CARE HOMES FOR OLDER PEOPLE
Blackwell Vale Nursing Home Rear 61 Durdar Road Carlisle Cumbria CA2 4SE Lead Inspector
Marian Whittam Unannounced Inspection 30th January 2007 10:00 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 Blackwell Vale Nursing Home DS0000010111.V323427.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. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Blackwell Vale Nursing Home Address Rear 61 Durdar Road Carlisle Cumbria CA2 4SE 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) 01228 512456 01228 810994 www.fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Helen Joyce Smallbone Care Home 60 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (28) of places Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 60 service users to include: up to 28 service users in the category of OP (Older people not falling within any other category) up to 32 service users in the category of DE(E) (Dementia over 65 years of age) Date of last inspection 26th April 2006 Brief Description of the Service: Blackwell Vale Care Home is owned by Four Seasons Health Care Limited and is located on the outskirts of Carlisle near to the racecourse. There is a bus stop nearby and ample car parking is provided. The home is divided into three areas with the ground floor providing nursing care for service users within the category of registration of Older People. The second floor accommodates and provides nursing care for those service users who are within the category of registration of Older People with dementia related illnesses. The home was purpose built and each unit has its own lounge and dining room. There is a conservatory and other lounge areas on the ground floor. Fees payable at the home are from £385.00 a week up to £525. 00 a week as at the time of the inspection on 30th January 2007. There are additional charges for hairdressing, private chiropody, personal newspapers and magazines, toiletries and taxis for personal travel. The home makes information about its services available through its own brochures, its service user guide and statement of purpose. These are available within the home. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 30th January 2007. The inspection was carried out by two inspectors who looked around the home and spoke with the manager, residents, with visitors to the home and with staff members. Staff recruitment records, training records, medication handling records and care plans were examined and a selection of records required by regulation. The home provided, in good time, information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, sent out by CSCI, were returned before the inspection took place and also provided information about their experiences of the home. What the service does well:
Residents spoken to like living in the home and spoke highly of the staff and the care and support they receive from them. One described the home as “sound’” and the staff as “smashing”, they liked living at the home but said that they would rather be in their own home but knows this is not possible so is “as happy as I can be anywhere but at home”. “The place is like a home from home” and “ the nurses, carers and manager have been outstanding” were two comments made by other residents. Residents commented on how friendly the home is and the kindness of the staff. Relatives survey responses were also positive with one saying, “The staff at the nursing home show both kindness and professionalism”. Throughout the day the inspectors saw that staff and residents get on well together, that staff know the residents and have a good rapport with them. The staff are friendly and welcoming and there is a happy and relaxed atmosphere about the home. Staff do provide support to residents and to their families especially during the difficult time when residents first come into the home. Overall the admission process is handled well even, as some relatives and residents pointed out, when it is done at short notice. The home maintains a good standard of catering that residents found acceptable with the majority of food home made, reflecting residents
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 6 preferences and choice. Efforts are made to ensure residents are offered a varied and nutritious menu that allows choice. The management has responded positively to the inspection process and in addressing areas of weakness and keeps the Commission for Social Care Inspection (CSCI) informed of problems and changes and seeks advice in a timely way. What has improved since the last inspection?
The home has clearly been working hard towards meeting the requirements made at the last key inspection and has been making good progress in important areas of care. Care plans have been improved and the documentation seen was complete and reflected the observed needs of residents. Care plans, along with medication records, are subject to audit and this has greatly improved the effectiveness of these systems. Any errors or omissions are being quickly identified through the audit system. Improvements in the medication practices and records seen at the last visit to the home have been maintained and records are in good order. One resident said that the “medicines were always given on time” and they felt that the nurses were always “considerate”. The reinstatement of regular staff meetings for care and nursing staff and for residents and relatives is a positive move. These meetings can provide opportunities for residents and relatives to put forward ideas and opinions that can affect the way the home is run for them and for staff to be more involved in an open and positive management planning. The home needs to keep building on this improved involvement and consultation. Alongside staff meetings the improved provision of regular supervision should help the manager as they develop training and annual objectives for the home and monitor practices in the workplace. The home has updated the statement of purpose to give up to date information for current and prospective residents. Although the home has not found a permanent solution for the problems with ventilation on the upper floors it is now addressing this and involving appropriate professionals to remedy it. The registered manager should make sure they keep CSCI informed about progress on improving the ventilation system. There have been improvements in the general decoration of some bedrooms and the provision of appropriate carpeting to counter odours in areas of the home has also improved the environment for residents. The grounds are much tidier with the old furniture having been removed from the rear of the building. The home has responded well to making some of the improvements required of it to meet national minimum standards and their challenge lies in maintaining those achieved and continuing to build upon them.
