Inspection on 08/09/09 for Blackmore House

This inspection was carried out on 8th September 2009.

CQC found this care home to be providing an Adequate service.

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 07/11/08

Blackmore House 06/06/07

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

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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 13/03/2010.

Key inspection report Care homes for older people Name: Address: Blackmore House School Drive Bromsgrove Worcestershire B60 1AY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Blackmore House School Drive Bromsgrove Worcestershire B60 1AY 01527575222 F/P01527575222 manager.bmhouse@bcop.org.uk www.bcop.org.uk Broadening Choices for Older People Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 28 Dementia (DE) 28 Date of last inspection Brief description of the care home Blackmore House was built in 1989 as a care home for older people. The home is single storey and incorporates an activity centre that helps to maintain links with the local community. The home provides single bedroom accommodation for a total of 28 people who are accommodated in 5 bungalows. Each bungalow represents a virtually Care Homes for Older People Page 4 of 29 Over 65 0 28 28 0 0 7 1 1 2 0 0 8 Brief description of the care home self-contained living environment with a lounge/dining space, toilets and bathrooms, bedroom accommodation and a kitchenette. Three of the bungalows each accommodate 4 people, while two of the bungalows accommodate 8 people. Out of the 28 places a total of 4 are occupied by people on a long stay basis. The remain 24 places are now deicated to providing respite (short stay). 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 block purchased by Worcestershire County Council Adult Services the standard bed fee. For further information regarding fees the reader should contact the service directly. Additional charges apply for items such as private chiropody, toiletries, magazines, newspapers and hairdressing. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at Blackmore House was carried out during November 2008. This inspection was unannounced therefore nobody in the home knew we were coming. An Expert by Experience (called the Expert in this report) helped with our inspection. This is someone with relevant personal experience who is trained to help inspectors on visits to care services. The Expert observes what happens in homes and talks to staff and people living there about their lifestyle and to get their views of the service. They make a report of their findings. The focus of our inspections is upon the outcomes for people receiving a service and includes where possible the views of people living there. The process we use considers the homes capacity to meet regulatory requirements, standards of practices and looks at areas of the service that need further development. Prior to our visit we looked at the information we were aware of since our last visit. We Care Homes for Older People Page 6 of 29 requested an Annual Quality Assurance Assessment (AQAA) from the home. The AQAA is a document completed by the service and provides us with information about the home and how they believe they are meeting the needs of people using the service. We sent out some questionnaires to a sample number of people. As the service is primarily short stay we were aware that it was unlikely that people we sent surveys to in advance of the visit would still be staying at the home at the time of our inspection. We looked around the home. In addition we also viewed records in relation to some people living in the home or who had lived in the home. We saw records such as care plans, risk assessments and medication records. We also viewed relating to some members of staff and others regarding health and safety. We spoke to the manager, the assistant manager, some staff members as well as residents and some visitors. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people make a choice about whether they would like to have a short stay at Blackmore House. People are invited to the home in order that their care needs can be discussed and assessed prior to the stay taking place. This helps to ensure that these needs can be met. Evidence: In our survey to residents we asked whether they had received enough information to help them decide whether the home was the right place for them. Everybody who answered this question told us that they had. The homes Statement of Purpose and Service Users Guide are combined into one document. The guide contains some useful information however it does not contain all the information listed within the National Minimum Standards such as the views of residents. Although some pages contain information about the service others appear to be standard pages for the orgainsation and do not reflect Blackmore House. For example the actions to take in the event of a fire mentions lifts but Blackmore House is all on one level it has no lifts. Care Homes for Older People Page 10 of 29 Evidence: During our previous inspection we suggested that it would be good to see consideration given to producing a separate document as a welcome pack giving information to each of the bungalows. During this inspection we were told that this suggestion was given consideration but at the moment this has not taken place. Blackmore House now only admits people for short stays. The Annual Quality Assurance Assessment (AQAA) stated that for all new residents to Blackmore House a meeting is arranged when they can visit the home. In order to ease people in to a respite stay day time visits or overnight stays are possible. The home would like to encourage