Inspection on 19/05/05 for Blair House

This inspection was carried out on 19th May 2005.

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 13/01/06

Blair House 25/11/04

Blair House 18/05/04

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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 Mike Perry Unannounced 19 and 20th May 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blair House Address 18 Roe Lane Southport Merseyside PR9 9DX 01704 500123 n/a n/a Mr Doug Edmondson Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Anthony William Moran Care Home with Nursing 36 Category(ies) of MD - Mental Disorder - 36 registration, with number of places Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 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. Date of last inspection 25th November 2004 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 accomodation 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 Edmundson and 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 F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days [8 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 7 care/ ancillary staff were spoken to. 11 residents were also spoken with and their views obtained. What the service does well: The home continues to develop well. There is a very positive attitude from the care staff and the residents feel listened to and included in the homes activities and routines. There are good rehabilitation programmes and many of the residents are benefiting from this so that some have been able to be discharged and supported in the community. The care plans are developed with the input of the residents and staff are open to new ideas to help residents meet their aims. An example of this is the ‘wellness’ model now being used by some residents and supported by staff to help residents to better understand what keeps them well and active. There is a good feel to the home and residents spoken to identify with Blair House as a positive place to live and feel secure. Staff monitor care programmes and residents are supported by health and social care professionals outside the home such as social workers and community nurses. The home is developing a good record of providing activities and opportunities for residents to socialise and develop self help skills. Residents clearly enjoy the activities, which contribute to improving their lifestyle. Staff at the home are settled and have a clear idea of the homes aims and how to meet the residents needs. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 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. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 8 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 standard(s) These standards not assessed. EVIDENCE: Not assessed. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6,7,8 Individual care plans are drawn up with the resident’s involvement and reflect changing needs and personal goals. Residents are assisted to make personal decisions and generally feel included in the running of the home, which helps ensure participation and develops quality of life. EVIDENCE: The residents in the home have care plans. These are drawn up with the resident’s involvement and copies are given. 3 care records were seen and these listed the care needs and were reviewed. All residents have two main care reviews each year where the plan is updated. Other smaller reviews are held weekly and notes are made in the care record. Daily activity sheets completed by care staff for some residents who need prompting with basic hygiene and personal care back up the system. Those residents on the top floor rehabilitation programme have care plans based around developing social and domestic skills. Two of the residents spoken to are involved in a new care plan model based around identifying any triggers that may affect feelings of wellbeing and the residents were able to describe how this works and their involvement. Two residents have been Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 10 discharged into the community recently which helps other residents to see some potential for themselves. Residents receive monitory benefits and are assisted to manage as needed. For example some are set targets and get involved in buying food for meals, which requires some budgetary skills. Residents talked about being involved in the planning of these projects. There are regular forums for residents to air their views such as resident meetings. At present some staff are involved in consulting residents with respect to the planning of summer holidays. Residents spoken to generally felt that they were listened to and felt part of the home. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 11 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 standard(s) 11,12,14,15,16,17 There is a planned, though flexible, approach to the organisation of social activities and programmes in the home, which encourages personal development for residents. There are opportunities for shared relationships and residents feel supported by staff. The daily routine helps promote independence yet is also able to support people who are less confident in there abilities. Meals are well managed and provide opportunities for residents to develop social and domestic skills. EVIDENCE: Residents are encouraged to join in activities if they so wish. The top floor rehabilitation unit has a planned programme of community living involving cooking, cleaning, shopping and budgeting. Residents spoken to were able to describe a flexible approach by the staff on the unit and felt supported so that they could develop and improve their confidence. Some residents attend local education courses, for example adult literacy classes. There is a programme of activities organised with some regular features such as bowling, trips to the YMCA and day trips in the mini bus on Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 12 Fridays and Sundays. Some staff are presently involved in seeking the views of residents on a venue for a summer holiday. There are opportunities for residents to develop intimate and personal relationships in the home and two of the current rooms are shared occupancy with appropriate staff support and guidance given when necessary. Menus are based on individual choice. Residents are encouraged to shop and cook according to individual abilities. There is a bright and comfortable dining room and residents are encouraged to serve themselves from an open serverey, which promotes choice and independence. Some residents are involved in cleaning and serving at coffee and tea breaks. The residents spoken to were very pleased with the food on offer. One resident spoken to had moved to Blair House from another home and said that ‘I do a lot more for my self here and the staff help me when I need them’. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18,19 Personal care is offered on an individual basis, which encourages independence and helps ensure appropriate standards so that residents are supported. Health care is well managed and where difficulties of access are evident staff are persistent in both representing and supporting residents so that health care needs are met. EVIDENCE: There is a wide variation in the home with respect to individual residents and their ability to carry out personal care for themselves. Discussion with staff revealed that this is recognised and the care plans reflect an individual approach. Those residents that need a lot of staff intervention for example have each area of personal care, such as bathing, recorded on a daily basis, which helps with monitoring and reviewing the care. A team of appropriately trained nurses who are experienced and skilled manage the psychiatric care in the home. Care records seen show that there is regular contact with the local psychiatric support services and reviews are held. Residents interviewed described how the staff supported them with routine health care needs such as dental and optical appointments. One resident was Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 14 attending an out patient appointment on the day of the inspection and transport was being arranged by the home. Staff discussed some concerns around the difficulties of some residents with mental health needs accessing routine dental care because of inconsistencies of attendance due to their mental health. Staff were persistent in representing residents needs however and were able to support residents at these times. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 15 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 standard(s) not assessed EVIDENCE: Not assessed. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24,25,28,30 The environment at Blair house is being developed along appropriate guidelines and principals which helps ensure therapeutic, comfortable and safe living conditions for residents. EVIDENCE: The general environment at Blair House has been subject to ongoing planning and upgrading over the past 2 years. This is so that the service can be developed along good practice guidelines as well as meeting required standards. For example the development of the top floor so that 6 residents can experienced a more intense rehabilitation programme has been very positive and there are plans to develop the home further along these lines. At the time of the visit the middle floor was in the process of being decorated and upgraded. Residents spoken to did not feel disrupted by the changes and could see the benefits to their over all lifestyle. For example residents were pleased with the introduction of the many en suite facilities and were pleased that the home was being maintained well as it felt brighter and more homely. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 17 Residents are encouraged to maintain cleanliness in their own rooms although this is based on ability and staff recognise that full assistance is required on occasions. There is therefore appropriate domestic staff who support this programme. The smoking lounge is particularly difficult to maintain in a clean state although this was found to be acceptable. The carpet in this area was in a poor condition and needs to be considered for replacement. The cleanliness and hygiene in the laundry has improved since the previous inspection and this area is now appropriately managed. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35 There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met. The recruitment processes in the home are not robust and do not provide sufficient protection for residents. EVIDENCE: Staff interviewed were very clear about their roles in the home and how they helped in the residents care. There is designated staff with different responsibilities; for example identified staff manage the rehabilitation unit and many of the residents have identified key workers although there is a lot of flexibility in this area. Residents interviewed were able to identify key staff and understood who was responsible for their care. For 36 residents in the home there was 2 trained and 5 care staff on duty. These numbers are flexible depending on resident needs on any one day. The manager is generally in addition to these numbers. There are support staff including administration and ancillary staff. The recruitment procedures in the home need to be reviewed in order to provide sufficient protection for residents. Two staff files lacked any police check although one person had been employed since January this year. Another staff file had no references recorded. Staff from overseas had no proof Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 19 of identity in some cases and no copies of work permits on file. This has been a requirement on previous inspections. There has been improvement in the organisation of training and each member of staff has a training plan linked to their role in the home. For example 2 staff have completed health and safety management training and there are current plans for care staff to undergo training on the management of aggression. Staff interviewed had completed induction training. The home accepts students who are training to be nurses who felt that the experience of working in the home had been positive. Residents spoken to were clear in that they felt supported by staff who they found to be approachable and would listen to their concerns. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42 The registered manager is qualified and competent and residents benefit from a well run home. The health and safety management is now effective and the welfare of residents is promoted and protected. EVIDENCE: The Registered Manager is Mr Tony Moran. Tony is a Registered Mental Nurse (RMN) as well as having a qualification in learning disabilities. He has experience in forensic psychiatry and has clinical skills in stress management. He was able to articulate clear aims and objectives for the service over the next 6 -12 months and displayed a good understanding of rehabilitation within enduring mental health. He has been in post for the past 2 years during which time the home has developed in a positive manner. The management of health and safety in the home has improved since the last inspection. The home has designated staff who are responsible for health and safety policy and these have undergone some training. Policies are clear and continue to be developed and are now included in the staff handbook. Records are kept on fire safety and these were up to date. There are regular health and safety discussions recorded at weekly staff meetings. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 1 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Blair House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 34 Regulation 19 Requirement Timescale for action 30.8.05 2. 3. 34 34 19 19 All staff must have have a criminal records bureau check prior to commencing work in the home. Two references must be obtained 30.8.05 for new staff employed befor they start work. Staff records must contain copies 30.8.05 of required certificates which record identity and eligiblity to work in the home [as identified in 2 of the Care Home Regulations]. 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. Refer to Standard 24 24 Good Practice Recommendations The home environment continues to be developed with reference to appropiate standards and principles of good practice. The carpet in the smoking lounge should be considered for replacement in line with the development of existing facilities. Blair House F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burlington House, South Wing, 2nd Floor 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 F53 F03 Blair House S17227 V224074 18.05.05 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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