included medication records, service records and staffing records. Blackmore House is registered to care for a total of 28 residents. At the time of this inspection the home was accommodating 15 residents including one who was in hospital. Out of the 15 residents 9 were receiving respite (short stay) while the remaining 6 residents were receiving long stay care. Blackmore House is currently unable to admit anybody on a long-term basis. 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 were replaced a couple of years ago and contain a dishwasher and a fridge. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 6 Residents are able to join in with the activities available within the day centre, although this is limited primarily to residents receiving respite care and only operates during week days. Both prior to and during this inspection the commission received a range of complementary comments regarding the service offered at Blackmore House. ‘Staff at Blackmore always listen to all our requests and fully engage us with suggestions about *** care and her needs.’ ‘It is a fantastic place and ** always enjoys her stay there’ ‘ My ** goes to Blackmore House and is always cheerful and clean when we collect her.’ ‘They look after her exceptionally well always going that ‘extra mile’ to make sure that she is comfortable happy and content’ ‘We are very grateful to everyone at BH.’ (Blackmore House) ‘Everything about Blackmore House is first class.’ A concise complaint procedure is available for people should the need arise. Some staff have attended training regarding the safeguarding of adults. This training needs to continue to include all members of staff. Recruitment procedures were sufficiently robust to safeguard people against potential abuse. The number of staff on duty was sufficient. Staff training records are well managed and informative. The majority of staff have undertaken the majority of mandatory training courses required. What has improved since the last inspection? The previous inspection was undertaken in September 2006. A number of requirements issued at that time were assessed as met during this visit. The management of medication has over recent inspections improved and further improvements were noted as part of this inspection. The temperature within the storeroom where medication is held was found to be more acceptable and improvements were noted upon the medication records. Records were found to be in better order and filed away as needed. The terminology on care plans and other documents was factual and non opinionated or judgemental. Some improvements were noted regarding health and safety measures within the home. The kitchen had received a deep clean which was an improvement Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 7 and a freezer which was showing high temperature records has been replaced. Staff members on duty were not wearing heavy jewellery which was noticed during the previous two inspections. The manager was able to assure the inspector that the washing machine meets the required water safety standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Blackmore House DS0000018462.V334932.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.V334932.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 . 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. Prospective people to use the service and their representatives are able to visit the home prior to admission during which care needs can be assessed. Admissions outside of specified times are not permitted resulting in difficulties for some carers. EVIDENCE: Blackmore House currently accommodates a small number of long stay residents, however the home is currently only admitting people on a respite (short stay) arrangement. Many people who use the service do so on a regular respite basis. Neither the statement of purpose or the service users guide were viewed on this occasion. The pre-inspection questionnaire completed by the registered Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 10 manager stated that no changes have taken place regarding the statement of purpose since the last inspection. These documents need to be reviewed as necessary in line with any changes in the service offered at Blackmore House. The file of one respite resident contained a copy of the home’s terms and conditions. The document gave details regarding the fee to be charged, the bedroom number, a list of staff members and the address of the commission. A copy of the Community Care Assessment (CCA) completed by the purchasing care manager (social worker) was on file. The assessment compiled by the care manager gave details of the assessed care needs and the service expected to be delivered by staff within the home. The pre admission assessment document completed by staff at Blackmore House was dated the day of actual admission. This form primarily contained similar information to the details upon the CCA. The information was however sufficient for an initial care plan to be drawn up and developed during the respite stay. Due to the high number of respite placements at Blackmore House the registered manager has previously stated that it is not possible to carry out pre admission assessments. Not always carrying out these assessments is not in line with the National Minimum Standards. As mentioned within the previous inspection report the registered manager needs to be able to demonstrate that assessed or acknowledged care needs can be meet. It was however evident that potential residents as well as their relatives / representatives can visit Blackmore House prior to their admission. One comment received by the commission stated ‘visit went well – pre assessment went well.’ During this inspection evidence was seen to show that the registered manager confirms in writing that Blackmore House is able to meet identified care needs. Due to the fact that Blackmore House admit and discharge a significantly higher number of respite stay residents than many homes an appointment system is in place to ensure that a senior member of staff is available. The system has however brought some concerns regarding the times available (11.00am, 2.00pm and 4.00pm). One relative made comments upon a questionnaire returned to the commission highlighting the difficulties experienced by people who are at work and need to bring somebody into Blackmore during a specific timeslot. The registered manager is aware that the timeslots can be problematic however the system in place is in order to be able to give dedicated time to ensure that admissions/ discharges are suitably organised while also ensuring that community support services are available if necessary. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 11 One comment received by the commission prior to this inspection regarding respite stated ‘It is a fantastic place and ** always enjoys her stay there’ Although Blackmore House provides respite care no intermediate care as described under standard 6 is provided. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 risk assessments containing conflicting or incorrect and out of date information can result in an inconsistency in care delivery and an inability to recognise and meet identified care needs. Medication systems need to be fully robust to ensure medicines are given safely. EVIDENCE: Individual care plans are in place for each resident. A representative sample of care plans were viewed and assessed during the inspection. The care plans seen included respite residents and long stay residents. Care plans are written on a computer and then printed off for carers to access. One file contained a number of different care plans. It was evident that the resident had received respite care at Blackmore House in the past. Two care plans were dated on the first day of the current respite stay, it was difficult to establish which was the most up to date version. No details of any re Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 13 assessment before admission were seen. Another care plan was printed out and dated about 6 weeks after the initial care plan however the up date failed to include information gleaned from reading the daily notes. It was evident that the resident had become poorly during this period of time including an on going chest infection, no care plan was in place other than reference to ‘ill health’. The daily notes made reference to a sore area while another record mentioned a skin tear. No further reference was made for a number of weeks although it was evident that a GP was consulted by means of a telephone call. The next recorded event regarding a sore was a month later when it was decided to introduce a turning chart. Staff on duty did not know what the current situation was regarding the apparent sore. The care plan stated that fluid intake was to be recorded however carers stated that the care intervention had ceased as the concern no longer existed. Risk assessments were lacking on the file seen. Although staff on duty did not know the current situation regarding the above sore generally carers had a good knowledge of the care needs of residents residing on the bungalow in which they were working. Another care plan stated that a resident was using pressure-relieving equipment. This equipment was seen to be in place as the resident concerned was transferred to a chair containing a pressure relieving cushion following a period in her bedroom. A care plan seen made reference to a history of falls. Although the care plan was up dated at a later date it made no reference to a fall. The risk assessment stated ‘ assess monthly and if falls occur’. A further fall occurred after this entry was made however the care plan and the risk assessment were not reviewed. The care plan stated that an individuals appetite had improved but needs monitoring. The document indicated that it was difficult to weigh the person concerned however records did exist to show a degree of weight loss over a short period of time. The care plan failed to give clear instructions to carers regarding how to ’monitor’ and what actions would be necessary should weight be lost. Due to the practice of typing over the previous care plan to form a more up dated one some information was not removed or amended sufficiently when care needs had changed. As a result some care plans contained conflicting information. An unsafe transfer was seen whereby a carer used a wheelchair without footrests in place. This practice can potentially result in entrapment and injury. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 14 During recent inspections concerns regarding the use of terminology in care documents were discussed with the registered manager. The terminology seen during this visit was factual and not opinionated or judgemental. Prior to this inspection the commission received a number of comments regarding the care provided: ‘They look after her exceptionally well always going that ‘extra mile’ to make sure that she is comfortable happy and content’ ‘ My ** goes to Blackmore House and is always cheerful and clean when we collect her.’ One relative stated that ‘any problems are quickly noted the GP / ambulance is called promptly.’ This comment was not however shared totally by another response made to the commission and was an issue discussed with the home during a previous inspection. As part of the inspection the management and administration of medication was assessed. Over recent inspections the commission has seen improvement in the way medication is managed. Medication is held in a store cupboard off a corridor area. At the time of the last inspection the cupboard was found to be warm and needed to be cooled down to ensure the safety of medication. Immediate action was taken at the time of the previous inspection and the measures put in place remain. Although the temperature was more acceptable it was however still close to the maximum recommended and the long-term use of a domestic fan needs to be risk assessed and monitored. Temperature records are now maintained in relation to the fridge used for storing medication requiring such a facility. It was reported that all senior staff and some care staff have now attended appropriate training regarding the management and administering of medication. A representative from the supplying pharmacy visited the home during this inspection and stated that he had no concerns regarding the management of medication within the home. The majority of MAR (Medication Administration Record) sheets were completed satisfactorily. Allergies are recorded or if none known this information is also recorded. When medication is prescribed on a variable dosage staff are recording the actual amount given. Colour coding highlights the time when medication is prescribed. All these are good practice and should continue. As part of this inspection is was apparent that staff are signing for medication before administering it as on occasions a signature was over signed by a code Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 15 stating why medication was omitted. Due to some over signing it was not possible to carry out a full drug audit regarding one resident. Some tubs of creams were noted within a number of residents bedrooms. All those checked had the name of the resident upon them. Residents seen looked suitably dressed taking into account gender issues and weather conditions. No concerns regarding the upholding of residents privacy and dignity were brought to the attention of the inspector or observed during this inspection. Blackmore House DS0000018462.V334932.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. 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. People who use the service are able to make some choices about their daily life. Activities are limited to the day centre which may not be appropriate or suitable to individual care needs. EVIDENCE: Visitors are able to call at any reasonable time. One visitor was consulted as part of this inspection. Visitors are able to use communal areas within the bungalows such as the lounge / dining room area as well as resident’s own rooms as they wish. Information is displayed regarding Redditch and Bromsgrove advocacy service. 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 Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 17 basis. In addition the day centre can be used as a resource during evenings and at weekends. A number of positive comments were made regarding the day centre as residents (primarily respite) are able to attend this facility. Activities for long stay residents appear to be limited, this was re- confirmed by residents during discussions in the bungalows as well as by staff members. One respite resident stated that there wasn’t a lot to do other than sit in your chair until lunch. Activities within the bungalows seem to consist of watch television or listening to music. The cook was on annual leave during the period when this inspection took place. As a result agency cooks were in place. It was of some concern that the potatoes for the following day were peeled and left in a saucepan of water some 22 hours before they would be served. The registered manager stated that they would be replaced. The menu on the first day of this visit consisted of leek soup, shepherds pie, green beans and gravy or jacket potato and salad. Tea was going to be ham salad, a choice of sandwiches and fruitcake. It was noted that on some bungalows nobody had the soup while on others residents were given soup in either a bowl or a mug to suit requirements. One resident commented that that the soup was ‘ hot . .very nice.’ One relative seen during the inspection stated that his mother says that the ‘food is really good.’ The crockery on one bungalow was noted to be chipped and in need of replacement. It was noted that only one vegetable was served with the mid day meal. One carer consulted confirmed that it was the norm to have one vegetable, not including the potatoes. On consulting the menu this fact was confirmed with the exception of Sundays when two vegetables are provided in addition to roast and boiled potatoes. Taking the above into consideration the registered manager should consider how the recommended 5 portions of fruit and vegetables per day is achieved. In addition she should consider the possibility that some residents may not like certain vegetables which currently could result in individuals having no vegetables at all. A page from BCOP’s web site regarding Blackmore House was on display. It stated ‘The main meal of the day is a three course home cooked lunch which residents can select from a menu with an alternative choice.’ The above statement was discussed with the registered manager, as it did not appear to be an accurate description of the menu offered. Blackmore House DS0000018462.V334932.