CARE HOME ADULTS 18-65
Blenheim Avenue Care Home 9 Blenheim Avenue Mapperly Nottingham NG3 6GD Lead Inspector
Joanna Carrington Unannounced Inspection 17th November 2005 09:30 Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 Blenheim Avenue Care Home DS0000008633.V266077.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 Adults 18-65. 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. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Blenheim Avenue Care Home Address 9 Blenheim Avenue Mapperly Nottingham NG3 6GD 0115 9555221 0115 9555221 mlesleyr@ncha.org.uk 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) NCHA Lesley Rawlinson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Blenheim Avenue Care Home is a detached bungalow located within the residential area of Carlton. There are some local shops and amenities nearby. The home is registered to provide care and support for four adults with a learning disability who all have additional physical disabilities. There are adaptations and equipment in the home required for providing assistance to service users with physical disabilities and who use wheelchairs. However, some of these adaptations are very old and need upgrading to ensure that the needs of service users are being safely and fully met. The accommodation comprises of four single bedrooms, a lounge/diner, and a bathroom/shower with toilet, separate toilet that is not suitable for wheelchair users, kitchen and a laundry room. The office is in the loft conversion, which also acts as a sleep in room for staff. There is an attractive garden to the back of the bungalow, which is accessible to wheelchair users. This is a partnership home, which is managed by the Nottingham Community Housing Association, with the Health Care Trust providing the employees. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over five hours on 17th November. This was the home’s second statutory unannounced inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which involved selecting three residents and tracking the care and support they receive through the checking of their records and discussion with the care staff. All of the residents were out during the inspection. The focus of this inspection was to follow up requirements and recommendations made at the last inspection and to inspect the remaining key standards. Therefore, this report should be read in conjunction with the previous inspection report. A partial tour of the premises took place and staff records were also looked at. Two members of staff were spoken with and the registered manager was available for discussion and feedback throughout the inspection. What the service does well: What has improved since the last inspection?
There has been significant progress with requirements and recommendations identified at previous inspections; an immediate requirement notice was issued for providing upgraded and appropriate equipment and adaptations in the bathroom. Although this equipment has not yet been installed there was enough evidence to prove that reasonable action has been taken since the
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 6 notice was issued in order to identify appropriate equipment and get funding authorised prior to its installation, which is aimed for the new year. The requirement will remain in the report until the equipment is provided, and any unnecessary delays will be a cause for concern. The Statement of Purpose has now been updated, which ensures that prospective residents have enough information to make an informed decision about where to live. Minutes of community care review meetings evidence that consultation is taking place with relatives / representatives over care plans and support provided. All information about residents is being stored securely, which is important for safeguarding confidentiality. There was also evidence seen that funding has been agreed for a wheelchair accessible vehicle for the home, which will improve opportunities for residents to attend day services and access to community. Staff now have regular supervision which residents will ultimately benefit from. Copies of recruitment information such as references and Criminal Record disclosures are now being kept at the home. Paper towel dispensers have now been provided at the home, which is best practice for infection control and hygiene and a new efficient boiler has been installed, which ensures that residents are provided with adequate hot water, and is necessary for the prevention of Legionella. 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. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 the following standard(s): 1 The Statement of Purpose now contains all necessary information needed for prospective residents to make an informed decision about where to live. EVIDENCE: All of the required information has now been included in the Statement of Purpose. There is more specific information on the arrangements for social activities, maintaining the privacy and dignity of residents and how contact between residents and their family and friends is maintained. As recommended at the last inspection, the Statement of Purpose is now presented in the order as specified in Schedule 1 of the Care Home Regulations. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 the following standard(s): 6 and 9 Care plans are thorough, with good accompanying risk assessments, and community care reviews evidence that relatives and representatives are consulted over how support is provided to residents. EVIDENCE: Residents have care plans that cover all aspects of personal and social support and healthcare needs and these are reviewed every ninety days. There are community care reviews held at least annually involving all relevant professionals and family. Minutes for one residents review were seen and showed that there is appropriate consultation over residents’ support and any significant changes. Risk assessments identify action to be taken to minimise identified risk and hazards but also identify the positive outcomes and benefits of taking (managed) risks associated with individuals’ chosen activities. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 15 and 16 Once the home gets its own vehicle there will be increased opportunities to attend appropriate activities and to access the community. Staff support residents to maintain contact with family and friends. An additional care plan will further demonstrate that the rights of residents are respected. EVIDENCE: On the day of the inspection residents were either attending their day centre or out with staff. The home’s budget is continuing to fund an activities post, which has been invaluable particularly for residents that do have limited statutory day service provision. At the last inspection staff expressed frustration over how activities are restricted due to lack of wheelchair accessible transport. The home is now a step closer to getting its own vehicle, with funding agreed the vehicle itself is now being carefully chosen. The manager also reports that once the vehicle becomes available this will enable residents to attend their day centres five days per week, if appropriate. It was evident from discussion with staff and also by looking at the relevant care plans, that residents’ contact with their family and friends is promoted. member of staff spoken with gave an example of when a party was recently
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 A Page 11 held for one resident, which his family attended and when the home has hired transport in the past staff have taken residents to visit their own families. To fully consider residents’ right to privacy and freedom of movement it was recommended at the last inspection that it is documented in a relevant care plan that due to residents profound disabilities they do not have unrestricted access to the home and do not have their own keys. This is now outstanding. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 18, 19 and 20 Improvements to recording mean that residents’ health care needs are well met and careful consideration has been given to ensuring that the essential equipment still required will meet the personal support needs and preferences of all residents. The system for medication administration promotes the safety of residents, however the temperature of medicine storage needs to be closely monitored. EVIDENCE: As recommended at the last inspection, care plans now show staff are recording outcomes of health care appointments under the relevant section of care plans, which prevents this vital information from getting lost. It is recommended that where healthcare professionals are involved in an individual’s care that this is included in the relevant care plan. Daily notes demonstrate that there is flexibility as it is documented when residents choose to have ‘lie ins’ in the morning. Although the required equipment in the bathroom has not yet been installed evidence was seen that the relevant professionals and advocates have been involved in identifying the most appropriate moving and handling and bathing equipment for meeting the personal care and hygiene needs of all residents that takes into account individuals preferences.
