Inspection on 17/05/07 for Blair House

This inspection was carried out on 17th May 2007.

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 18/04/06

Blair House 12/12/05

Blair House 03/07/05

Blair House 07/10/04

Blair House 06/05/04

Blair House 25/06/02

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

CARE HOMES FOR OLDER PEOPLE Blair House 24 Pevensey Road St Leonards-on-sea East Sussex TN38 0LF Lead Inspector Wendy Mills Key Unannounced Inspection 17th May 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 Blair House DS0000021055.V337752.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. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blair House Address 24 Pevensey Road St Leonards-on-sea East Sussex TN38 0LF 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) 01424 437608 01424 442667 manager.blair@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd Jane Rajamogan Vacant Care Home 29 Category(ies) of Dementia (29) registration, with number of places Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-nine (29) Service users must be older people aged sixty-five (65) years or over on admission Service users with a dementia type illness only to be accommodated Date of last inspection 18th April 2006 Brief Description of the Service: Blair House is a residential home providing care for up to twenty-nine older people with failing mental capacity. It is a large detached property situated in a residential area of St Leonard’s on Sea. The registered providers are Regal Care Homes. The manager, Miss Emma-Louise Ashton, has been in post for the last six months. She is in the process of preparing her application for registration with the Commission for Social Care Inspection (CSCI). The home has plenty of communal space. There are two good-sized lounges on the ground floor. There is a newly built conservatory overlooking the garden at the rear. At present this is a designated as the residents’ smoking area. There are two dining rooms, one on the ground floor and a larger one on the lower ground floor. Most of the residents are accommodated in single rooms but the home also has three double rooms. There is a shaft lift that gives access to all levels of the home Outside there is pleasant, safe, enclosed rear garden. The front door is accessed by a flight of steps but level access can be gained via the side and rear of the building. A limited amount of car parking is available at the front of the building and there is unrestricted on-street parking nearby. Both the town centre and the seafront are within walking distance. However, the home is situated on a hill and the return walk might present some difficulty for those who are not good at walking up hill. Fees are currently £410 - £445. Additional charges are made for certain items such as hairdressing and a full list of these is contained in the home’s Service User Guide. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit lasted five hours. During this time the key standards for the care of older people were inspected. It was possible to speak to several residents. Direct and indirect observation was used to see how staff interacted with residents and to see how those who were unable, or did not wish, to communicate were being cared for. Three members of staff were spoken to in private and others were spoken whilst making a tour of the home. In depth discussion was held with the new manager, Miss Emma-Louise Ashton and a range of documentation was examined. Health and Social care professionals were contacted by telephone to find out how well the home cooperates with them. All the requirements and recommendations made at the last inspection have been met. Significant improvements were noted in many aspects of care at the home. The manager is commended for her diligence in working to improve the home and the staff are commended for their commitment to their work and the support they have given the manager. All comments received about the home and the care it provides were very positive. The residents, staff and manager are all thanked for the welcome they gave and their assistance throughout this five-hour visit. What the service does well: The home is well managed. There are good quality assurance systems in place and communication with residents, their relatives and supporters, and staff is very good. The home is calm, caring and homely. Routines are flexible and the residents are encouraged to enjoy their daily lives as much as possible. There is a programme of upgrading and re-decoration, which is aimed at improving the environment. The health and social care needs of the residents are very well met. Good relationships are maintained with health and social care professionals and their advice is followed. There is a committed and enthusiastic staff team. There is a good level of both mandatory and specialist training and a high percentage of staff hold the National Vocational Qualification (NVQ) at level 2 or above. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 7 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 Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 8 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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents, their relatives and supporters, with the information they need whilst living in the home. Appropriate pre-admission assessments are made. This ensures that only those residents who are suited to the home, and whose needs can be met, are admitted to the home. EVIDENCE: Since the last inspection the Statement of Purpose and the Service User Guide have been completely revised. The Service User Guide is now in two formats. One is more detailed and the other is written in Plain English and contains a number of illustrations to help the residents understand their rights whilst living in the home. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 9 The pre-admission documentation has been updated and is very thorough. Good evidence was noted to show that thorough pre-admissions assessments are made. There are sound admissions policies and procedures. Arrangements are made for a prospective resident and their supporters to make a pre-admission visit if they wish. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home cares for the residents very well indeed. It promotes their health and well-being in a proactive and positive way. EVIDENCE: Since the last inspection all care plans have been revised. They are now much clearer and use pictures where appropriate. The care plans are supported by a “bedroom plan” that gives a quick overview of each resident’s daily needs. These plans are kept discretely in the bedrooms and are updated daily. The manager does regular spot checks on these plans to ensure that appropriate care is being offered. She also tours the home at least once a day, talks to residents and staff and checks cleanliness. In April this year the home gained “preferred provider” status with East Sussex County Council. This means that they home has been deemed to meet their rigorous standards for care and staff training. