Inspection on 18/04/06 for Blair House

This inspection was carried out on 18th April 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 17/05/07

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 Lindy Latreille Unannounced Inspection 18th April 2006 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.V288669.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 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.V288669.R01.S.doc Version 5.1 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 blairhouse@regalcarehomes.com Regal Care Homes Ltd Vacant Care Home 29 Category(ies) of Dementia (29) registration, with number of places Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is twenty nine Only people over 65 years of age suffering from a dementia type illness will be admitted 12th December 2005 Date of last inspection Brief Description of the Service: Blair House Care Home is registered to provide accommodation for up to 29 older people suffering from dementia and admits people with low to high dependency needs. The premise is a large detached property situated in St Leonards. It has 23 single rooms, all with a wash hand basin and 10 are ensuite (toilet and wash hand basin) in addition there are three double rooms all of which are ensuite (toilet, bath and wash hand basin). Bedrooms are situated on first and second floor. There is a shaft lift in place allowing the residents access to all parts of the home. Residents have access to three lounges situated on the ground floor and the dining room in the basement. One lounge is the designated smoking area although the home is aiming to become non-smoking and no longer admits those that smoke. There is a flight of steps to the front door, but level access is possible from the rear of the building. The home has a secure rear garden with seating and lawn area for residents to enjoy. Car parking is available within the street outside. The building is located a short walk from the town centre and a slightly further walk will bring you to the seafront. Joint activities and social events are carried out with another care home in an adjacent street also owned by Regal Care Homes Ltd. Information about the home is provided upon request. Fees are currently £352 - £425. There are currently 26 residents. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place from 10.00 until 17.45. Twenty-six residents were in the home. A new manager was appointed on 06/03/06. He explained that he is in the process of identifying shortfalls and working to raise the quality of care through improved systems with staff liaison and management. He feels well supported by his line manager. Following discussion with the manager it was agreed that the term residents would be used throughout the report Residents have been admitted to the service since his appointment and staff recruited; some staff have had a change of responsibility to maximise their skills. Residents were spoken to in the lounges and all residents were up for lunch. A group musical activity was observed in the afternoon. A tour of the home and outside laundry was completed; interviews were conducted with the Head of Care, two seniors, one carer, and the maintenance man and kitchen staff. Care plans, staff personnel files, complaints, rota, service user’s guide were sampled and examined. The Director of Care, the manager’s line-manager, attended the feedback. Two residents surveys were returned and both were positive. What the service does well: What has improved since the last inspection? The new manager, who has worked for other Regal Homes in other counties, and the return to the home of the experienced Head of Care following a sixmonth absence, is a significant improvement. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 6 To meet the requirements of the last inspection fire safety tests are carried out to meet the required frequency; the complaints procedure is displayed and further waste containers have been put in place. Bedroom care plans have been devised and are in place confirming all basic personal care given and providing a prompt to new or agency staff. 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. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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.V288669.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and the service user guide do not provide sufficient information so that prospective residents can be clear about the services that the home provides. All prospective residents are fully assessed prior to admission ensuring that residents’ needs are met. Standard 6 is not applicable. EVIDENCE: The service user guide was last reviewed in June 2005 along with the statement of purpose. The former is not presented in a way that residents with a dementia type illness would understand. The term “service user” is used in the statement of purpose and a discussion with the acting manager took place at inspection to clarify that the report would use the term “residents” as being more empathic. The acting manager was aware of the need to develop a userfriendlier document. The statement of purpose does not reflect the new acting manager by name or his credentials. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 9 The care plans evidence that prospective residents are assessed prior to admission. When residents’ transfer in from out of county information is requested from other homes or discharge information from a hospital, social services care manager’s reports or General Practitioner’s patient summery printout providing a sound basis for needs assessment. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 and 10. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans have not been fully and regularly reviewed which may have lead to inconsistent care. Medication follows robust procedures promoting good health. EVIDENCE: The care plans in place do consider the holistic needs but have not been fully and regularly reviewed at least monthly before the acting manager was in post; but he intends that they will be now. He has implemented a new system that can be audited easily by senior carers and demonstrates the physical daily tasks to be completed in respect of personal care. This new initiative had been discussed with, and welcomed by, the residents’ families. This new system particularly supports new staff and agency carers. Carers commentated that they found the initiative useful. Medication policies and procedures are in place and the Head of Care manages the ordering and a senior carer checks the medication back into the home, a system that supports good practice. No resident is self-medicating and all systems for administered medication are satisfactory. Where a controlled drug Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 11 needs to be signed by two carers they have not been putting a full signature, as has been previously done. The Head of Care initiated instructions to staff concerning the change to the recording immediately. Residents who were spoken to during the inspection confirmed that they felt well cared for and comfortable in Blair House. Staff were seen to be respectful to all residents and handle them gently; informing them of events that were to happen before they took place and also respecting residents’ privacy by knocking on doors before entering. Two residents surveys were returned and confirmed positively that they felt satisfied with their care. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14 and 15. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible, including house activities, contact with the local community and family and friends, and residents are able to exercise choice in their daily routines. Meals are home-cooked and varied and meet residents’ tastes and choices. EVIDENCE: A varied activity programme is displayed on the notice board in the hallway and a carer has been appointed as the new activity co-ordinator. Activities are mostly planned for the afternoon period when reducing the number of carers is easier on the remaining staff. Outings are planned and some activities take place at the sister home, in the next road in St Leonards. Residents are able to choose if they wish to join in. Residents spoke enthusiastically of visits from family and friends. Two residents attend a community group each week. The last residents’ meeting was in November 2005, but the acting manager confirmed that he is planning for one for next month. Families and friends are invited to attend. The care plans did not record each residents ability to exercise choice and what appropriate choices they where able to make. The residents spoken to were Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 13 not able to remember the routine of the day or many of the choices that they had made. Some residents did clearly remember that they had selected their clothes for that day. The menu seen and the meals recorded showed a variety of home-cooked food, which the residents confirmed was very good. Kitchen staff confirmed fresh food purchases and sufficient supplies to provide nourishing and varied meals. The meat pie served for lunch had three fresh vegetables and potatoes and a choice of dessert. Drinks are freely available. The care plans sampled detailed how residents could be encouraged to eat and enjoy their meals when the support given was appropriate. The dining room is a pleasant environment and staff offer support as needed. The residents spoke positively about the enjoyable meals and this was confirmed in the returned residents surveys. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. EVIDENCE: No complaints have been received from residents or their families in the home or to Commission for Social Care Inspection. Residents felt able to speak to staff if they were worried about anything and no resident was anxious to speak about any problems they might have. Staff follow the Skills for Care induction which includes adult protection. Most staff are trained in prevention of elder abuse and had a good understanding, and the acting manager is developing the training schedule for the coming year. There have been no adult protection alerts and accidents and incidents are appropriate recorded. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 15 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): 19, 21, 22 and 26. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a clean and tidy environment but their care in compromised by insufficient assisted bathing facilities and adequate storage space for mobility equipment. EVIDENCE: A majority of the rooms were viewed at the inspection. All were clean, tidy and well ventilated creating an odour free environment. In some of the bedrooms mobility equipment and wheelchairs were stored in the rooms, reducing the area for residents to move easily and with risk of hazard and for non-ambulant residents it is undignified to have to look at equipment all day that confirms their infirmity. The home has three ensuite bathrooms and two further bathrooms that are not in use. At present only one assisted bath and one assisted shower and another ordinary bath are used for bathing all the residents and staff need to ensure Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 16 that residents are moved with dignity about the home in readiness for bathing and over as short a distance as possible. The laundry has an improved floor covering and sufficient machines. Soiled laundry was placed in open baskets inside and outside the laundry room; some on the path that was the disabled access to the rear garden. The laundry room is small but consideration should be given to the overall management for the safe containment of soiled articles and further shelving so that there is a safe floor area to work in and the items are contained within the laundry room, so that residents are thoroughly protected. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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 and 30. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on each shift who work well as a team, but few of them are trained and may affect consistency of care. EVIDENCE: The rota shows evidence of sufficient staffing arrangements. The new activity co-ordinator is a carer and her hours for managing activities are not detailed. This should be clearly stated on the rota so that an audit can be made to ensure that she is not required to support care when organising activities. Three overseas carers have been assessed by the Home Office to be educated to National Vocational Qualification level 2 but have not been assessed by an authorised assessor to standards of care. One further member of staff has achieved level 2 in Care, and three are in training at level 2. All staff are offered and follow appropriate training. Not all personnel files contained all the recruitment requirements of an application form, an interview format with applicant’s responses, explored gaps in employment and whether staff were given the GSCC code of conduct. All staff had an enhanced Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. The acting manager had identified the recruitment shortfalls and intends to maintain best practice in the future. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 18 The acting manager confirmed that he is developing a new staff training programme, as one was not in place at his appointment. New staff are following accepted induction training and all remaining staff are trained in the mandatory areas. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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): 31,33,35, 36, 37 and 38. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is well supported by senior staff and developing his plan and vision for the home and intends to communicate this to the residents, their families and the staff. EVIDENCE: The acting manager is qualified at National Vocational Qualification level 2 and 3 in Care and is studying for his Registered Managers Award (RMA). He has held a management position within the company prior to his appointment in March 2006. During the inspection he showed an understanding of his role and staff management and spoke of the need for open and transparent management, putting residents at the heart of practice for the effective running of the home. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 20 The Director of Care is working closely with the acting manager to support him and develop good quality assurance systems. She met with the Inspector and the acting manager for the feedback. The monthly report was received following the inspection and as previously, was comprehensive. Residents and their relatives’ feedback is captured each month. Residents’ monies are now being fully recorded in liaison with relatives. There was no staff supervision programme in place when the acting manager took up post and he is developing this. There was evidence that relatives were involved in the reviews of care, if they so wished. Samples of records seen showed that health and safety was being actively managed by the acting manager and recorded by the staff and maintenance man. The labels on the fire extinguishers did not denote the full date that they were examined, however a certificate shows the date as being 27/06/2005. The acting manager confirmed that he would contact the organisation that had serviced the appliances. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X 2 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 3 3 Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 22 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. 2 3 4 5 6 Standard OP1 OP1 OP7 OP22 OP29 OP31 Regulation 6(a)(b) 6(a)b) 1592)(ad) 13(4)(a) 19(5) 9(2)(b)(i) Requirement That the statement of purpose is updated. That the service user guide is presented in a user-friendly format. That care plans are reviewed at least monthly. That storage is provided outside the bedrooms for hoists, mobility aids and wheelchairs. That gaps in employment are explained at interview and recorded. That an application is made to Commission for Social Care Inspection for the registration of the manager. Timescale for action 31/05/06 18/10/06 18/05/06 18/10/06 18/05/06 18/10/06 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 OP38 Good Practice Recommendations That the fire extinguishers are fully dated following DS0000021055.V288669.R01.S.doc Version 5.1 Page 23 Blair House 2 3 4 5 OP26 OP36 OP21 OP28 servicing. That shelving is provided to free up the floor space in the laundry and prevent baskets being kept outside on the path. That staff receive supervision six times a year. That access to bathing or showering is conducted with dignity and facilities are nearby. That overseas staff are assessed to National Vocational Qualification competence. Blair House DS0000021055.V288669.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000021055.V288669.R01.S.doc Version 5.1 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. 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. 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