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to people living within the home. Staff training is taking place to provide additional protection to residents against abusive practices. EVIDENCE: The commission for social care inspection have received no concerns, complaints or allegations regarding the service offered at Blackmore since the last inspection. The registered manager stated that no formal complaints have been received at the home since the previous inspection. Information regarding the home’s complaints procedure including details of the commission was displayed near to the main entrance. People consulted had knowledge of how to report any concerns or complaints should the need arise. The pre-inspection questionnaire completed by the registered manager stated that no referrals have taken place regarding any allegations of actual or potential abuse since the last inspection. A discussion took place during this inspection between a number of senior carers and the inspector regarding safeguarding vulnerable people. It was Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 19 evident during this discussion that the staff concerned took their responsibilities to safeguard people living in the home seriously. Staff training took place the day before the second part of this inspection regarding the safeguarding / protection of adults involving about a third of the workforce. Additional dates are to be arranged to ensure that all members of staff have received this training. The corporative document regarding safeguarding adults (protection of vulnerable people) is in need of reviewing and up dating. The document needs to include reference to the Worcestershire guidelines and the Commission for Social Care Inspection. Blackmore House DS0000018462.V334932.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some environmental matters are in need of attention. The lack of progress regarding one physical aspect of the home could potentially place people within the home at risk. EVIDENCE: Blackmore House 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 Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 21 communal bathroom and communal toilet facilities. None of the bedrooms have en-suite facilities. 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 2 years ago and look domestic in character. The majority of bedrooms fall below 10m² usable floor space; this is compensated by additional communal space. Bedrooms are lockable it was noted that one resident held her own bedroom key and staff confirmed to the resident concerned that they had locked her room. Not all bedrooms have a lockable piece of furniture. People living at Blackmore House on a long-term basis are able to personalise their own bedroom with furniture and ornaments. As many bedrooms are used for respite purposes these bedrooms tend to be more functional. The furniture within a number of bedrooms are showing signs of wear and tear and in need of replacement. Some bedrooms not in use at the time of the visit had an aroma within them. The communal areas of the home were odour free. One visitor to the home commented on the fact that the home is free from smells. The majority of respondents to the questionnaires issued by the commission stated that the home is usually clean. One comment was made about a un- fresh aroma in a bedroom (different to the one mentioned above) but stated that the room was frequently cleaned to try and reduce the odour. A previous report recommended that the manager carried out an audit upon the brakes fitted to bed legs to ensure there suitability. This recommendation was not re assessed however the manager was confident that no concerns existed. The communal areas of the home remain comfortable although paintwork is damaged in a number of areas. The carpet in the dining room part of Brocksmyle bungalow is stained and the carpet near to a toilet is a trip hazard. The plaster work in one bedroom was damaged and the bedroom is in need of redecoration. 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. One toilet area in particular had an offensive odour within it. The registered manager confirmed that she is continuing to seek a new system of dealing with clinical waste. The manager confirmed that one of the two washing machines has a sluice facility and operates in line with the Water Regulations. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 22 A previous inspection report noted that the bathroom within both of the larger bungalows contained a newly fitted electric overhead hoist. One member of staff stated that she had not received any training upon the safe use of this equipment. It was stated that the majority of residents use the showers fitted within the same bathrooms. Bars of soap were located in each of the large bathrooms. The potential sharing of bars of soap is an infection control matter. Liquid soap and paper towels were available within the toilets but not within the large bathrooms. Bathroom doors have a pictorial image of a bath on them to assist people using the service with a dementia type illness find their way around the home. Some toilets had a pictorial image while others did not. The roof over the main corridor leading to each of the units is made from glass. Concerns regarding the extreme heat in the corridor as a result of the roof were included within the last inspection report. Although ceiling fans are in place it was again noted during this inspection that the corridor was uncomfortably hot with the suns rays coming through the glass. The registered manager and the assistant manager both stated that discussions with the landlord were on going regarding methods of combating what is potentially a serious health and welfare issue due to the risks of sun stroke. One relative described the corridor as’ far, far far too hot.’ Some bricks which form part of the drive / footpath from the car park had become loose and were a potential trip hazard. Blackmore House DS0000018462.V334932.