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Inspection on 20/09/05 for Blakesley House Nursing Home

Also see our care home review for Blakesley House Nursing Home for more information

This inspection was carried out on 20th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home welcomes visits from family and friends.

What the care home could do better:

The home needs to pay more attention to the individual preferences, needs and desires of service users. This relates especially to personal care in particular personal grooming and to the social and leisure interests of service users. Service users need to be given more informed choices regarding their day to day activities. Service users should be encouraged and assisted by staff to follow any interests they may have. Service users should be listened to and responded to as individuals.

CARE HOMES FOR OLDER PEOPLE Blakesley House Nursing Home 7 Blakesley Avenue Ealing London W5 2DN Lead Inspector Paula Eaton Unannounced 20 September 2005 09:00 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 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. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Blakesley House Nursing Home Address 7 Blakesley Avenue Ealing London W5 2DN 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) 0208 991 2364 0208 991 5256 Mrs Margaret Nyambura Lane Mrs Margaret Nyambura Lane CRH (Care Home) 22 0 PD(E) Physical dis - over 65 Category(ies) of OP Old age registration, with number 0 of places Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8/04/05 Brief Description of the Service: Blakesley House is a care home for twenty-two older people. There are sixteen beds for older people who need nursing care and six beds for service users who require personal care. The Registered Manager is also the owner of the home. The home is situated in a detached house, located in a quiet residential area of Ealing. It is close to Ealing Broadway, with its shopping centre, buses, and underground and main line station. There are eleven shared bedrooms. The home has five bathrooms. Some are situated between bedrooms with access from both rooms. There are bedrooms on four floors, including the ground floor. The passenger lift does not go to the top floor, so service users are required to be able to use the stairs to those rooms. There is a lounge on ground floor, with an adjoining conservatory. These rooms are also used for meals as there is no separate dining area. There is a small private space on the ground floor, which has seating for meetings of up to four people. There are no communal areas on the other floors. There are steps from lounge to the area where the lift is located. A portable ramp for these steps is available for wheelchair use only. There is a garden to the rear of the property. The kitchen is located off the main lounge and there are separate laundry facilities and a food store located in an outbuilding in the garden. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and hours as part of the annual inspection process. The manager, deputy manager and five service users were spoken to and records, policies and procedures were examined. The Registered Manager and Deputy Manager were not at the home at the beginning of the inspection but did arrive shortly afterwards. What the service does well: 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. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 7 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 standard(s) 3 The home has an adequate system in place to assess the needs of service users prior to admission to ensure the home is able to meet their needs. More detail could be recorded. EVIDENCE: There had been five new admissions to the home since the last inspection took place. The home carries out a pre-admission assessment. The information contained in the assessment documentation inspected covered all areas of need for each service user. However, it was noted that some of this information could be more detailed. The home had also obtained any Care Management assessments that had been completed. The homes assessment and the Care Management assessments had been used to develop care plans for the service users. All assessments had been carried out by a qualified member of staff. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 8 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 standard(s) 7, 8, 9 and 10 Individual plans of care do not always accurately reflect the current circumstances of service users. Health care needs are satisfactorily met. The medication at the home is not always managed in a way that ensures the safety of service users. Service users are not always treated respectfully. EVIDENCE: The service user plans viewed covered all areas of need, however, two service users who had been admitted to the home over the weekend prior to the inspection did not yet have a care plan in place. The care plans that had been completed were being reviewed regularly and service users had signed care plans where able to do so. Since the last inspection three service users have moved into Blakesley House from the Registered Providers other registered home whilst some refurbishment is taking place. The care plan for one of these individuals was viewed. Although the move from one home to another was mentioned in the records viewed it was only mentioned very briefly. There was no information recorded regarding the service user being consulted about the move, no information about the placing authority being notified and very little information recorded about staff monitoring how the service user had coped with the move and if they were happy about it. It was also noted that the Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 9 service user plans contained very little information regarding their social and leisure interests. Appropriate records for assessments are maintained including moving and handling, pressure area risk, nutritional and continence assessments. These had been regularly reviewed. Records of healthcare appointments and visits from healthcare professionals are maintained in the service users daily log books. The records viewed showed that regular healthcare checks were taking place as required. The medication store and records were viewed. The storage of medication in the home was generally satisfactory, however, a service user had recently moved into the home from another care home. The medication that was transferred from this home had not been appropriately checked. One item of liquid medication