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 8 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. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 9 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 Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has up to date information in the statement of purpose and service user guide and pre admission assessments are in place to ensure individual needs will be met on admission. EVIDENCE: The home’s admission process includes a pre admission assessment of individual needs for residents before admission to the home. There is a six week trial period for new residents, during which time the homes assessment is continued to see that resident’s needs are being met and that they want to stay in the home. Resident’s have in the past used respite as a way of being introduced to the service. Information is gathered from other agencies on care and health needs and where appropriate a social services management plan is obtained and held on file. Where appropriate families, other specialised care agencies and
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 11 professionals are being involved in providing information on the health and personal needs to be met for residents. All prospective residents and their families are invited and encouraged to visit the home prior to admission. This gives them an opportunity to assess the quality and suitability of the home. One resident commented on how the manager visited them at home before they moved in even though it was an emergency admission. The resident also said that despite it being an emergency they were, “pleased I came in”. A relative commented on the admission process saying, “ it was done at very short notice, but it was done really well”. One resident said they liked it at the home, “I wouldn’t have stayed for so long and would have looked for somewhere else if I was not happy”. They said they had looked around several homes before settling on Blackwell Vale, and chose this home because it was “very homely”. A new resident was seen and spoken with as they were being admitted into the home. One member of staff with them helping them to settle in, a second member of staff came in to say hello and stayed and looked at pictures with them that were important to the resident. The staff both had different approaches to helping the resident settle in but were both very kind and considerate, they came across as being very caring towards the new resident who told them what “nice lassies” they were. The home has a statement of purpose and service user guide and these have been updated to reflect changes in the organisation and provide up to date information for the residents. All residents are given the information pack when they come to the home. The home also has an informative colour brochure that is part of its information pack for new and prospective residents. As a good practice measure the home could provide this information for residents in different formats such as large print of a tape for the visually impaired Residents had contracts and terms of conditions in place, also social services contracts and contracts for the provision of nursing care are on file. Blackwell Vale Nursing Home DS0000010111.V323427.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): NMS 7, 8, 9 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning and assessment system in place to provide information for appropriate staff to meet resident’s individual health, personal and social care needs. EVIDENCE: All residents have a plan of care plan and relevant personal and clinical risk assessments in place that are being reviewed and updated. The care plans contain relevant information and new and changing needs are added as necessary and old problems discontinued. The social history section is particularly good, with a lot of personal history, likes and dislikes, wishes for end of life and funeral arrangements as well as other relevant information. The home has a policy in place for supporting residents and relatives at the end stages of life. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 13 The home has a comprehensive set of instructions on what to do in the event of the death of a resident that looks at the beliefs and processes of different religions and cultures. The home also uses the Liverpool Palliative Care Pathway for residents who need terminal care. The manager confirmed that training and support on palliative care and the care pathways was being provided by the specialist Macmillan nurses at the local hospital. The care plans for the residents on the EMI unit are the same as the plans for the residents on the elderly care unit. However, staff have added into care plans individual’s psychological and social problems, which does show that they are aware of the importance of these issues. The manager was able to provide examples of the new paperwork planned for the residents on the EMI unit. This new documentation is due to be implemented early this year and will make a significant difference to the way the needs of this group of residents are considered. The home has also been working with the outreach team from the mental health unit on care mapping for residents with dementia and on reviewing medication. Observation during the inspection, records of care planning and conversations with residents and relatives suggests that residents are treated very much as individuals with their dignity, independence and choice promoted by staff. Relatives survey responses indicate they feel welcome in the home and kept up to date on any changes affecting their relative. One resident described the staff as “very nice and very helpful” and when asked how they felt treated they said, “the staff are very kind, it is not embarrassing