Inspection on 25/01/06 for Blatchington House

This inspection was carried out on 25th January 2006.

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.

Other inspections for this house

Blatchington House 14/03/07

Blatchington House 07/07/05

Blatchington House 03/12/04

Blatchington House 29/06/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Blatchington House Firle Road Seaford East Sussex BN25 2HH Lead Inspector Jennie Williams Unannounced Inspection 25th January 2006 10:30 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 Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Blatchington House Address Firle Road Seaford East Sussex BN25 2HH 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) 01323-891702 01323-490393 www.blatchingtonhouse.co.uk AHLE Limited Mrs Carol Breeds Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33) of places Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A maximum of thirty three (33) service users to be accommodated. That a maximum of twenty (20) service users are in receipt of nursing care. That a maximum of thirteen (13) service users are in receipt of personal care. That service users are aged sixty five (65) years on admission. That service users may have a physical disability. Date of last inspection 7th July 2005 Brief Description of the Service: Blatchington House is a care home registered for 33 places. Residents accommodated must be aged 65 years or over on admission and may have a physical disability. The home can accommodate 20 residents in receipt of nursing care and 13 residents in receipt of personal care. Blatchington House is located in a quiet residential area in Seaford. It is located approximately one mile from the seafront. There is car parking available at the home or on the adjacent street. There are two double rooms and 29 single rooms. Rooms are located over three floors. There is a passenger shaft lift available to assist residents to access all floors. There is a large garden area with seating and wheelchair access. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Blatchington House will be referred to as ‘residents’. This unannounced inspection took place over approximately seven hours on the 25 January 2006. Care plans, medication procedures, residents’ personal allowance and some policies and procedures were inspected. The environment and some individual rooms were spot-checked. Staff and residents were spoken with throughout the inspection process. There were 32 residents living at the home on the day of the inspection, of which 20 were in receipt of nursing care. 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. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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 the following standard(s): 4 The home has information available to prospective residents and their representatives to make an informed decision if the home is suitable for their needs. All prospective residents are assessed prior to moving into the home. EVIDENCE: The Statement of Purpose and Service User Guide were not inspected on this occasion as it was fully met at the last inspection. The Manager or a Registered General Nurse will undertake assessments on all prospective residents, with the involvement of a relative/representative, wherever applicable. Information is obtained from other health professionals, wherever applicable. No new admissions pre assessments were looked at on this occasion as this standard was fully met at the last inspection. The home does not admit any resident whose needs cannot be met at the home. The Inspector was pleased to note a policy titled ‘Enable clients to maintain personal cleanliness. This provides staff with guidance on different religions and cultures. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 8 Prospective residents/representatives are encouraged to visit the home prior to moving in. Emergency admissions are very rare as the home usually has a waiting list of prospective residents. Staff individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. The home does not have dedicated accommodation to provide intermediate care, but respite care is offered if there is a place available. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 9 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 & 10 Information and recording in care plans are improving, but there continues to be minor shortfalls. Residents’ health needs are being met. Residents’ privacy and dignity are respected. EVIDENCE: Care plans spot-checked demonstrated that there remains shortfalls in the information, however the documentation in care plans is improving. There continues to be lack of recording on turning charts and fluid balance records. One resident was noted to have a diet/fluid thickener in their room. This is added for texture to food/liquid for residents who may have swallowing difficulties. There was no mention in the care plan if this is currently being used or not. A staff member was unsure if this resident still needed this, but confirmed they were not using it when assisting the resident. Care plans need to give clear guidelines and substances not required for use must be removed from a residents room to avoid any confusion. One resident with some complex nursing needs had a good care plan in place and specialist advice is inputted into this. Staff have received training on additional skills required to care for this resident. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 10 One turning chart had a whole day of pressure relieving care not documented. A fluid balance chart demonstrated that someone did not have any fluids for a period of 11.5 hours. It was confirmed that this resident did have meals and fluids throughout this period. The Inspector spoke with staff on duty during their handover to reiterate the importance of clear documentation. A personal cleansing chart in use had an abbreviation on it. Any abbreviations used needs to be explained eg. A/W = Assisted Wash. Care notes are improving, but still require work. The manager confirmed she is constantly reminding staff to ensure they reflect the care/health needs of individuals. This has not been reflected as an outstanding requirement as work is being done to comply. Health needs are being met at the home. One resident who was observed to be wearing glasses confirmed that their eyes were checked the day before the inspection. Another resident stated that the home was ‘very good at referring to the GP’. There was evidence that specialist advice is sought when needed. There is pressure relieving equipment available at the