had been prescribed in March 2005, it had no date of opening on it and the home was administering this medication even though there were clear guidelines on the bottle stating that the medication should be disposed of three months after opening. The Registered Manager and Deputy Manager said that they were not sure when the medication had been opened and that they would check with the other home and contact the service users GP to get a new prescription for the medication. Only one service user in the home is prescribed controlled drugs. The records for these were satisfactory. An issue had been previously raised regarding the personal care needs of the service users not being fully met, in particular many of the men at the home looked unshaven and dishevelled. This had improved at the time of this inspection. However, two of the male service users spoken to during the inspection had not had a shave that day and when asked why one of them said that he was unable to do it himself and ‘the girls’ were often too busy to do it. He said that he would like to have a shave every morning but that this did not happen. It was also noted that many of the female service users still had very short cropped hairstyles. The Deputy Manager said that a new hairdresser had been employed by the home and that service users who were able to choose were asked how they would like their hair to be cut and styled. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12, 13 and 15 The home does not meet the social and leisure needs of service users. Staff encourage service users to maintain contact with family and friends. Meal provision at the home is satisfactory. EVIDENCE: The daily routines of the home are fairly relaxed and allow service users a certain amount of choice. Service users are able to choose whether to take their meals in their bedroom or in the communal lounge/diner and they are able to decide whether to participate in any activities taking place in the home. The leisure and social activities available to service users in the home are very limited. There is an activities programme available on the notice board in the lounge; however, it is just written on a piece of A4 paper and is hardly noticeable. Two of the gentleman spoken to during the inspection said that they did not do much at the home. When asked what they would like to do they said they would like to go out for a day trip somewhere by the seaside and that they would love to go out to a local pub occasionally. A pack of cards had been purchased for one of the gentlemen spoken to however they were still waiting for a game of dominoes to be purchased so that they could play dominoes together. The Deputy Manager said that an entertainer now attended the home weekly instead of fortnightly and also said that service users are occasionally taken out to the local shops or pubs. However, the records relating to social and leisure activities did not evidence this. The home must Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 11 review the leisure and social activity provision provided in the home, find out what service users would like to do and take action to meet these requests where possible. It was noted in the service user plans viewed that very little was recorded in the way of social and leisure interests. It was recommended at the last inspection that the home considered employing an activities coordinator. The Deputy Manager said that someone had been interviewed for this position but that they had decided not to commence work at the home. A game of bingo did take place in the home during the inspection. Visitors are welcomed at the home. One lady living at the home said that she has regular visits from friends and family. The home also has a cordless telephone for service users to use in their rooms to speak on the telephone in private. The daily records seen also showed records of visitors to the home. A lunchtime meal of beef burgers or lamb with potatoes and cabbage was provided on the day of the inspection. This had already been prepared by 9:30 at the beginning of the inspection. Service users appeared to be enjoying the meal and staff were assisting people where needed in an unhurried manner. All the service users spoken to said the food provided in the home was okay. There is limited dining space in the home for service users to eat, as there is only a small conservatory area with a few dining tables that would not seat all of the service users in the home. Therefore many service users take their meals in their bedrooms or whilst sitting in a chair in the lounge area. This is not ideal as not all service users would be able to sit at a dining table if they wished to do so unless there were two sittings at mealtimes. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 The home has a satisfactory complaints system with information available to service users, staff and visitors to the home. The home has adequate systems in place for the protection of service users from abuse. EVIDENCE: The home has a satisfactory complaints procedure in place that provides all of the relevant information for someone wishing to make a complaint. The complaints record showed that there had not been any complaints since the last inspection. The home has satisfactory procedures in place for the protection of service users and clear guidelines for staff regarding the action they should take if they witness or suspect abuse is taking place or if an allegation is made. No allegations had been made since the last inspection. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 20, 21 and 26 The bathroom facilities require updating. The environment was clean, tidy and generally well maintained. Individual accommodation was satisfactory, however, communal living space is limited. EVIDENCE: There were no maintenance issues at the time of the inspection and a satisfactory programme of renewal and maintenance was seen for the year ahead. Any maintenance issues are recorded along with the action taken and date. Service users spoken to were happy with the accommodation provided at the home and confirmed that they were able to personalise their rooms. There is only a small lounge with a conservatory attached that is used as a dining area. The communal space in the home is limited and would be quite cramped if the home were full to capacity. As mentioned earlier there is not adequate dining space for all service users to eat at dining tables together. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 14 The bathrooms in the home are generally adequate but are quite old and dated. The Registered Manager said that one of the bathrooms was going to be updated and refurbished once the works are completed at her other care home. This was a recommendation made in an Occupational therapy assessment of the home last year. The home was clean and hygienic at the time of the inspection. There were no malodours in the home and the laundry facilities were clean and tidy. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 There are satisfactory numbers of staff employed by the home. The current recruitment practices of the home do not safeguard the welfare of service users. EVIDENCE: On arrival at the inspection there was one qualified nurse on duty and several carers. Neither the Registered Manager or the Deputy were on duty, however, when examining the staff rotas both the Registered Manager and Deputy Manager were on the rota to be working that morning. The Deputy Manager arrived shortly after the inspection commenced and said that it was his day off and the Registered Manager arrived about an hour later and said she had been at the airport picking up a relative. The staff rotas must accurately reflect the staff working in the home. There were adequate numbers of staff on duty at the time of the inspection. The Registered Manager and Deputy said that there is a cleaner employed by the home who works between the hours of 6am and 9am to carry out cleaning such as vacuuming and dusting but that the care staff manage the rest if the cleaning in the home as well as the laundry. The staff records viewed generally contained all of the required information and appropriate checks had been carried out prior to employment. However, it was noted that in the records for one member of staff who was working at the home as an adaptation nurse that the Criminal Record Bureau’s portability service had been inappropriately used and therefore this member of staff had not had a POVA First or CRB check before commencing work at the home. On Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 16 examining the application form for portability more closely it was evident that the Registered Manager had stated that the position the member of staff was working in did not require a POVA check. Any member of staff working in a care home requires a POVA check to ensure that they are not listed as a member of staff who is unable to work with vulnerable adults. This was discussed with the Registered Manager who said that she did not realise that this applied to all staff working in her home. Any member of staff commencing work in a care home must have a new CRB check and must have a POVA First check completed before commencing work. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The home has a well-established manager. It was not possible to assess if staff receive adequate supervision from the records viewed. The health and safety of service users and staff are satisfactorily protected. EVIDENCE: The Registered Manager has completed her NVQ level 4 training and the Deputy Manager is in the process of completing his. The Registered Manager and Deputy Manger were also due to start an Assessors training course to enable them to be mentors for student and adaptation nurses. The staff supervision records were examined. Although according to the records viewed regular supervision was taking place it was difficult to assess the value of these supervision sessions, as the records were no more than two lines once the initial supervision session had taken place. Therefore it was not possible to ascertain the detail of the discussions that had taken place. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 18 The health and safety maintenance and servicing records for the home were viewed. These were all in order and up to date. The accident records were satisfactory and adequate fire safety checks were being completed. A checklist is maintained for the fire safety checks carried out and boxes had been ticked to evidence that these had taken place. It is recommended that the person carrying out the checks initials the boxes to provide a record of who has completed the checks. It was noted that a fire door had been propped open in a main hallway on the ground floor. An Environmental Health Officer had visited the home the day before the inspection and the records relating to this visit were seen and were satisfactory. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 2 x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x 2 x 2 Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 20 Yes 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. 2. Standard 7 7 Regulation 15(2)(b) 15(2)(b) Requirement Care plans must include all information regarding changes in a service users care. Care plans must include detailed information regarding each service users social and leisure interests/needs. The date of opening must be recorded on liquid medicines. Any medicines coming into the home must be thoroughly checked before being administered to a service user. Service users must be consulted and given a choice regarding personal grooming such as hairdressing and shaving and their preferences must be taken into consideration (Timescale of 1/06/05 not complied with). Service users must be consulted about their social and leisure interests and the activity provision in the home reviewed in light of this information. (Timescale of 1/07/05 not complied with) Staff rotas must accurately reflect the staff working on each shift in the home. Staff must not commence work Timescale for action 1/11/05 1/12/05 3. 4. 9 9 13(2) 13(2) 20/09/05 20/09/05 5. 10 12(4) 20/09/05 6. 12 16(2)(m) (n) 1/12/05 7. 8. 27 29 Schedule 4 (7) 19(1)(b) 20/09/05 27/09/05 Page 21 Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 (i) 9. 38 23(4)(a) at the home without a POVA first check being completed. (Timescale of 1/04/05 not complied with, immediate requirement issued) Fire doors must not be propped open 20/09/05 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 36 38 Good Practice Recommendations Supervision records should be more detailed to evidence the quality of formal supervision provided for staff. Records relating to fire safety equipment checks should be signed by the persn carrying out the checks. Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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 Blakesley House Nursing Home G61-G10 s10942 Una-Blakesley House v214913 200905 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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