when they have to help me with a bath and things, I can’t do much for myself, but the staff don’t make me feel a bother, we can have a laugh and a joke”. The home has a comprehensive set of polices and procedures that deal with medication issues, including administration, storage, disposal and selfadministration. Medication practices, the storage of medicines and their handling is of a good standard and has improved significantly since the last key inspection. The home uses a single drug dispensing system and printed medication administration records (MAR charts). All drugs on the medication records examined have been recorded correctly and the correct amount of medication dispensed. A weekly audit is being undertaken on the medication charts, these recorded relevant information and followed the homes policy. Any errors or omissions can be quickly identified using the audit tool and helps maintain the improved standard of medication record keeping and practice Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 14 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): NMS 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. Dietary needs are catered for and offer choice but recreational and social activities are limited for residents. EVIDENCE: The home has a very basic activities timetable at present that is not fully meeting the expectations and assessed needs of all the residents. The home does not have an activities coordinator at present to organise and oversee the provision of activities that meet individual’s different social, cultural and recreational needs. This does have an impact on the residents in terms of meeting their expectations and preferences for social and recreational needs. However, residents and staff did explain that the current staff are trying hard to provide the residents with as many activities as they can, examples were given of staff taking residents out for a walk to the local beauty spot, and evidence was seen in two care plans were staff have had one to one discussions with one resident and had given another resident manicures/hand massage. The manager also confirmed that in the short term she has brought in more external entertainers. Notices were displayed on the day room walls
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 15 about a musical afternoon that week. With the current staffing levels in the home it is not possible for the care and nursing staff to provide the residents with a full and regular activities timetable or one suited to individual social needs and capabilities. The home had information about an advocacy service displayed on the wall for the residents and relatives to view and access if wanted. The manager operates an open door policy for visitors, there are no time restrictions and visitors are offered refreshments during their visit. During the visit the manager was seen to spend time speaking with relatives especially those of newer residents. The home produces all its own meals on site; the kitchen appeared to be reasonably well equipped and was clean and tidy. The head cook keeps copies of the meals the residents have chosen and is aware of the likes and dislikes of the majority of the residents. The home has two menus, one is the main menu for the day, and this is run on a four-week rota. The second menu is available at any time and offers more choice in what were described as “snacky meals”. This included such things such as pasties, sandwiches and salads. Residents spoken with said they were happy with the choice and quality of the meals. One resident said the food was always nice, with a good variety and that the “cooks are lovely”, saying that they ate what they were given because they were not fussy, but was aware that if they did not like a meal they could ask for something different. Another felt “the food is ‘passable”, but went on to say that they are ”quite fussy,” but that they often ask for something different to what is on the menu and always gets offered different choices. The lunch that was served on the day of the inspection visit was well presented and freshly cooked; residents were seen having alternative meals. Some residents require a soft diet and the head cook confirmed that all the elements of the meal are liquidised separately to allow the residents a choice of which parts they eat. This also helps to make the meal seem more “like a normal meal on the plate, it looks much nicer”. . Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 16 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): NMS 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints and adult protection procedures in place to help protect residents interests and welfare. EVIDENCE: Since the last inspection the home has not logged any complaints or made any adult protection referrals. The home has a clear complaints procedure and a system for logging complaints for investigation. The procedure is displayed in the home and in the service user guide given to all residents on admission. However it is not available in alternative formats such as large print or audio for residents with disabilities and visual impairments. Although care plans and pre inspection information indicates at least 6 residents have visual impairments. Residents spoken to said that they knew whom they would speak to if they were not happy. They would speak to their carers or the manager and one said they would speak to the manager if they had any problems and described her as ‘very nice’ and “approachable”. Those spoken with felt confident the manager and staff would listen and take action if they were unhappy. This is reflected in survey responses as well. Advocacy services are available to residents if they want someone to act on their behalf and information on this is displayed.