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People residing within the home are able to have their care needs met by staff who are generally trained to deliver that care and by carers who have undergone a suitable recruitment process. EVIDENCE: Prior to this inspection the commission received a number of questionnaires from relatives. Many of these made reference to the staff at Blackmore House with the following comments ‘Staff at Blackmore always listen to all our requests and fully engage us with suggestions about *** care and her needs.’ ‘Staff are very motivated – they know him well and have his interests at the centre of their care.’ ‘always plenty of staff available – they always genuinely take an interest in her needs and wishes.’ Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 24 During the visit to the home one relative described the staff as ‘excellent – put residents at ease.’ The staff rota was viewed and evidenced that normally 3 or 4 carers are on duty during the morning plus at least 1 senior carer. The afternoon shift consists of 3 carers plus a senior. The number of senior staff on duty often depends upon whether any admissions or discharges are scheduled to take place. Care staff usually work on a particular bungalow. Senior carers oversee particular bungalows and the staff working within that team. The night shift is covered by 2 waking carers. Agency staff are used at Blackmore House to cover staff shortages. The preinspection questionnaire indicated the number of shifts which needed to be covered over a 8 week period. Although the number of shifts needing covering was fairly high it was noted that continuity of care delivery was addressed by having regular agency staff who therefore are able to gain some knowledge of residents needs. No domestic staff were on duty at the start of the first visit to the home although it was reported that some would be working later that day. The assistant manager interviewed a candidate for a 20-hour domestic post on the day of the inspection. The number of staff on duty was sufficient taking into account the number of people living within the home. When determining the number of staff to be on duty the layout of the home needs to be taken into consideration. The files of two recently appointed members of staff were viewed. It was evident that two references and a CRB (Criminal Records Bureau) disclosure were obtained prior to employment starting. The application form of one employee did not detail the names of the referees. Interview notes are kept and held on file. A well-managed and up to date staff training matrix is in place. The document is colour coded to show staff who are in need of training refreshers or staff who have training booked. The majority of staff have attended the necessary mandatory training although a few gaps were evident. A total of 13 carers hold a level 2 NVQ (National Vocational Qualification) while another 2 carers hold a level 3 qualification. As a total of 26 carers, including bank (relief) staff, are employed at Blackmore House the number of qualified staff equates to 55 of the workforce which is slightly above the National Minimum Standard. Blackmore House DS0000018462.V334932.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. An experienced manager manages Blackmore House. Monitoring systems including quality assurance matters need to be developed further to ensure that the views of people using the service are established and acted upon. Some health and safety matters are in need of attention to ensure that people living within the home are not placed at potential risk. EVIDENCE: At the time of the previous inspection the registered manager reported that she had almost completed the Registered Managers Award (RMA), which is a level 4 NVQ (National Vocational Qualification) in management. The manager Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 26 now expects to have completed this training by the end of this year. The assistant manager has delegated responsibility for administration within the home. The registered manager already holds the Diploma in Social Work; therefore once the RMA is completed she will hold the qualifications stipulated within the National Minimum Standards which were due to be held by registered managers by the end of 2005. One relative described the management within the home as ‘slick and well run’. The certificate of registration and a suitable certificate regarding public liability insurance were displayed near to the entrance hall. Although visits have taken place reports were either not provided or not available until recently. No annual development plan or business and financial plans were sought as part of this inspection. Blackmore House has the facilities to hold in safe keeping a small amount of money on behalf of residents. As part of this inspection the balances held on behalf of two residents were checked and found to match the records held with receipts in place to account for expenditure. On the vast majority of occasions only one member of staff had signed the expenditure sheets when money was withdrawn. It is good practice to have two signatures for all transactions. It was noted that persons such as the hairdresser sign a separate sheet therefore not disclosing information upon residents cash balances, this is good practice and should continue. Previous inspections highlighted that the home had no policy regarding the disposal of unknown items held within the safe. Although the policy was not viewed the inspector was informed that a policy is now in place. 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. Over the past few months these visits have taken place by a representative of the organisation and reports were available. A quality assurance system has been piloted at another BCOP care home. It was reported that meetings have taken place involving the manager and assistant manager at the home with the person who undertook the quality assurance within the other home. As no quality system is currently in place Blackmore House continues to not meet the associated National Minimum Standard. Conflicting information was given to the inspector regarding the frequency of formal supervision care staff receive. Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 27 The previous two reports highlighted concerns regarding a freezer which was consistently showing high temperature readings. This freezer was in urgent need of replacement to ensure that food was stored at a safe temperature. A new freezer was in place at the time of this inspection. Although some gaps were evident within the temperature log for fridges and freezers those recorded were within the acceptable range. Furthermore the previous inspection report highlighted some on going concerns regarding the cleanliness of the kitchen. It was reported that a deep clean took place during the previous inspection. The report concluded that the kitchen needed to be kept in a clean and hygienic state. Records regarding the testing of portable electrical equipment were not sought as the testing was taking place during the last inspection at the home and therefore known to exist. The previous inspection report highlighted a number of shortfalls regarding fire safety records. Some shortfalls were apparent as part of this inspection in relation to the visual checking of fire extinguishers and the testing of the emergency lighting. A door in Fairview bungalow was recorded as ‘still not repaired.’ The glazing in the patio doors on the small bungalows was noted to be up to BS6206. The suitability of glazing is detailed in the Workplace (Heath and Safety) Regulations 1992. Guidance issued by the Health and Safety Executive states ‘ serious injuries have occurred when people have fallen through glass windows. It may therefore be necessary to fit suitable safety film (or replace with safety glazing to BS 6262 to glass at or below waist level’. The guidance continues with ‘Glass doors and patio windows must be fitted with toughened or safety glass or covered with a protective film that prevents glass from shattering. They must have a conspicuous mark or feature sufficiently obvious that people will be unlikely to collide with them. When replacement glass is required then reference to BS 6262 should be made.’ Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 28 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 (1) (2) Requirement 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. This requirement with a timescale of 31/10/06 remains unmet. A revised timescale is given for full compliance. 2 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 This requirement with a timescale of 31/10/06 remains unmet in its entirety. A revised timescale is given. 3 OP9 13 (2) The registered manager must ensure that medication is administered as prescribed and that the Medication DS0000018462.V334932.R01.S.doc Timescale for action 31/07/07 31/07/07 06/06/07 Blackmore House Version 5.2 Page 30 Administration Record (MAR) sheets are completed correctly. This requirement with a timescale of 21/09/06 remains unmet in its entirety. A revised timescale is given and must be met in full. 4 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. This requirement is similar to one previously issued which remains unmet for people remaining within the bungalows. A revised timescale is given. 31/08/07 5 OP18 13 (6) 30/09/07 All staff must receive suitable training to prevent residents being placed at harm or suffering abuse. This requirement is part met with a time scale of 31/12/06. A new revised timescale is given for full compliance. 6 OP19 23 (2) (b) People living within the home must be provided with an environment that will not place them at risk of harm, danger or ill health. 31/08/07 7 OP26 13 (3) People living with the home must 31/07/07 not be exposed to odours which are unpleasant nor must they be placed at risk due to any DS0000018462.V334932.R01.S.doc Version 5.2 Page 31 Blackmore House shortfalls in infection control procedures. This requirement is similar to one previously issued with a timescale of 30/11/06 which remains unmet. A revised timescale is given. 8 OP38 23 (4) (c) The registered manager must ensure that the required fire safety test records are up to date and maintained. This requirement is similar to one previously issued with a number of timescales of 30/11/06 which remains going back to 10/11/05. A revised timescale is given which must be met. 12/06/07 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 OP15 Good Practice Recommendations The current menu should be reviewed to ensure that a real choice is available and that residents have 5 portions of fruit or vegetables available to them daily. The corporative document regarding safeguarding adults (protection of vulnerable people) should be reviewed and include reference to the Worcestershire guidelines. Opportunity should be taken to provide appropriate visual signage for residents to assist in the location of areas and rooms within the building. Opportunity should also be DS0000018462.V334932.R01.S.doc Version 5.2 Page 32 2 3 OP18 OP22 Blackmore House 4 5 OP26 taken to use colour and décor for orientation purposes. Efforts to determine a suitable method of disposing clinical waste should continue. A suitable quality assurance and monitoring system should be developed in line with National Minimum Standard number 33. Procedures regarding the withdrawal of residents money should be reviewed to safeguard residents and staff against abuse or allegations of abuse. OP33 6 OP35 Blackmore House DS0000018462.V334932.R01.S.doc Version 5.2 Page 33 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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