CARE HOMES FOR OLDER PEOPLE
Blackwood House Roskear Camborne Cornwall TR14 8BA Lead Inspector
Lynda Kirtland Announced Inspection 17th October 2005 09:30 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 Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 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. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Blackwood House Address Roskear Camborne Cornwall TR14 8BA 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) 01209 713498 01209 613495 Cornwall Care Limited Miss Diane Hicks Care Home 44 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (20) Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 20 adults of old age (OP) Service users to include up to 24 adults aged over 65 with dementia (DE[E]) Service users to include up to 24 adults aged over 65 with a mental illness (MD[E]) Service users not to exceed a maximum of 44 Date of last inspection 9th June 2005 Brief Description of the Service: Blackwood House is one of eighteen care homes owned by Cornwall Care Ltd. It is registered to accommodate forty-four older people in need of personal care. The home has on the first floor a separate unit for twenty-four service users who have dementia or other forms of mental ill health. On the ground floor, separately accommodated are twenty service users who are elderly. All service users have their own room with access to nearby toileting facilities. A range of lounge areas with dining facilities and kitchenettes are available for residents use. Residents are able to access all parts of the home and there is a large garden area for residents use. The full range of community health care professionals visit the home on an as need bases or routinely. The home also provides a day centre and day care for up to twenty service users. There is no intermediary care facility. Admissions are planned and emergency admissions are avoided whenever possible. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Blackwood House Residential Home on the 17 October 2005 and spent eight hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 9 June 2005. In addition the inspector focused on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and some management areas. On the day of inspection 43 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff, the registered manager and interim manager to gain their views on the services that Blackwood House offer. The registered manager also completed the pre inspection questionnaire, which is similar to a survey asking for information on what services/facilities the home provide. Completed comment cards from three residents and three relatives in gaining their views on the home were received and assisted in the inspection process. Blackwood House records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. The registered manager, Ms D Hicks will not be based at Blackwood House for the next six months. Therefore an interim manager, Ms B Wills has been appointed from 1 October 2005 to cover this post. Both managers were present during this inspection process. What the service does well:
Service users and their representatives stated that Blackwood House provides good quality care and accommodation. Relatives and residents commented that staff are ‘kind’, ‘caring’ and ‘patient’. Residents commented that they felt that they were consulted about their care needs which staff ‘ met at all times’. Residents and staff commented that in the main there are sufficient staffing levels on duty, but that staff are ‘busy’ and whilst their care needs are met it would be beneficial to have more staff available. The management team are already addressing this. Residents commented that the welcome to the home was a positive experience and ‘relieved anxiety’ about moving into a care home. Residents commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard. Health professionals spoken to also commented that Blackwood House provide good care to residents and Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 6 felt that referrals to them were appropriate and that the staff listened to their advice and put it into action. The managers want to expand the level of activities on offer. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community but also would ‘like more to do’. Residents felt their visitors were welcomed to the home. Residents, relatives and staff stated that if there were any issues they felt able to approach the registered manager directly and that their ideas would be listened to and where appropriate acted on. Blackwood House has a stable staff team that allows staff and residents to get to know each other well and provide consistent care to residents. Residents were complimentary about staff skill and attitude. Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive and support from the management team. What has improved since the last inspection? What they could do better:
From this inspection two requirements have been re notified to Blackwood House. It is acknowledged that work in respect of these improvements to the toilet facilities for day care service users and that water pipes are boxed in, is in progress. However as this is in the early stages of development these have been re notified.
Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 7 In this inspection 3 recommendations were identified: to ensure that the homes statement of purpose accurately reflects the homes and Cornwall Care ltd changes in management team: to ensure that when staff transcribe medication this is witnessed by two staff; and that the adult protection policy is reviewed as per discussion with Cornwall Care ltd and CSCI Residents and staff could not think of any improvements that Blackwood House could make. This inspection highlighted that Blackwood House provides a good standard of care to residents. The inspector would like to thank the residents, staff and management team for their assistance during this inspection process. 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. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5, Blackwood House has detailed information, which informs service users and their representatives about the services that they provide. Due to management changes this needs to be updated. The home completes an assessment of prospective residents to make sure they are able to meet the person’s needs. Blackwood House provides a planned trial period of stay at the home. Staff are experienced and competent to meet resident’s needs. EVIDENCE: Blackwood House has detailed information, which informs service users and their representatives about the services that they provide. Due to the recent management changes at Blackwood House and in Cornwall care Ltd these must be reflected in the home statement of purpose. From discussion with residents they confirmed that they were consulted about their care needs prior to admission to the home, and in some their involvement was recorded. From inspection of four residents files it was evident that pre admission assessments occur. Care needs identified by the referring
Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 10 professional assessments were incorporated in the assessment process and transferred to care plans. This assessment identifies the residents individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A month’s trial period is offered to all new residents after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. From records inspected and in discussion with residents they commented that the preadmission and ‘moving in period’ are carried out sensitively by staff and could not see how this process could be improved. They also stated that this was undertaken with their participation and that their care needs were identified accurately. From observations of staff, plus inspection of forthcoming training programme and records it was evident that the staff team are experienced in the area of older peoples care and receive training to update their knowledge in this area. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to residents. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. Health care needs are met to a good standard. Medication is administered by trained staff and stored securely. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: From discussion with residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately and that residents are encouraged to express their views in the formation of their care plans. Care plans clearly identify service users care needs and from this specify what actions staff should take to ensure that the care need is approached in a consistent manner. Residents commented that health needs are met by the staff at the home and by external professionals to a good standard. Detailed records of all health professional visits to individual residents further evidenced this i.e. CPN, chiropodist, dentist and optician. In discussion with a community nurse, she
Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 12 commented that Blackwood House make appropriate referrals to their and the GP service, and that the staff at the home listen to what treatment is needed and put this into practice. She felt Blackwood house has a ‘good reputation’ with her colleagues. There has been some recent training between the community nursing team and Blackwood House in increasing staff knowledge in blood sugar monitoring, which has been successful. Cornwall Care Ltd has produced a detailed corporate policy in the ordering, administration, storage and disposal of medication. Designated staff attends annual training in this area of care. In addition the home has a contract with the local pharmacist to ensure that medications are ordered, administered, stored, disposed of correctly, and will provide a audit of their practice. Permission from residents is sought in the administration and storage of their medication Medication sheets were in the main completed correctly but the inspector recommended that when staff transcribes medication that two staff members witness this. Medication kept in the fridge was inspected. Daily temperatures of the fridge are monitored. All residents spoken with stated that staffs display a high standard of respect in their daily interactions. Residents stated that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. The inspector noted that the atmosphere of the home and residents appeared to be relaxed. Residents commented staff ‘were ‘kind’ and ‘patient’. Residents confirmed that they have a choice as to when to rise/ retire to bed, receive their mail unopened, have access to a private phone and can receive visitors in private. In addition the inspector observed staff interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Blackwood House provides a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. A varied and nutritious diet is provided to all residents in a relaxing atmosphere. EVIDENCE: From discussions with residents some commented that there is ‘enough to do’ during the day, others felt more should be provided but could not identify what extra activities they would like to occur. The inspector noted on the day of inspection a variety of activities taking place; socialising in lounges, reading newspapers, receiving visitors, listening to music and in the day centre decorating cakes. Some staff felt that the area of activities needed to be developed further and the use of the garden area should be encouraged more. The managers also felt that more emphasis needs to be placed on promoting and developing activities further and this is in process. Individual interests are recorded in service user pre admission information and their ‘life story book’. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 14 There is a flexible visiting policy and residents determine where they meet with their guests. Residents felt their visitors were welcomed to the home positively and could not think of improvements in this area. Visitors echoed this. Residents made positive comments to the inspector in the variety and quality of food provided. Some made comments such as ‘the food is good’ and commented on the amount of choice. The meal of the day was on display so that residents could choose their preferred dish that day from the menu. They can also choose where to have their meals, either in their room or in the dining area. The dining area was observed to be a relaxed and social occasion. Cornwall Care Ltd has implemented the ‘food project’, which ensures that a varied and appealing diet is provided to residents in a relaxed atmosphere. Blackwood House is in the process of implementing this and has increased the menu options for residents. Menu cards are in the process of being developed. Training to catering staff has been provided. All equipment in the kitchen works satisfactorily. New fridges are planned to be ordered and installed for next summer, which will allow more storage for fresh vegetables and fruit. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, Blackwood House has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. EVIDENCE: Cornwall Care Ltd has completed corporate policies in respect of the complaints procedures. Blackwood House and CSCI have not received any complaints about the home. From the inspectors discussions with residents all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. All felt able to approach the management team if they had any concerns. CSCI have met with Cornwall Care Ltd management team to discuss reviewing their corporate adult protection procedures. This is in progress. Therefore this was not inspected further. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,25 Sufficient toileting facilities must be provided for those who visit the day centre. Blackwood House provides a comfortable and safe home for those who live, work or visit the home. EVIDENCE: Two requirements were identified at the last inspection in respect of the environment. Since then the registered manager has discussed with Cornwall Care Ltd and has drawn up architect plans to review the toileting facilities for those service users who attend day centre. Therefore this requirement remains in progress. The second was to ensure that water pipes in residents’ rooms were boxed in. This again remains in progress. The remaining sections of this standard were inspected in detail at the previous inspection and were viewed to offer a safe and comfortable home to all who live, visit or work at the home. From a tour on this occasion this was seen to continue and it was noted that a refurbishment and maintenance programme is ongoing.
Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Suitable trained and experienced staff are employed in sufficient numbers at all times to meet residents care needs. Robust recruitment procedures are put into practice to ensure that residents are protected in the home. Cornwall Care Ltd ensures that staff have access to ensure staff are trained to undertake their work. EVIDENCE: The majority of residents, relatives and staff all commented that they felt there were sufficient staffing levels on duty at all times. Residents in particular stated that an increase in staffing would be beneficial as ‘staff are so busy’ and that whilst their care needs are met that sometime they need to wait for staff response due to this. The registered manager stated that it is the homes aim to increase staffing as the dependency level of residents has become more complex. This is in current negotiation with Cornwall Care ltd. Residents were all were complimentary about the care and approach they receive from the staff team. The inspector observed staffs that were competent in their work. Ninety Six percent of staff has achieved a minimum of NVQ level 2 or above. Some staff is in the process of obtaining their NVQ level 2. Eleven staff have completed first aid training. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 18 Cornwall Care Ltd prioritises staff training and from discussion with staff and inspection of staff files this demonstrated a commitment to staff updating their training From inspection of recently recruited staff files they evidenced that appropriate employment checks have been completed. Cornwall care Ltd recruitment policies were not inspected on this occasion. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36,37,38 The management approach creates an open, positive and inclusive atmosphere for residents and staff. Financial accounts are maintained to ensure viability of the home. Satisfactory arrangements are in place to provide a safe environment for all who live, visit or work at the home EVIDENCE: With the recent change of management team in Blackwood House, staff and residents felt that this had minimal impact on the service provision. The interim manager aims to hold a residents meeting to formally introduce her to all the residents and has arranged staff meetings. Staff stated that they felt the interim manager is approachable and are looking forward to working with her more closely. The interim manager is a registered manager of another
Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 20 Cornwall Care home and has experience in working in the area of older persons care. The quality assurance process is being reviewed by Cornwall Care ltd management team and therefore not inspected. Cornwall care Ltd is a not for profit charity and accounts are maintained at Cornwall care Headquarters. The registered manager stated that the home is financially viable and has relevant insurance in place. Cornwall care Ltd have cooperate policies in the management of service users monies. Service users are encouraged to manage their own monies and hold their own accounts. However they can sign an agreement to request that Cornwall care assist them in the management of a small amount of their monies. From inspection of service users monies records were accurate and tallied. The previous recommendation to ensure that an accurate inventory of the belongings held in the safe has been complied with. Staff supervision records did not evidence that supervision occurs on a regular bases. This needs to be addressed Records held by the home are stored in a confidential manner and in the main are in line with the Data protection Act. Documentation also evidenced that the home undertakes appropriate individual and generic risk assessments, to promote minimising future risks to all who live, visit or work at the home. The home is maintained satisfactorily and all appropriate inspections by various authorities are carried out. Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 21 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 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 2 X X X 2 X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X 3 3 2 3 3 Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 22 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 OP21 Regulation 23(2)(j) Requirement Timescale for action 30/05/06 2. OP25 13(4) The registered manager must review the toilet facilities for day care service users in order that they do not impact on permanent service users facilities or privacy. (Fourth notification) 30/03/06 All water pipes in service users bedrooms must be boxed in to prevent health and safety risks. This is re notified to you (2nd occasion) 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 3 Refer to Standard OP1 OP9 OP18 Good Practice Recommendations The homes statement of purpose should be updated to reflect management changes locally and centrally. When transcribing medication two staff members should witness this. The adult protection policy should be expanded to include a timetable of initiating an adult protection referral and explain what procedure should be followed.
DS0000008909.V258465.R01.S.doc Version 5.0 Page 23 Blackwood House Blackwood House DS0000008909.V258465.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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