Inspection on 13/01/06 for Blair House

This inspection was carried out on 13th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blair House 19/05/05

Blair House 25/11/04

Blair House 18/05/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

Barkerhouse Road (123)

Fernhaven

Thames House

Creative Support

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Blair House 18 Roe Lane Southport Merseyside PR9 9DX Lead Inspector Mr Mike Perry Unannounced Inspection 13th January 2006 09:30 Blair House DS0000017227.V278779.R01.S.doc Version 5.1 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 Blair House DS0000017227.V278779.R01.S.doc Version 5.1 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 Adults 18-65. 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. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Blair House Address 18 Roe Lane Southport Merseyside PR9 9DX 01704 500123 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) Mr Doug Edmondson Mr Albert Marcel Zachariah Mr Anthony William Moran Care Home 36 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (36) of places Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the NCSC. 19th May 2005 Date of last inspection Brief Description of the Service: Blair House is a detached converted building situated on a main road in a residential area of Southport. It has easy access to Southport Town Centre and is close to Hesketh Park. The home provides accommodation and nursing care for younger adults with mental health needs. The main day space is situated on the ground floor with 3 lounge areas, a dining room and a large entrance/foyer, which is also used for recreation. Bedrooms are over 3 floors and are accessible by lift. There is a garden to the rear of the building and parking spaces at the front. The home is owned by Mr D Edmondson and one other partner and is managed by Tony Moran, a Registered Mental Nurse with many years experience. A first floor extension has been added in recent years and there is more upgrading work planned. The top floor of the home is now a rehabilitation unit with shared kitchen and lounge facilities for 6 residents. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day [5 hours in total]. It was an unannounced visit and was carried out as part of the regulatory requirement for care homes to be inspected at least twice a year. There has been no reason to visit the home since the last statutory inspection. For this inspection a partial tour of the home was conducted. Care records and other nursing home records were inspected. The owner, manager, 2 trained nursing staff, administrator and residents were spoken with and their views obtained. The inspection concentrated on those ‘core’ standards that where not assessed on the previous inspection in May 2005. For a more complete view of the home this report should be read in conjunction with the last inspection report. The inspection was carried out at a time when the home is expanding with work being carried out on extending the building to accommodate 4 more beds as well as increased day space. What the service does well: The assessments made by the staff prior to a resident being admitted are generally good and appropriate. There is good liaison with referring professionals such as mental health teams. Following admission to the home there are further assessment carried out which assist in identifying care issues and also in drawing up a plan of care. A resident who had been newly admitted to the home felt that things had been handled well. As well as a pre – visit to the home there had been good support and understanding over the period of settling in. There is attention paid to measuring any risk factors in resident’s behaviour so that they can be appropriately supported in any chosen activity. For example one resident who may be unsafe to go out of the home currently unsupervised had been assessed and an appropriate plan of care devised so that outings could be arranged. Residents felt supported and not unduly restricted. Residents feel able to contribute to the daily life in the home as well as the local community. Some residents have daily excursions to shops as part of rehabilitation programmes. Some residents attend local education courses. Other residents have in house jobs, which are paid. Staff plan a good range of Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 6 leisure activities so that residents are encourage to spend time outside the home. There is a complaints procedure in the home and the management take concerns seriously and act on them. One complaint investigated by the Commission since the last inspection was assisted by the management who were open and supported the process. What has improved since the last inspection? What they could do better: Although generally good the assessments made prior to admission should be consistent for all residents and display evidence of discussions and assessments by referring professionals as well as the resident concerned. The home encourages residents to self medicate when appropriate. The policy and procedure could be updated to be more specific as discussed on the inspection. Residents who self medicate should have appropriate lockable storage facilities. There are some more minor recommendations made in the report to improve the service in the home and these can be found in the main body of the report as well as in the ‘recommendations’ section. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 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. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 The assessments carried out by the home are good and help ensure that the home can meet the needs of residents admitted. There are opportunities to visit he home prior to admission so that residents can be better aware and choose more positively. EVIDENCE: All residents are assessed prior to admission so that the home can be fully aware and can meet any needs. Generally there is appropriate liaison with referring agencies such as social services and psychiatric services and copies of health and social assessments were seen on the care files. The home has developed their own in house assessments once residents are admitted including for various types of risk [such as smoking for example]. The standard needs to be maintained throughout however. One care file seen for a recent admission had copies of risk assessments by the referring psychiatric service but their was little evidence of any other discussions made at the time of the assessment or written agreements about initial aims and objectives. This resident was on leave from hospital under the Mental Health Act 1984. It is advisable to have a copy of the appropriate leave form with the Consultants instructions [Sec 17 form] so that this can be transferred to the care plan. The nurse interviewed was aware of the need for transfer of CPA Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 10 [Care Programme Approach] details once the resident was discharged from hospital and fully admitted to the home. [Staff spoken to were a little unsure about their role with respect to any perceived powers of detention of residents on leave at the home under the MHA and should revise this fully.] The resident felt that the transfer had been well managed and that there had been an opportunity for an initial visit to the home. Staff had been supportative and had given time to ‘settle in’ to the home. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The management of risk factors associated with resident’s choice of lifestyle or behaviour is effective so that residents feel supported n activities they choose. EVIDENCE: The management of risk was discussed with reference to 3 residents in the home. One resident was assessed currently as at risk when leaving the home and the care plan was written to include agreement that any time outside the home was always with a staff member. Another resident was on a programme of gradual self-medication and this was being managed with careful attention to risk factors and liaison with a consultant psychiatrist. Another resident had been assessed as ‘high risk’ regarding smoking in the bedroom. A programme had been devised so that the resident would only smoke at a specific table in the bedroom with ashtray available. This had reduced the risk to a manageable level. This was not included in the care plan however. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 12 Residents spoken to felt that staff were supportative in their choice of lifestyle and that the home was not oppressive or unduly restrictive. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 As much as possible residents are encouraged to contribute to activities and therefore feel part of the external and internal community of the home. EVIDENCE: There are 36 residents in the home and all have differing levels of need with respect to involving themselves in community life and this is dependant on capacity and ability. There is a small group involved in more rehabilitative programmes involving managing money and shopping and this involves them in activities daily outside of the home. Some of these residents are also involved in local education courses. 6 residents for example attend for education courses in maths and English. There are no residents employed outside the home but there are some inhouse paid jobs and residents expressed some satisfaction that they are contributing to community life within the home. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 14 There are opportunities for residents through the social activities available for trips outside the home. One resident discussed has trips out to a local pub on a regular basis. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Thee are safe procedures in the home so that residents can be encouraged to and safely administer their own medicines within acceptable risk. EVIDENCE: There are 5 residents in the home who self medicate to some degree. All have been care fully assessed for any risk and this is ongoing. All residents in the home have their medicines discussed with them and this is recorded in the care notes. The staff spoken to explained that information on individual resident s medication is also included with care plans and kept in their bedrooms. Medicine administration and recording records [MAR] were seen and were clear and easy to follow. Medications coming into the home are recorded on these sheets. Medications returned are recorded in a separate book. Policy and procedures for the safe administration of medicines were available. The procedure for self-medication is very brief and the inclusion of a more detailed procedure is recommended along with reference to and a copy of the current risk assessment chart. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 16 Two bedrooms of residents who self medicate were seen. One resident has no key to his locked cupboard although assured the inspector that his bedroom door is always locked when he is out of the room. The other resident has locks on draws so that medication is kept safe although these were padlocks and were inappropriate in terms of the furnishings in the room. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 There is an effective complaints procedure in the home so that residents and their representatives feel that they are listened to and their concerns are acted on. The policies and training of staff in the home evidence good awareness of issues surrounding the protection of vulnerable adults so that residents are protected from abuse. EVIDENCE: The manager keeps a record of complaints. This recorded 5 complaints since the last inspection. One of these was investigated by the Commissions and was concerning the attitude of a staff member but the complaint was withdrawn a late stage [resident satisfied with outcome]. The other complaints were all dealt with satisfactorily in house by the manager. There is a complaints procedure in the residents information pack. Residents spoken to felt that staff listened to their concerns and responded appropriately. Not all staff interviewed were very clear about the complaints procedure or how to access it. It is a recommendation that staff are reminded of the process and that the procedure is also displayed in the home. The home has a copy of the local Adult Protection Procedures and has accessed these when reporting issues of concern around possible abuse of residents. Staff were able to demonstrate an understanding of good care principals and there has been various training initiatives to raise the level of awareness around abuse. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 18 Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed EVIDENCE: Although not assessed in any depth on this inspection it is noted that there is ongoing work in the home to develop the service and that there will be an application for a variation in registration in the future to increase the registered beds as well as create more day space and separate units. From the discussions with the inspector it is pleasing that the management are following initiatives that not only meet minimum standards but also follow other good practice guidelines. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 The staffing in the home is settled and minimum numbers are maintained. There is an appropriate skill mix of staff so that residents who have mental health needs can receive appropriate care. The recruitment processes are good and ensure that residents are protected. EVIDENCE: On the day of the inspection the home had 36 residents. Staffing consisted of 3 trained nurses and 7 care staff. The manager is supernummery to these numbers. There was adequate ancillary staff as well as a full time administrator employed. From the last inspection there has been little change in personnel in the home. The rained staff have a skill mix that includes Mental Nurse cover [RMN] and also nursing staff who are originally trained in Learning Disability but have had many years experience in working with people with mental illness. Trained staff have also had extra training in skills such as aroma therapy, counselling and reflexology. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 21 Care staff have also attended appropriate training with respect to residents in the home. For example updates in epilepsy, diabetes and counselling. Of the 14 care staff employees 10 have NVQ training and others are to commence. Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportative and easy to approach. Following requirements from the last inspection around recruitment checks the management have now updated staff files to meet standards. The 2 staff files seen were inclusive of the required references and checks. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The home have a number of quality processes that aim to continually develop the service with respect to the needs and wishes of the residents in the home so that the service is benefiting residents in the home. EVIDENCE: The home a number of Quality Assurance [QA] initiatives that aim to seek the views of the residents. There is a yearly external quality audit [PQM], which includes a resident’s satisfaction survey as well as resident interviews with the assessor. These are then fed back in the audit to the management of the home. The opinions of residents in this survey were positive. [The results of the satisfaction survey are currently not published in the service user guide]. The home is now doing Investors in People award, which tends to look more at the development of staff in the home. There are regular resident meetings held and again residents are free to air any issues through his forum. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 23 The home has made good links with the local psychiatric service and at least one consultant is a regular visitor to the home in order to review residents. Any views regarding the care are canvassed at these meetings. The more recent development is that now there are 4 clear teams of staff working with residents and there are key workers identified. This has helped resident feedback, as there is more consistent interaction. The management have plans to develop the home further in terms of the building and the organisation of the care and these plans have consistently followed good praise guidelines as well as paying attention to the National Minimum Standards. The home has a good record of meeting any statutory requirements that are made. Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X 3 X X X X Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA2 Good Practice Recommendations Copies of MHA Sec 17 forms should be included as part of the admission assessment for any such resident. Assessments should also include reference to agreed aims and objectives following liaison with the referring service. Staff should revise their awareness of the homes role with respect to any perceived detention powers for residents admitted on leave under the Mental Health Act All assessed risks should be included in the care plan for residents. All residents who are self medicating should have suitable lockable facilities within their rooms. The medication policy and procedure should be revised to include a more detailed self-medication procedure and reference to the homes risk assessment process. The complaints procedure should be displayed in the home. All care staff should be aware of the procedure. The results of the resident satisfaction survey should be included in the service user guide. DS0000017227.V278779.R01.S.doc Version 5.1 Page 26 2 3 4 5 6 7 YA2 YA9 YA20 YA20 YA22 YA39 Blair House Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blair House DS0000017227.V278779.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!