CARE HOMES FOR OLDER PEOPLE
Blackwell Vale Nursing Home Rear 61 Durdar Road Carlisle Cumbria CA2 4SE Lead Inspector
Lorraine Frost Unannounced 09 June 2005 09:00 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 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 F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Blackwell Vale Nursing Home Address Rear 61 Durdar Road Carlisle Cumbria CA2 4SE 01228 512456 01228 810094 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons Health Care Limited Helen Joyce Smallbone Care Home 60 Category(ies) of DE(E) - Dementia - over 65 registration, with number OP - Old Age of places Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commision for Social Care Inspection 2. 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 failling 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 6 December 2004 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 a dining room as well as limited staff facilities. There was a conservatory and other lounges on the ground floor. The courtyard area to the rear is not a secure area, but was partially enclosed with seating and tables for service users and their visitors to use. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection by Lorraine Frost and with Paula Banham as the second inspector. The inspection started at 0900 hours and concluded at 1715 hours. The Registered Manager assisted throughout. The inspection process involved a tour of the building, meeting with and talking with the residents on all the units. Three visitors were spoken to. Staff were observed throughout the day and where the opportunity arose the inspectors took time to talk with staff. Records were checked for randomly selected residents, and newly appointed staff. All the other staff files had been checked at the previous inspection. What the service does well:
Despite the staffing levels being inadequate on the two units upstairs and the unexpected staff shortage downstairs, the inspectors saw that throughout the home staff worked well together. They had a good approach, and a good attitude towards each other, the residents, and visitors. One visitor commented that he felt very comfortable when visiting the home and was very pleased with the care being afforded to the person he was visiting. Residents confirmed that staff were helpful and said that they were very willing and that they liked living here. Other professionals were actively involved in supporting the staff and to supporting the residents to make important decisions. Meals were commented on positively and the cook demonstrated a clear understanding of the specific needs of the residents. Staff said that the cook was very accommodating and he said that he liked to personally find out if the residents had enjoyed their meals. He was looking into another way to gain feedback from staff and residents. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The manager and her staff need to address the shortfalls highlighted following their recent care plan audit and to ensure that the documentation is consistent, complete and that mental, physical and social care needs are fully assessed. Four Seasons must ensure that although their policy for staffing levels is based on numbers of residents that they address the serious concerns raised by the inspectors about the inadequate staffing levels at Blackwell Vale based on the witnessed and documented high level of care and intervention that the residents on Chadwick and Nightingale units required. The health and safety of residents and others must be protected by ensuring that items and potentially harmful substances are stored appropriately and that the fire officer’s report is complied with by the date stated by Four Seasons. The recruitment and selection procedure must be robust and must be followed to protect residents from the possibility of staff being employed who may be unsuitable to work in this environment. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 7 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. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Residents’ needs are assessed before they are offered accommodation in the home so that care staff will know what assistance each person will need on admission. Residents’ benefit from being able to visit the home prior to making a decision to move there. EVIDENCE: Residents’ files include a pre admission assessment of their needs, which is carried out before they are offered accommodation in Blackwell Vale. Care staff are knowledgeable about the identified needs of the people living in the home and the support they require. Residents’ families said they had visited a number of homes before choosing Blackwell Vale for their relative. The husband of one resident said that the home “has a good name in the area”.
Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10 The documents completed following admission do not fully identify or address all the health and social care needs of all residents, which in some cases lead to needs not being fully met. There was clear evidence of help, support and guidance being accessed to promote the health and welfare of the resident where specific needs had been identified. Medication administration practices had improved, but lapses in the storage of some medication placed some residents at risk of harm. Residents were treated respectfully with their dignity maintained. EVIDENCE: The Registered Manager and another qualified nurse had carried out audits of resident files identifying numerous shortfalls in the care planning and risk assessment process. Files examined showed that residents were not thoroughly assessed once living in the home and that documentation regarding wounds, mental and physical health needs and social needs varied between the units with some of it being contradictory. Care planning training has been arranged. Staff spoke kindly to residents and when one resident was distressed the staff tried to identify the cause and tried a number of ways to divert the person.
Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 11 Residents benefit from other health professionals who are involved with the home. Medication administration was observed. The nurses spoke to the resident throughout the process gaining consent for administration as well as assisting the resident appropriately. Staff conveyed messages to the nurses regarding the need for analgesia for certain residents who had asked for pain relief. The shortfalls were that medication had been left in a resident’s room placing the residents on that unit at risk of harm. The keys to the medication trolleys were left on view in the locked treatment room and on another unit the keys were left in the unattended trolley during medication rounds. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15 The menu is balanced and varied with special diets catered for, offering the residents a wholesome and nutritious diet. The open visiting policy enables residents to maintain links with family and friends. However, resident opportunities for taking part in activities are very limited, reducing the amount of choice available to others. EVIDENCE: Residents have a choice of meals that they chose from a menu, which is changed regularly. Meals are attractively presented and provide variety and choice. Visitors know that they are welcome in Blackwell Vale and residents choose where to see the visitors they receive. Activities are poorly organised with only 15 hours per week provided by the activities organiser. Residents do not have easy access to recreation and stimulation and some rely on the visitors they receive to provide stimulation and distraction. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: This section was not assessed on this occasion. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 23, 24 and 26 The bedrooms are clean, well maintained, and provides a homely environment to live in but, communal and service areas are poorly maintained, dirty, with poor storage posing risks to the residents living in the home. EVIDENCE: Residents’ bedrooms are well maintained, personalised, and decorated to a high standard. Areas requiring refurbishment have been identified and remedial work has been organised. Carpets in a number of communal areas are badly stained and require cleaning or replacing. Residents are placed at risk by poor maintenance of one dining room and the unhygienic condition of the kitchen and kitchen equipment. The home provides a range of equipment to assist residents including assisted bathing facilities, grab rails, hoists and wheelchairs. Storage facilities are inadequate and equipment is stored in inappropriate areas including corridors and bathrooms and obstructs residents’ movement and use of facilities. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. There are not enough staff on duty on two of the three units to meet the needs of the residents placing them at risk and not enabling staff to adequately deliver social and health care to each resident. Residents were treated as individuals and the staff were doing as well as they could with the staffing levels available. Robust recruitment of staff had not been carried out correctly putting residents at risk. Training was being made available which had given staff more confidence and a greater understanding on how to care for the residents. EVIDENCE: The staffing levels on Cavell unit were lower than usual due to the unexpected absence of two members of staff. There had been attempts to rectify this situation and the staff worked very hard to meet the needs of those residents during the inspection. On Nightingale and Chadwick unit the staffing levels were not lower than usual, but the inspectors saw that there were not enough staff to meet the needs of the residents, or to afford them the choices that they should be able to make because the routines of the home had to be set around the numbers of staff on duty and not the wishes and needs of the residents. Extra funding had been provided for two residents to receive one to one care, but only one resident was receiving this. Staff were unaware that the other resident was to receive one to one care, but did identify others who should receive it.
Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 16 There were a number of residents requiring constant help and assistance throughout the day and at lunchtime the inspector had to advise the staff of an incident that was placing a resident at risk of injury. Staff were very kind, patient, and demonstrated a good knowledge of the residents. Staff training was much improved with staff saying how much they were enjoying it. The courses covered recently were infection control, Dementia Care, Nutrition, Adult Protection, as well as informal hands on training. Newly appointed staff files were checked. Three staff had worked shifts before the appropriate checks had been completed. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 38. Monitoring systems were either in place or being put in place to measure, and to improve the quality of care, the standard of documentation and the environment for the residents. However, some practices were placing residents and other people at risk. Staff supervision was taking place, enabling staff to bring forward views and for the supervisor to discuss where necessary issues that impact directly upon the life of the resident. EVIDENCE: Harmful or dangerous substances were not stored safely. This has been highlighted at a number of inspections and it is very disappointing to see that staff continue to leave cupboard doors unlocked, products in bathrooms and bedrooms that may be harmful and that storage of some items was placing people at risk. The fire officer’s report had not been complied with although the manager had been in contact with the Estates department and was awaiting a
Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 18 response. A date for the work to be completed was given to the manager during the inspection and the new date is shown in the Requirements table. Staff said that they had received training on mandatory topics such as moving and handling, fire, health and safety, and Control Of Substances Hazardous to Health Training was arranged for the near future. Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 1 x x 3 3 3 x 1 STAFFING Standard No Score 27 1 28 1 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x 3 x 1 Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard OP7 OP8 OP9 Regulation 15 15 13.2 Requirement All documentation must be complete, and consistent. All health care needs must be identified and addressed. Policies and procedures for the safe handling, storage and administration of medicines must be followed at all times. (This is an outstanding requirement with a compliance date of 15.01.04) Social care needs must be identified and documented. The home must comply with the requirements of the Fire Department. (Thisis an outstanding requirement with a compliance date of 20.12.04) All areas of the home must be clean and hygeinic. The staffing of the home must at all times promote and protect the health safety and well being of the service users. Where extra staff are required to meet the needs of a service user then this must be made available and all agreements and arrangements must be fully documented. Timescale for action 30.06.05 30.06.05 15.01.04 4. 5. OP12 OP19 15 23.4c 31.07.05 21.06.05 6. 7. OP26 OP27 23.2 18 20.06.05 10.06.05 8. OP28 18 10.06.05 Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 21 9. OP29 19 schedule 2 10. OP38 13.4 11. OP38 13.4 Staff must not work in the home 10.06.05 until all appropriate checks have been carried out. The manager must be fully aware of the recruitment and selection policy and procedure for Four Seasons. Products must be stored safely in 26.08.04 accordance with COSHH regulations. (This is an outstanding requiremnt with a compliance date of 26.08.04) The dining on Cavell unit must 10.06.05 be made safe and action taken to reduce risk to staff, service users and visitors whilst waiting for the new flooring to be fitted. 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 Good Practice Recommendations Blackwell Vale Nursing Home F58 F10 s10111 blackwell vale v208641 090605 ui stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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