home and specialist advice is sought from a tissue viability nurse when required. Residents were very complimentary about the staff working at the home and felt that their needs were being met. Some residents confirmed that staff discuss their care with them. One resident was observed to be using a wheelchair with no footplates in place. The resident informed the Inspector that this was their choice and it is safer for them without footplates. It is required that a risk assessment be undertaken to evidence this. MAR charts inspected demonstrated that medication was being signed for at the time of administration. There are accurate records maintained of controlled drugs. It was confirmed that the resident who self medicates has a risk assessment in place. Not all MAR charts contained a photo of the resident. It was confirmed that photos are currently being updated. This is not reflected as a requirement as the home is taking action to address this. There was no form located that contained a sample signature of all staff administering medications. It was confirmed that there had previously been one. The registered nurse spoken with was going to ensure this was located. This has not been reflected as a requirement/recommendation. The home needs to ensure that there is clearer guidance on ‘as needed’ (PRN) medication. One resident prescribed additional nutritional supplements was not receiving the number prescribed, according to the documentation Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 11 maintained by the staff. These were also not marked/signed on the MAR chart as being given. One resident was prescribed medicated shampoo twice a day. This was not marked off on the MAR chart and not reflected in the care plan. One prescription had written to administer ‘as directed by the GP’. This was not reflected in the care plan and when tracking information, no directions could be located. This tracking exercise was undertaken with a registered nurse who will feedback to other nurses working at the home. The home must ensure that MAR charts are kept up to date. It is recommended that the person amending the MAR chart sign any handwritten amendments. All residents spoken with confirmed that their privacy and dignity are respected. Residents are able to receive visitors in private if the wish. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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 & 15 Residents have opportunities to participate in activities that are of interest and within their capabilities. Visitors are welcomed at the home. EVIDENCE: There is an activities co-ordinator employed for three days a week. The Inspector spoke with the activities person who is currently in the process of arranging a variety of outings. The home has access to a mini bus that can accommodate wheelchairs. The majority of residents spoken to confirmed that there were enough activities should they choose to be involved. A few residents felt that there were not enough activities provided. When the Inspector asked what the home could be offering, there were no definite responses. These residents did confirm that the activities person was very good. No requirement has been made, but the provision of activities will be reassessed at the next inspection. The activities person is aware that the recording of activities needs to be improved. This has not been reflected as a requirement as the activities person confirmed she will be taking action to address this. Residents spoke positively about the activities and provisions made at Christmas. A staff member spoken with felt that there were sufficient activities provided at the home. On the day of the inspection, seven residents were observed to be relaxed and enjoying facials and manicures. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 13 Visitors are welcomed at the home and there is a visitors book at the entrance of the home that all must sign when entering and leaving the establishment. Residents are able to choose whom they see and do not see. Residents spoken with confirmed that their routine of daily living is flexible and their own choice. They choose when to go to bed or get up and have a choice of when they have a bath etc. Residents are able to bring in personal possessions with them. This was evident when the Inspector spot-checked some individual rooms. One resident was observed to have a computer in their room and confirmed that they had received training on the use of computers, which is allowing her to keep in touch with friends and relatives easier. This resident has arranged internet connection for her individual room. Residents were complimentary about the food provided at the home. Comments received ranged from ‘pretty good’ through to ‘excellent’. One resident stated ‘it could be improved’. Residents were observed to be enjoying their lunch on the day of the inspection. Meal times were observed to be unhurried. Residents are provided each day with a choice of meals. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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): 18 Residents/representatives are provided with opportunities to raise any concerns. EVIDENCE: Residents/representatives are provided with information on how to make a complaint. One resident spoken to said that they would speak up for themselves if they had a complaint. There have been no direct complaints made to CSCI since the last inspection. The manager has recently attended a train the trainer course on adult protection. The homes Protection of Vulnerable Adults (POVA) policy is in the process of being updated. This has not been reflected as an outstanding requirement. The policies and procedures in the care staffs station needs to be updated and old information removed to avoid any confusion. The policies and procedures that the Inspector read were outdated and not containing sufficient information. This was discussed with the registered manager on the day of the inspection. There has been one POVA investigation since the last inspection. This resulted in a staff member resigning. This investigation is currently ongoing as it is being dealt with through the judicial system. This investigation demonstrated that the home followed correct POVA procedures. It is required that a copy of the updated complaints and POVA policies and procedures are forwarded onto CSCI upon completion. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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 & 26 The location of the home provides opportunities for residents and visitors to access local amenities and transport. Residents live in a safe environment that suits their needs. EVIDENCE: Blatchington House is located in a quiet residential area in Seaford. It is located approximately one mile from the seafront. There is car parking available at the home or on the adjacent street. There are two double rooms and 29 single rooms. Rooms are located over three floors. There is a passenger shaft lift available to assist residents to access all floors. There is a large garden area with seating and wheelchair access. The home has a good size dining room and suitable lounge areas. Hoists, grab rails and other aids were seen to be located throughout the home to assist maintaining independence. Rooms were seen to be individualised to reflect the residents choice and taste. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 16 There is a small shop located at the home that provides an opportunity for individuals who are unable to access local amenities to purchase toiletries and confectionery. An old bathroom on the first floor, which was not regularly used, is being converted into a wheel in shower. This will benefit the residents by offering more choice in assisted bathing facilities. The home was clean and free from offensive odours on the day of the inspection. There are suitable steps implemented to assist with promoting infection control. Staff were observed to be wearing gloves when required. There are sluice facilities available at the home. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 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 Residents’ needs are met with the number and skill mix of staff on duty. Staff are competent to undertake their duties. EVIDENCE: The rota provided to the Inspector demonstrated that there were generally six care staff working in the mornings and four care staff on duty in the afternoons. There is a registered nurse on duty at all times. Residents spoken with were complementary about the staff working at the home and felt that there was enough staff on duty. Comments about staff ranged from ‘staff assist me well’ to ‘excellent’ and ‘brilliant’. Staff work a waking night. The home is working towards the 50 ratio of NVQ level 2 trained staff. Three staff have completed their NVQ level 2 and two staff have completed NVQ level 3 qualifications. There are currently an additional six staff undertaking NVQ level 2 studies. Staff files were not inspected on this occasion, as there have been no new staff recruited since the last inspection. It was confirmed that work is being done to ensure that staff files comply with Schedule 2 as required from the last inspection. This has not been reflected as an outstanding requirement and will be reassessed at the next inspection. A staff member spoken with confirmed that they are kept up to date with mandatory training. Training records were not inspected on this occasion as this standard was met at the last inspection. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 18 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, 32, 35 & 36 Residents and staff benefit from clear leadership within the home. Residents are safe guarded by the systems in place to monitor the health, safety and welfare of residents. EVIDENCE: The registered manager is a registered nurse with current Nursing and Midwifery Council (NMC) registration. She has just completed her NVQ level 4 in management. She is experienced and competent to manage the home. There are clear lines of accountability within the home. Residents and staff were complimentary about the management at the home. A staff member spoken with find management approachable and supportive. The staff member felt there was good staff morale and people work well as a team. The processes of running the home are open and transparent. There is evidence that there is a commitment to equal opportunities in the home. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 19 The financial viability of the home was not assessed on this occasion. The home has given no cause of concern regarding the financial viability. Residents personal allowance spot-checked demonstrated that clear accurate records are being kept. There are receipts kept of any individual financial transaction. The home has implemented steps to ensure that residents can access the personal monies at any time, as required from the last inspection. Staff are receiving regular supervision. Records of these sessions were not checked, but staff spoken with confirmed that supervision is undertaken every four to six weeks. The health and safety records were not inspected on this occasion. There are suitable systems in place to ensure the health, safety and welfare of residents and staff. On the day of the inspection, the fire alarm was being tested. The maintenance men were observed to check that all fire doors were closing effectively. The Inspector noted one door not closing effectively and this was pointed out to the maintenance man, who will be addressing this. Any risks to the health and safety of residents have been highlighted in the relevant sections of the report. Hazardous substances are stored securely at the home. This standard was fully met at the last inspection. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 20 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 X X X 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 X X Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP7 OP7 Regulation 15 15 Requirement That care plans reflect actual current practice. (Timescale 31.08.05 not met) That turning charts or fluid balance charts in use are accurately completed. (Outstanding from last two inspections) That a risk assessment be undertaken when wheelchair footplates are not in use. That clearer guidelines be provided regarding ‘PRN’ prescribed medication and MAR charts be kept up to date. That a copy of the recent complaints procedure be forwarded to the local CSCI office. That a copy of the amended POVA procedure be forwarded to the CSCI. Timescale for action 31/03/06 31/03/06 3. 4. OP7 OP9 13(4)(c) 13.2 15/03/06 15/03/06 5. OP16 22 31/03/06 6. OP18 13(6) 31/03/06 Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 22 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 OP9 OP37 Good Practice Recommendations The any written amendments to MAR charts are signed. That the policies and procedures in the care staffs’ station are updated and information no longer in use be removed. Blatchington House DS0000013964.V264853.R01.S.doc Version 5.0 Page 23 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. 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