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 17 The home has policies and procedures in place on adult protection and physical intervention and this has been reviewed and reflects multi agency guidance. Staff are given training on protecting vulnerable adults during their induction and they complete workbooks on this as part of the training. However training information and records do not make it clear if all staff training on adult protection and physical intervention is current and up to date. The manager confirmed that they have obtained information on Adult protection ‘Training the Trainers’ Course. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 18 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): NMS 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately maintained for residents with the equipment needed to promote mobility and independence although some areas of the grounds require general improvement so residents can make better use of them. EVIDENCE: The home is currently does not have a maintenance person to take care of daily maintenance and safety checks. The cook is presently carrying out the safety checks as an additional duty to make sure that these checks are done. Rooms are being decorated and new furniture provided on a rolling programme and this needs to continue to promote a consistent standard of decoration in bedrooms. Rooms that have been refurbished so far are of a good standard. The home is generally clean in areas used by residents but there were some cobwebs on a stairwell that should be attended to.
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 19 The manager has identified the areas where unpleasant odours persist, due to residents with complex continence needs. Carpeting that is designed to help combat the problem has been installed and is helping the problem. The lounges on the units are attractively decorated with suitable furnishing for residents but it was observed that call bells are not accessible to residents in there. One resident confirmed this problem saying that they “had a problem with using the day room”, as there are no call bells available. The resident said that they have to wait for staff to go past and then ”I try and get their attention, if I can’t get them the first time I hope I get them the next time’. Clearly this is unacceptable and the home must make sure that call systems with an alarm facility are easily accessible in the lounges and all other areas of the home used by residents and that the systems are suited to their abilities. The problem with the temperature on the top floor being too hot at times is being addressed to improve the environment for residents. An engineer is due to visit during the week with the accommodation manager to assess what can be done. Due to the nature of the problem it will take some time to effect a long-term solution but action to improve this is beginning to happen. The home has an onsite laundry, employing two full time laundry staff. The laundry assistants were observed to follow good hygiene practices using gloves and aprons when dealing with the dirty laundry. One resident had previously commented that some times they had to wait a while for their laundry to be returned. A better system of monitoring the labelling of resident’s clothing is needed before clothes go to the laundry to ensure that the residents receive their personal laundry back in a timely manner. The grounds are much tidier than previously but do not provide a comfortable and attractive outdoor environment for residents. There is no suitable seating or safe recreational areas for residents to use especially those with physical and cognitive impairments. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 20 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): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has effective recruitment procedures and adequate levels of staff to meet resident’s personal care needs. EVIDENCE: The levels of staff and skill mix in the home are adequate to provide personal care to residents and basic nursing care to meet their assessed physical needs. The home has had to use agency staff to cover shifts on a regular basis and does have some staff vacancies. Residents spoken with felt that the care they received met their personal care needs. One said that “the staff have a lot to do” and the nurse call bells can “take a while to answer, not too long, at the most 10 minutes”. When asked if they felt 10 minutes was a long time to wait for a nurse they said “the staff will always run if it’s an emergency”. Residents spoken with felt the staff were “helpful” and “kind” when providing care for them, she said that because they were so busy they didn’t really have time to just sit and talk but they were always chatty and pleasant when they were helping them such as when they got up and dressed in the morning. Physical needs are evidently being met although interpersonal and recreational ones less so as the home does not have an activities coordinator at present. This does have an impact on the residents in terms of meeting their expectations and preferences for social and recreational needs.
Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 21 Due to the complexity of some residents needs and their physical frailty 1 to 1 social support and interaction is more appropriate than group activities. The home is still working towards achieving the 50 ratio of staff with NVQ level 2 it is required to have. The home does now have its own NVQ assessor on the staff so this should help progress. The home has individual staff training files for staff but these are not all up to date so it is difficult to assess, from the records with any certainty, what training individual staff have been given. This was evident for moving and handling training, which was behind according to records seen. The home does not have a current training or development plan for this year and a more systematic approach needs to be take to the organisation and recording of training being given so it is evident who has done what, when and when it is to be updated. The manager is aware of this need and has begun to address the need to ensure training and development programme is up to date and reflects staff needs. Robust recruitment procedures and practices are in place and are being observed. Records of recent staff recruitment show that all necessary checks to safeguard residents are being done prior to staff starting work. Staff have clear job descriptions and terms and conditions of employment. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 22 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): NMS 31, 32, 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. There are procedures are in place to promote and safeguard resident’s welfare and financial interests. EVIDENCE: The registered manager is appropriately qualified and has experience of working with older people. During the visit it was observed that the manager operated an open door policy for staff, residents and relatives and spent time talking with relatives. This was evident for a new residents family as they adjusted to their relative coming into residential care. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 23 Staff, residents and relatives spoke well of the manager and one relative pointed out the emphasis placed on helping them by the manager and care team and helping them adjust. The records kept show that staff are being given regular supervision, individually and where appropriate in a group. Group supervision has been used well where staff have a particular issue they want additional help with, in one case this was a palliative care issue that affected a number of staff. However the manager does need to make sure they remain focused and continue to identify and prioritise what they need to do to continue to improve the service. Several improvements are evident and the manager has to continue to build on this to make a uniformly good service for residents that reflects what they want from the service and allows then to participate in the way the home is run. The home is now holding staff meetings for carers and nursing staff and has recently held a relatives and residents cheese and wine evening with speakers, although this was not well attended. The home does use residents and relatives satisfaction surveys to gauge opinions and the last one indicated a good level of satisfaction. Policies and procedures are being reviewed and the home is carrying out systematic audits of care plans and medications with good effects upon practice. There are procedures in place to safe guard the residents finances with records kept within the home. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety. There is evidence that appropriate water testing and cleaning is being carried out. Records showed that servicing and maintenance of equipment is being done. Fire training records indicate this is being given and that new fire risk assessments have been done in line with changes in fire regulations. The manager does need to make sure that staff moving and handling training is up to date, clearly recorded and reflects current good practice. The laundry has a large general COSHH poster displayed on the wall. The laundry staff were however unable to say where the COSHH information sheets were for the detergents and liquids they used on a regular basis. The manager informed us that they were in a file in the laundry, however the staff that use them on a daily basis were not aware of this important information. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 11 2 2 3 2 X 3 3 2 STAFFING Standard No Score 27 3 28 29 30 3 3 2 3 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 25 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 OP22 Regulation 16 (2) Requirement The registered manager must make sure that call systems with an accessible alarm facility are easily accessible in the lounges and all other areas of the home used by residents and that they suit residents capabilities. Staff training and development must be planned for, recorded and brought up to date. Outstanding requirement from 23/03/06 and 07/11/06.Timescale extended. Timescale for action 28/02/07 2. OP30 18(2) 28/02/07 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. 2. Refer to Standard OP1 OP15 Good Practice Recommendations The home should consider putting its statement of purpose and residents information in different formats such as large print and audio tapes. The home should make sure there are dedicated activities
DS0000010111.V323427.R01.S.doc Version 5.2 Page 26 Blackwell Vale Nursing Home 3. 4. 5. OP18 OP19 OP20 6. 7. 8. 9. OP26 OP26 OP38 OP38 staff to make sure activities are offered that meet resident’s social and recreational expectations and needs. The manager should make sure all staff have been given up to date adult protection and physical intervention training and that this is recorded. The registered manager should make sure they keep CSCI informed about progress on the ventilation system. Suitable seating and recreational areas in the grounds should be provided that would meet the differing needs of residents, especially those with physical and cognitive impairments. A more effective system for making sure resident’s clothing is properly labelled before it goes to the laundry should be found. Stairwells should have cobwebs on the ceiling cleaned away. The manager should make sure that moving and handling training has been updated for all staff. The manager should make sure that laundry staff have current training on COSHH substances and that information on this is retained in the laundry. Blackwell Vale Nursing Home DS0000010111.V323427.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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
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