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 11 Records show that residents are registered with a GP and that health and social care appointments are made on their behalf. The manager said that good relationships are maintained with health and social care professionals such as district nurses, care managers and specialist nurses. Responses form health care professionals confirmed this view. The home cares for residents with a wide range of dependencies. It works hard to prevent pressure sores and has a very good regime for looking after those residents who are less mobile. Specialist equipment, such as hoists, is well maintained. Moving and handling risk assessments are in place and staff are trained in moving and handling techniques. Medication is stored safely and only staff trained in the management of medicines administer medication. The home maintains good relationships with the local pharmacy and has robust systems for the ordering of medicines and the return of unused medicines. There are no controlled drugs used in the home at present. One resident is able to partially self medicate. There have been no mediation errors since the last inspection and documentation is well maintained. Nutrition is well monitored and the importance of good nutrition is well understood. Weights and food intake are checked, alternative meals offered if a resident does not eat their meal and fortifying drinks are offered if appropriate. There is a very good level of staff training and a skilled staff team. Staff training will be dealt with in more detail in the section about staffing. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily routines of the home are flexible and support the residents to be as independent as possible and to live as fulfilling lives as possible. EVIDENCE: Care plans contain details of the residents’ likes and dislikes. This includes preferred times for getting up and going to bed, food choices and current and past interests. Religious needs are also noted in the care plans and arrangements are made for those who wish to continue to practice their religion to do so. Outside entertainers such as singers and activity leaders are paid for from the home’s budget. On the day of this visit chair exercises and a game of indoor bowls was taking place. Care staff also encourage chair exercises, reminiscences and other activities. Currently the home is advertising for two, part-time activity co-ordinators. This will mean that some form of meaningful activity can be encouraged on every day of the week. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 13 There is a pleasant, safe and enclosed garden at the rear of the home. On fine days many of the residents enjoy spending time here. Some help with the preparation of hanging baskets. One or two residents like to help out with household chores such as laying tables or dusting. Care staff support them if they wish to do this. Friends and relatives are made very welcome to the home and several have expressed their gratitude for the kindness the home has shown both to their relatives and themselves. The meals at the home are appetising and easy to eat. On the day of this visit there was plenty of good quality produce in the home. The main meal was sampled. It was well presented and tasty; there were plenty of vegetables and the meat was well-cooked and easy to chew. The chef said that she is able to order plenty of food and that fresh meat and vegetables are purchased locally. She said that there is a varied menu that is agreed with the manager. There is always a choice of two main meals. This choice is offered in the morning and the main meal is taken at lunchtime. This means that there is not too long a time between making the choice and being served the meal. This reduces the risk of a resident not remembering what they have requested. Residents are always offered something different if, when it comes to the mealtime, they do not want what they have chosen. Food intake and residents’ weights are carefully monitored and nutritious drinks are offered if appropriate. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of the residents and their supporters are listened to and acted upon. This means that any concerns or complaints are dealt with in a timely and appropriate way. There is a good understanding, at all levels, of the need to work to protect vulnerable adults from harm. This minimises the risk of residents being subjected to any form of abuse whilst living in the home. EVIDENCE: Since the last inspection a new complaints and concerns form has been introduced. Recording of complaints and concerns has become more rigorous. Three verbal complaints from relatives have been noted over the last six months. These complaints were tracked and two were substantiated. The home responded appropriately to these complaints. They have now introduced more robust measures to ensure that the same problems do not reoccur. Induction programmes include training in the protection of vulnerable adults. There is also additional training in this area for all staff. Staff spoken to were all very clear about their responsibilities to report any concerns about the Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 15 welfare of the residents. They all said that they would have no hesitation in going straight to the manager if they had any concerns. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a welcoming, spacious, safe and comfortable environment. This gives the residents a pleasant place in which to live. EVIDENCE: Since the last inspection a new conservatory has been built and improvements have been to the garden. There is an ongoing programme of redecoration in the communal areas and plans are in place to completely refurbish two toilets and a shower room. The conservatory has now been made the designated smoking area for residents. This means that the small room that leads from the ground floor dining room is no longer the smoking room. It is now used for a variety of activities. On the day of this visit the hairdresser was using it. She was kept very busy with many of the residents taking the opportunity to have their hair done. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 17 The communal areas are spacious and there is plenty of choice of sitting and activity space for the residents. Some prefer to spend time in the quieter of the two lounges whilst others enjoy the more active environment of the larger lounge. Several residents like to walk around the home and they were allowed the freedom and support to do this. The laundry is situated in an annex close to the main building. This means that staff have to carry soiled laundry to the annex and return clean laundry to the building via an outside path. In wet weather this could mean that clean and dry laundry could get damp. The laundry itself is an awkward shape, and this makes infection control measures difficult to adhere to. For example, there is a tendency to leave dirty laundry outside the main door of the laundry due to lack of space. The home uses the soluble red bag system for soiled laundry and their systems for managing this are satisfactory although not ideal. It is recommended that the registered providers appraise the laundry and the laundry systems to ensure that infection control measures in this area are robust and that the health and safety of staff is safeguarded. There are two cleaners employed at the home. Both are diligent and manage to keep the home very clean despite the building being old and having many nooks and crannies that are difficult to access. One cleaner also carries out some maintenance duties and there is an additional maintenance person. Cleaning routines are well organised. They are planned to cause as little disruption to the lives of the residents as possible. For example, the lounges are vacuumed whilst the residents are at lunch. The manager makes spot checks on bedrooms and other areas to ensure standards are maintained. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and recruitment practices are good. There is a wide range of skills and diversity amongst the staff. Staff training, supervision and morale are very good. This means that a skilled, motivated and cheerful staff team cares for the residents. EVIDENCE: The staff are from a variety of backgrounds and there is a good mix of age, gender and ethnicity. Staff rosters show that there are enough care staff scheduled for each shift to meet the care needs of the residents. The home’s own staff, or those from a nearby sister home, cover for annual leave and other shortfalls in staffing. No agency staff are used. This means that the residents always receive care from staff who know and understand their needs. The care staff are supported by and adequate level of ancillary staff. There are two cleaners, (one of whom also carries out maintenance duties), a chef and a maintenance person. Staff were spoken to in private. They were all very positive about their work in the home. One said, “I love it here”. Another said that it is a nice place to work and one said that it was “Like a dream” compared to a previous lace of Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 19 work. They said that staff get on well together and that differences of opinion are discussed and solutions found. Inspection of staff files showed that recently recruited staff have all come with good qualifications. All appropriate pre-employment checks have been made and each staff file has a checklist attached to ensure all aspects of employment are covered. Staff training is excellent. There is a high percentage of staff who hold the National Vocational Qualification at level 2 or above. In addition, four more staff are currently undertaking the course. The training matrix that has been developed by the current manager is well laid out and shows that mandatory training is on schedule and that a significant amount of specialist training is also being undertaken. Examination of a sample of staff files showed good evidence of a wide range of training course that had been successfully completed by all staff. The manager is also a qualified trainer (“Trained trainer”) for the protection of vulnerable adults. In addition she has recently gained. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 20 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): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and is run in the best interests of the residents. EVIDENCE: The manager, Miss Emma-Louise Ashton, was appointed six months ago. She has a background in banking and some seven years experience in caring for older people, including three years as deputy at another home in the area. Her record of achievement is kept on the premises of Blair House and was available for inspection. She has maintained an impressive level of continuing professional development. She holds the NVQ level 4 in care, has undertaken a variety of courses including counselling courses and a fire manager course. She is a qualified “Trained trainer”, for protection of vulnerable adults. Emma Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 21 is currently undertaking a part-time degree course in mental health and psychology. Conversation with Emma showed that she has a very good understanding of the care needs of the residents and is committed to best practice in dementia care. In addition she has a very good understanding of budget management and other management practice. Her standard of record keeping is very good. Throughout this visit she was able to put her hands on all documentation requested. All records were appropriately stored, up-to-date and in good order. Since coming into post Emma has ensured that regular one to one staff supervision is established and that there are regular staff meetings. She has forged good relationships with relatives and demonstrated a kindly, gentle and relaxed way with all the residents. Staff said that, “Emma is really well-liked and respected”. They said that she is prepared to “roll her sleeves up” and help out when needed. Staff confirmed that there are regular meetings and supervision. They said that Emma is easy to talk to and understands how difficult the work can be on occasions. There are robust systems in place to account for the residents’ finances. There are very good quality assurance systems both within the home and the company. The area manager makes regular quality visits and written reports are produced following these visits. Emma tours the home at least once each day, talks to residents and staff and notes any issues that may need attention. All health and safety records were well maintained and up-to-date. No health and safety hazards were noted on the day of this visit. Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP31 Regulation 9(2)(b)(i) Requirement Application for registration of the present manager to be made to CSCI. (NB: Although a requirement was placed to this effect in the last report, it referred to a different manager.) Timescale for action 30/09/07 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. Refer to Standard OP26 Good Practice Recommendations An appraisal should be made of the laundry and surrounding area to see if it is possible to improve on laundry systems and infection control Blair House DS0000021055.V337752.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © 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 DS0000021055.V337752.R01.S.doc Version 5.2 Page 25 - 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. 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