the up take of this service in the future. During this inspection we saw staff showing people around the home having had an initial discussion with them to assess individual care needs. Where possible the home attempts to inform people which bedroom they will have during their respite stay. The home operates a system whereby they ask people to make an appointment for their admission to ensure that they do not have two people arriving at the same time and to ensure that staff are available to provide sufficient time for a smooth and reassuring transaction. A relative told us that she felt supported by staff at the home when her relative was admitted. The AQAA states that the home carries out a comprehensive pre assessment to guarantee we can offer a placement that meets the service users needs and family expectations. We saw information on a computer following a discussion held between a senior member of staff an potential resident and their family. The details obtained would be sufficient to develop an initial care plan to provide staff with information in order to meet the agreed care needs. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not always contain up to date information or details as to when changes were made to ensure that care needs are able to be met. People believe that they receive appropriate care and support. Generally people can be confident that they will receive their medicines as prescribed. Evidence: During this inspection we viewed a sample number of care plans and risk assessments. A care plan is a document designed to guide staff about the level of care required by each individual to ensure that identified needs are met and people receive the support they require. Care plans develop over a period of time as staff become more aware of peoples needs and what people are able to do. As Blackmore House has a considerable number of people coming and going due to their respite service it is vital that care needs are recognized and recorded in order that staff are able to become familiar with peoples needs. Care Homes for Older People Page 12 of 29 Evidence: Following the initial assessment a care plan is printed out from the computer. We saw some handwritten amendments on care plans however these were not dated. We saw records showing that a resident had fallen however this was not reflected in the care plan which stated fell four months ago. We saw a risk assessment regarding this person showing the risk as high however another sheet showed the risk as low. The assessment was not reviewed following the fall. We saw a body map dated August 2009 showing that somebody was sore. The care plan did not mentioned this therefore no strategies to treat the soreness or prevent further soreness were in place. Another care plan included details of a known risk regarding the person wandering and gave instructions to staff. We also saw a risk assessment regarding the wandering, which mentioned ensuring doors are secure but made no reference to monitoring. Care staff were however aware of the need to be vigilant. We are not aware of any incidents when the individual concerned was at any risk of becoming lost. The care plan was, although basic in places, sufficiently detailed for staff to carry out their duties. In our survey to people using the service we asked whether they receive the care and support they need. Everybody who responded stated that they did. People also told us that they get the medical care they need. The family of one resident told us that her relative looks forward to going there and is quite happy when he has to return for respite. One relative told the Expert by Experiance I am very happy to know that my mother is safe and happy here. As part of the inspection we assessed the management of medication within the home. Medication is suitably stored and a record of both room temperature and a fridge for storing certain types of medication are held, these records were in good order and showed that medication is safe. We viewed a sample number of MAR (Medication Administration Record) sheets and found the vast majority to be in good order. MAR sheets were completed satisfactorily although we saw that staff were using a code S for sleep which did not appear on the sheet with other codes as a key. We noted that one resident was on some eye drops for a period of 5 days. The MAR Care Homes for Older People Page 13 of 29 Evidence: sheet showed that the drops were administered earlier on the morning of our inspection however this was now the 8th day. Therefore staff had carried out the treatment for longer than prescribed by a medical practitioner. Immediate action was taken to remove these drops. Another course of eye drops was on the 7th day of a 7 day course. We did not see any indication on the MAR sheet to remind staff to discontinue the treatment. A number of audits were carried out to check the stock of medication against the records held. All of the audits we carried out balanced correctly. Some boxed medication did not have the date of opening recorded upon it which could of made the auditing more difficult. One person had, for a few days, run out of medication. A member of staff told us that they were awaiting family bringing in more medication for the person concerned. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to take part in social and recreational activities which reflect their personal preferences. People enjoy their meals and are offered a choice from the menu. Evidence: Blackmore House has an activity room. This room was previously called the day centre. Although the room is used for day care people who are living in the home are able to join in. Many individuals who receive respite attend the day centre when living in the community. The Service Users Guide suggests we also regulate day care however this is not the case. Once day care has finished for the day a greater emphasis is put into providing activities for people who are residing in the home. Some additional hours were made available for this to happen although these are not contracted to anybody in particular. This arrangement does not therefore happen every day. The AQAA states that Participation in social activities is encouraged for all service users, although we recongnise that not everyone will want to take part, so their decision is respected. Care Homes for Older People Page 15 of 29 Evidence: We asked people if activities are arranged that they can take part in. Everybody who returned a survey answered always. One member of staff told us that the home provides a stimulating environment with activities. The AQAA stated that over the last 12 months the home has liaised with others such as the Mental Health team regarding the provision of social activities. At the time of our visit the home was preparing for a Seaside Theme week. The idea was to recreate the environment of a typical British sea side resort around the 1940 50s. We saw a Punch and Judy tent which was being made. During our visit we saw a reminiscence session taking place. This was described by the Expert by Experience as well planned and very well received We also saw a game of musical bingo taking place which seemed to be enjoyed by those taking part. Staff were seen to be patient, encouraging and recognized peoples self worth. At the time of our visit BCOPs (Broadening Choices for Older People) charitable services manager was in the process of applying for grants for a reminiscence project within the home. One person stated that the service could be improved by providing more trips for people living in the home. On the AQAA, when asked what the service could do better, this was recognized as an area for improvement. Bromsgrove town centre is fairly close by and staff can, therefore at times, accompany people to the local shops. The manager informed us that following the death of a local vicar nobody is currently visiting the home in order to address peoples religious care needs. We were told that attempts are being made to remedy this shortfall. Outings to a local Methodist church centre for refreshments in their cafe do however take place. Two visitors were spoken to during our visit. Both of these people were happy with the care provided. We saw sheets used to record what people have selected for their mid day lunch and afternoon tea. These showed a wide range of food offered. A starter is provided each day comprising of dishes such as soup, fruit juice or sorbet. A choice of main meals is provided as well as a third alternative of jacket potato. The tea menu also shows a range of alternatives that are available often including a hot dish. In our survey we asked people whether they like the meals provided. The vast majority answered always. We were told that the menu is discussed with relatives when people are first admitted to Blackmore House to ensure the home has a knowledge of peoples likes Care Homes for Older People Page 16 of 29 Evidence: and dislikes. Staff were seen to be assisting people discreetly and sensitively with their meals. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although systems and procedures are in place people can not always be confident that concerns about the service will be responded to as needed. Staff training is provided regarding safeguarding although staff may need refresher training more frequently than they currently are. Evidence: The Service Users Guide contains information about the homes complaints procedure. It states that a leaflet is available which contains addresses of where comments, complaints and compliments can be sent. The guide needs to be amended to reflect changes with the regulator as the Commission for Social Care Inspection no longer exists. The terms of residency seen on one file also made reference to the former regulator but did inform people that the regulator can be contacted at any time. In our survey we asked if people know how to make a complaint about the service. Most people answered yes to this question. One person answered no but added never had the need. Since our last inspection we have sent one complaint received by us to the registered manager to investigated. We asked to be advised of the outcome. Although told verbally that the manager found no evidence to substantiate the matter we did not Care Homes for Older People Page 18 of 29 Evidence: receive a written reply. The AQAA stated that over the previous 12 months the home had introduced customer surveys and that these give service users the opportunity to voice any concerns and opinions they may have with the service we provide. While looking over some responses to questionnaires sent out by the service we came across a response from a relative of somebody who had received respite care at the home. The information returned stated that future respites were cancelled due to the care received and gave details of some concern. We inquired what had happened regarding this matter and were told that the person concerned had refused care to be delivered during the respite. Records indicated that the individual concerned was at risk of falling. We also saw records showing that the person refused care and was at times challenging to staff when they tried to assist. The comments were not however seen by the service as a complaint and no response had happened. The staff training matrix showed that the majority of staff have received training in PoVA (Protection of Vulnerable Adults) however for some staff this dated back to 2007. The matrix highlighted staff who had not received this training and showed a scheduled date for when this was going to take place.One newer member of staff confirmed that she had not received any training in safeguarding but was aware that it was to be provided in the future. Senior members of staff have received training in the Mental Capacity Act however this again was during 2007. More recently the manager attended training in the Deprivation of Liberty Standards. The assistant manager is able to apply for CRB (Criminal Records Bureau) checks on new members of staff. It is policy within the organisation to reapply for CRB checks every three years. We saw the file of a newly appointed member of staff which contained a current enhanced CRB. Having these checks helps to protect people from unsuitable staff working in the home. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a pleasant living environment which is well maintained. Evidence: Blackmore House is separated into five bungalows. Each of the bungalows has an entrance off a central glass domed corridor. Two of the bungalows accommodate 8 people while the remaining three accommodate 4 people. Each bungalow has a homely feel about it containing a dining area, a lounge area, toilet and bathing facilities as well as bedrooms. All the bedrooms are single occupancy, none of them have en-suite facilities. One relative described the home as very comfortable and a home from home which is very reassuring.The Expert by Experiance described the home as bright and homely. The central corridor has seating areas so that people can sit and relax in a more open area or have a rest if walking down the corridor to, for example, the activities area. Over recent inspections we have identified the fact that the corridor became uncomfortably hot during warm weather due to the glass roof. For a period of time staff in the home were having to try and reduce the temperature by opening doors, having fans in place and discouraging people remaining in the corridor for long periods of time. During this inspection we were informed that a film had been placed over the glass which appears to have solved the problem. Care Homes for Older People Page 20 of 29 Evidence: Since the previous inspection the home has introduced some visual signage and a colour scheme to assist people with a dementia type illness find their way around the home. The colour scheme extends to signage on the bungalow door from the central corridor as well as signage within the bungalow itself. Within each bungalow is a white board which shows information such as the name of the carer on duty within that area of the home. The decoration around the home is adequate. We previously commented on some varnished areas that were painted over without any sanding down. We saw places where the paint is peeling off revealing the original varnish. Some skirting boards have damaged paint work as a result of wheelchairs knocking into them. A hairdressing room is available. The hairdresser visits the home once every two weeks. This room was tidier than when we last visited when we found it was used as a storage area. The items are now hidden behind a shower curtain in a shower unit which is not used. We have previously found the laundry to be suitable and organised. Since our previous inspection additional fencing has been put around the perimeter of the home to improve safety. The garden is well maintained but it lacks colour and suitable seating for people to sit outside. General standards of cleanliness and hygiene within the home were good. We asked in our survey whether people believe the home to be fresh and clean, the majority of people responded always. The carpet in a number of bedrooms has been replaced with polywood heavy duty safety flooring as a means to combat some issues regarding odour. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training to ensure they have the skills they need to carry out their job. People are protected by good recruitment procedures. Evidence: In our surveys sent to staff we asked whether there are enough staff to meet the individual needs of people living in the home. The majority of those returned replied always while the remainder answered usually. Staffing levels during the day remain as reported within previous inspection reports. Three carers plus a floater are on duty in addition to senior carers and the registered manager. In addition to care staff are catering staff and domestic staff. The Expert by Experience told us that staff appear friendly and approachable and seem to treat the residents with courtesy and patience. One relative wrote on our questionnaire Staff have great empathy for people with Alzheimers and their family. Another relative wrote, in relation to the staff team very friendly but also very professional in their approach and attitude to all our needs. Care Homes for Older People Page 22 of 29 Evidence: The AQAA stated that 16 members of staff have a NVQ level 2 or above. The Service Users Guide says that All care staff have or are working towards National Vocational Qualifications in care. We were told that three senior care assistants have a level three NVQ and three staff are working towards completing the course. The training matrix, given to use during our visit, confirmed that 16 people have completed level 2 of this training which is 66 of the work force. One member of staff told us that she is provided with up to date training. The training matrix demonstrates that staff have undertaken training however as highlighted elsewhere within this report some of the training was provided some years ago. Within the previous inspection report we highlighted the need for more staff to undertake a two day course in dementia care. Everybody has attended basic training in dementia care however for many people this was over 3 years ago. Since our last inspection three members of staff have attended the two day course. We were informed by the assistant manager that more dates for the two day training are coming up and that it is intended that all staff undertake this training. As Blackmore House is a specialist home for people with a dementia illness suitable training regarding strategies to care for people is important. We viewed the records of a newly appointed member of staff and found that good recruitment procedures were followed in order to safeguarding people from unsuitable staff working in the home. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in some management systems and the introduction of a quality assurance system could ensure that people are safer and have greater confidence in the service provided. Evidence: The registered manager is a qualified social worker. She also holds a diploma in welfare studies and is a NVQ (National Vocational Qualification) assessor. Within recent inspection reports we have highlighted that the manager had not completed the Registered Managers Award (RMA). The RMA is a NVQ level 4 in management. It is an expectation within the National Minimum Standards, first introduced in 2002, that a manager of a care service holds this qualification. During this inspection the manager confirmed that she had not completed the award and stated that she was awaiting the introduction of a new qualification. Blackmore House does not have a deputy manager. The assistant manager takes on primary responsibility for administration tasks including the booking of respite stays Care Homes for Older People Page 24 of 29 Evidence: and staff training. The assistant manager has a delegated responsibility for all non care staff such as those involved in catering and domestic work. A team of senior carers take on the responsibility for care duties in the absence of the registered manager. Our previous inspection report stated that quality assurances systems within Blackmore House needed to be developed further to ensure that people using the service are safeguarded from potential harm and as a means to effectively monitor how outcomes are met. The AQAA indicated that the proposed quality assurance system had not commenced. It is planned to introduce BCOPS quality assurance system into the home in the near future. A manual containing the polices and procedures relating to this system is in place and the home intends to work towards the implementation of it. The registered manager showed us a quality assurance system held within the home. This system was however one prepared by Hereford and Worcester County Council a considerable time ago and unlikely to be relevant to current expectations, standards and legislation. We saw a number of surveys returned to the home. One of these contained a concern about the service as mentioned earlier within this report. The vast majority of the comments returned were however complimentary about the service provided. The results of these surveys had not been collated. The manager told us that regular visits are undertaken by a representative of the organization. Following visits which need to be on a monthly basis, a written report needs to be prepared upon the findings of the visit. These reports are to be available for the purpose of inspection. No reports were available for us to view on this occasion. The current certificate of registration was on display in the entrance hall. Staff confirmed that they receive supervision in line with the associated National Minimum Standard. The registered manager carries out supervision of senior carers who in turn supervise the care staff. Residents or their representatives are able to deposit small amounts of cash for safekeeping. We checked the balances held in relation to a small sample of people and found them to be correct against the written records. We recommended that receipts are given when money is handed in to the home in order to safeguard everybody Care Homes for Older People Page 25 of 29 Evidence: against any abuse or allegations. We viewed some records regarding health and safety. The weekly test of the fire alarm was seen to have taken place most weeks and is done in sequential order. We did notice some gaps when it is believed the person who carries out this task was on holiday. Nobody else is designated to carry out this task, this should be addressed to ensure that the safety checks are carried out as needed. The home has two portable hoists, it was evident that these are serviced as needed. The last service took place during May 2009. All equipment that lifts people needs to be serviced / checked by a competent person every 6 months. The home also has some over head hoists on a track in two of the bathrooms. People told us that they are not used, a sticker on one of them indicated that they were last serviced during September 2008. The registered manager was unable to clarify whether a more recent service had taken place. Due to not using the over head hoists nobody currently has a bath, instead everybody has a shower. Although hot water taps have a device fitted to control the temperature these are not fail safe and therefore water temperatures should routinely be checked. This check was not happening on a monthly basis. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 Risk assessments must identify strategies to eliminate or minimise potential risks. To properly safeguard people living at the home from identifiable harm 30/01/2009 Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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