CARE HOME ADULTS 18-65
Blandford Lodge 4a Blandford Waye Hayes Middlesex UB4 0PB Lead Inspector
Robert Bond Unannounced 30 June 2005 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. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Blandford Lodge Address 4a Blandford Waye, Hayes, Middlesex UB4 0PB 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) 020 8573 0129 020 8573 0129 blandfordlodge@yahoo.co.uk Mr Poucarshing Luchmun Mr Poucarshing Luchmun Care Home 3 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia (3) of places Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd November 2004 Brief Description of the Service: Blandford Lodge is a care home for three service users with mental health needs. It is a detached family house with garden in a quiet residential area on the Hayes/Southall border, close to the Uxbridge Road. It is within reach of local shops and bus routes to larger neighbouring shopping centres. The home has three single bedrooms, one down and two upstairs, a lounge/diner, kitchen, two toilets, bathroom and shower room. Outside there is a patio that acts as a smoking area. The Registered Provider is also the Registered Manager and he is supported by his wife as deputy manager, and six other support staff. There is a minimum of two staff on duty during the day, with one sleeping in at night. The Registered Provider and his wife live close by. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspector spoke to the Registered Manager, the deputy, two residential care workers, two service users, and a visiting care manager. No one spoken to raised any concerns. One service user was due to move out on the day of the inspection to a home that could more easily meet his physical needs. The care manager was introducing a new potential service user, and his mother, to the home. The third service user was out for the day. The Inspector examined the care records of two service users by using the case tracking method. Other records were also examined. In total 30 Standards were inspected against. Of these, 23 were fully met, 4 were almost met and 3 were not met. A total of 10 requirements were made, 2 of which were restated form the last inspection. 3 recommendations were also made. The Inspector was concerned that insufficient attention is being paid to Health and Safety issues in the home. What the service does well: What has improved since the last inspection? What they could do better:
The building of a patio and a shower room should now be completed and further ways of gaining registration of the fourth bedroom should be investigated. As the Registered Manager also has a fulltime post elsewhere, a
Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 6 fulltime Manager is required in the home. Additional NVQ training for staff is also required. The bedroom that has just been vacated is in need of refurbishment that would include repairs, replacement of some furniture, and decoration. One current service user might benefit from a day centre place. Service users should have individualised terms and conditions of their residence agreement issued to them. The home’s complaints procedure and their adult protection procedure both require to be updated/amended. A number of Health and Safety issues were noticed that require urgent attention. 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. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 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 Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 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) 2, 4 and 5. Outcomes for Standards 2 and 4 were met, but that for Standard 5 was not met. EVIDENCE: On the day of the Inspection, a prospective service user and his mother and care worker were visiting the home. The Registered Manager asked the Care Manager to provide him with a needs assessment, risk assessment, CPA reports, and a discharge summary from hospital or rehabilitation. The Registered Manager explained that if the referral appeared to be appropriate, the prospective service user would be invited to visit for an evening meal and house meeting, then to have an over-night stay, then a weekend stay, and finally he would move in for a trial period of 4 to 6 weeks which could be extended to 8 weeks. A copy of the Service User Guide is given out at the time the trial placement commences. Although the home has individual contracts for service users which are entered into with the placing authority, the service users themselves do not receive the required statement of the terms and conditions of their stay in the home. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 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, and 9. All four outcomes are fully met. EVIDENCE: Two care files were examined in detail using the case-tracking methodology. It was noted that detailed care plans were in existence, as were risk assessments, CPA reviews and internal monthly reviews. Service users attended these, and relatives were invited to. Service users’ choices are ascertained at reviews and during weekly minuted house meetings. Responsible risk taking is encouraged subject to through risk assessments. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 10 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, 13,14,15,16 and 17. All the outcomes are fully met. EVIDENCE: One service user has part-time work and a girl friend. A second service user goes to a local church and a café, daily. A third service user has been referred to a local day centre for attendance. All three have the opportunity to play football and volleyball in the park, and to enjoy barbeques in the back garden. Their relatives visit when they are able to. Meals are produced according to a four-weekly cycle, with service user substitutions possible on the day. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 11 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, and 20 All the outcomes are fully met. EVIDENCE: Care plans are detailed and signed by service users. Service Users’ emotional needs are addressed during one to one sessions with the care staff. All service users are subject to the Care Programme Approach, with support given by the Community Mental Health Team, including a psychologist. Local GP’s are used, and all the service users have social workers (Ealing Borough). None of the service users are able to manage their own medication but the staff have been trained in the administration of medication by the Boots pharmacist and the medication records were seen to be in order. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 12 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) 22, and 23 Neither Standard was fully met. EVIDENCE: The home’s complaints policy indicates that complainants may refer their complaint to the CSCI when internal procedures have been exhausted. The National Minimum Standard requires the policy to say that complaints may be referred to the CSCI at any stage. The home had not recorded any complaint since the last inspection. The home’s existing Adult Protection procedure/policy is not up to date as it does not refer to The London Borough of Hillingdon’s Adult Protection policy. This must be obtained and staff trained in its use as the home is in the Borough of Hillingdon although referrals tend to come form within Ealing Borough. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 13 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, and 30 The outcome for Standard 24 is not met, primarily because of the number of Health and Safety concerns. That for Standard 30 is met. EVIDENCE: The soon to be vacated bedroom is in a poor state of repair with dirty walls, damaged furniture, holes in the ceiling and a broken light shade. It must be refurbished before a new service user moves in. There is no opening restrictor on this downstairs bedroom window, which could be a security issue. A shower is being created in the downstairs toilet, but the shower unit is not yet installed. In the toilet/shower there is a trip hazard that must be eliminated as far as possible. Loose telephone cabling is present at ground level in the kitchen. The empty fourth bedroom which currently acts as store, including the cleaning chemicals store, was not locked, as required. Builder’s rubble was present at the front and rear of the premises. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 14 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) 32, 33, 34, 35 and 36. Outcomes for Standards 34, 35 and 36 were fully met. Those for Standards 32 and 33 were almost met. EVIDENCE: Staff rotas demonstrated that sufficient staff were employed. There are 6 care staff and a deputy manager. Three staff members have achieved NVQ level 2, which equates to 43 of the care staff team. A further two are undertaking the award at present. The most recent member of staff has had a CRB check undertaken and two references supplied, but neither is from his previous employer. The Registered Provider is still the Registered Manager despite working fulltime elsewhere. Training records, training needs analysis, and training certificates, as well as supervision records, were all in place. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 15 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) 38, 39, 41 and 42. The Outcomes for Standards 38 , 39 and 41 are fully met. That for Standard 42 is almost met. EVIDENCE: The Inspector noted an open and positive atmosphere in the home. Record Keeping is good. Quality Assurance surveys have been undertaken and the findings acted upon. The fire alarm and smoke detectors are tested weekly, with a fire risk assessment having been commissioned from a private company. Fire drills are weekly, and the emergency lighting is tested four weekly. However there remain a number of Health and Safety omissions that are detailed above under ‘environment’. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 16 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 3 x 3 1 Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Blandford Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x 3 1 x G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 17 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 5 22 Regulation 5 (b) 22 Requirement Service users must have an individual statement of terms and conditions. The homes complaints procedure and complaints leaflets must show that complaints may be made directly to the CSCI at any time. The homes adult protection procedure must link in with Hillingdons procedure All staff must be trained in applying Hillingdons adult protection procedure. Downstairs bedroom must be refurbished before a new service user moves in. Telephone cables in kitchen must be secured. Cleaning chemicals must be stored securely Builders rubble must be removed from front and rear of the premises. 50 of care staff in the home achieve the NVQ level 2 in care by 2005. THIS IS RESTATED FROM THE PREVIOUS INSPECTION. TIMESCALE OF 01/01/05 WAS NOT MET. If the Registered Provider does Timescale for action 010905 010905 3. 4. 5. 6. 7. 8. 9. 23 23 24 24 and 42 24 and 42 24 and 42 32 13 (6) 18 (1c) 16 (2c)and 23 (2d) 13 (4) (a) 13 (4) (a) 13 (4) (a) 18 (1)(a)(c) (i) 010905 011005 010805 010805 010805 010805 .010106 10. 33 8(1)(biii) 01/10/05
Page 18 Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 not intend to be in charge of the home full time, a suitably qualified and experienced manager must be put forward for registration. THIS IS RESTATED FROM THE PREVIOUS TWO INSPECTIONS. THE TIMESCALES OF 30/07/04 AND 01/12/04 WERE NOT MET. 11. 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. 3. Refer to Standard 24 24 34 Good Practice Recommendations Fit window opening restrictors in downstairs bedroom. Use yellow and black tape to highlight the trip hazard step in the downstairs toilet/shower. One reference should be from the previous employer. Blandford Lodge G61 G10 s27125 Blandford Lodge v214303 300605 Stage 4.doc Version 1.30 Page 19 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
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