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 13 Medication Administration Records were looked at and appeared in order. There have been no errors with administration and the instructions for administration are clear. The storage cupboard is secure but is located in a very small room shared with the washing machine and tumble drier. It was noted at the inspection how warm and humid this room was. The temperature of this room must be monitored regularly and if it is exceeding twenty-five degrees Celsius then medicines will need to be stored somewhere else. This will be reviewed at the next inspection to ensure that appropriate action, if any, has been taken. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 22 and 23 There is an appropriate complaints procedure in place and staff are aware of the Nottinghamshire Adult Protection Policy and Procedures and of their responsibilities in protecting residents from abuse. EVIDENCE: There have been no complaints made by either residents or their relatives / representatives over the last year. The manager explained how a previous inspector recommended that due to the profound disability of the residents and therefore their inability to access the complaints procedure themselves staff should be encouraged to access it on their behalf. It was reinforced how this is good practice. Staff spoken with demonstrated an awareness and understanding of the Nottinghamshire Adult Protection Policy and Procedures. This procedure has not yet had to be followed, as there have been no disclosures or allegations. It is recommended that staff access the training run by the Adult Protection Unit so to clarify roles and responsibilities in accordance with the policy and procedures. The manager remains as the appointee for residents. This issue has been considered at a higher level. It is not good practice to assume that the manager will automatically be appointee for residents. It needs to be documented why this is in the best interest of each individual and also relatives / representatives must be consulted and are in agreement with the arrangement. There are already care plans in place for how finances are safely managed for each resident but this must also clearly identify who is the appointee.
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 24, 29 and 30 The environment is kept clean and safe and reasonable steps have been taken for the installation of essential equipment and adaptations. EVIDENCE: At the last inspection an immediate requirement notice was issued for the provision of upgraded equipment and adaptations in the bathroom, necessary for meeting the personal care needs of residents and protecting the health and safety of both residents and staff. The equipment has not yet been installed but evidence was seen during the inspection that reasonable progress has been made. Multi-disciplinary meetings have been taking place to ensure that what is provided is suitable for all residents and an occupational therapist has been responsible for identifying the appropriate equipment. Minutes of meetings show that an advocacy service have been involved on behalf of residents. The plans also include extending the separate toilet so that this is wheelchair accessible. The requirement to provide this equipment will remain in this report until all of the work has been carried out, which the manager reports should be in the new year. The bathroom walls, in desperate need of maintenance and redecoration will be done when the building work is carried out and the equipment is installed.
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 16 Therefore, this requirement also remains in the report until all of the work has been carried out. All other communal areas of the home are pleasantly decorated with a homely feel. All equipment is now stored safely not causing obstructions or hazards. The home was clean throughout and for the purposes of good hygiene and infection control paper towel dispensers have now been installed in the home instead of using hand towels. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 17 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 36 Residents’ benefit from a competent and effective staff team, which is well supported following progress with the implementation of supervision sessions. Significant progress has also been made with retaining staff records on the premises, which is important for ensuring the recruitment process protects residents. EVIDENCE: The manager reported that morale of the staff team has been increasing over the last few months and this was confirmed by staff that spoken with. There are currently some posts vacant at the home but these have been advertised and interviews are taking place early December. Regular agency workers are being utilised when necessary and one agency worker spoken with had only very positive comments to make about staff and the home in general. The manager is committed to getting all staff through their National Vocational Qualification (NVQ). Three members of staff already have National Vocational Qualification (NVQ) level 2, two staff are working towards it while another member of staff is doing level 3. Once completed three more staff will then commence the course. Four staff files were examined. These showed that regular supervision sessions with staff are now being undertaken. In accordance with the Care Home Regulations copies of information that is held centrally for staff is now also being retained at the home. Copies of
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 18 contracts, proof of identification and evidence of Criminal Record Bureau (CRB) disclosures are on staff files. For some staff obtaining copies of references is still required. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 19 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41 and 42 All client information is now stored securely which is important for maintaining confidentiality. With the installation of a new boiler system, this promotes and protects the health and safety of residents, however, improved fire safety practice is required. EVIDENCE: There is now a padlock to the cupboard downstairs where communication records, containing information about residents, is held securely. At the last inspection it was identified that the boiler was not efficient as temperature records showed that hot water was being regularly supplied at a lot lower temperature than the regulated forty-three degrees Celsius, which is the safest minimum temperature for the prevention of Legionella. Since then a new boiler has been installed and temperature records now show that adequate hot water is provided. Fire records were examined during the inspection. Although both the manager and staff present stated that fire alarm testing has been carried out weekly there is no evidence of this as fire log records have not been filled in since
Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 20 June of this year and no other record of these tests could be found. In accordance with Fire Precautions Regulations this is required. Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 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 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X 1 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Blenheim Avenue Care Home Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X 3 3 X DS0000008633.V266077.R01.S.doc Version 5.0 Page 22 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. Standard YA20 Regulation 13 Requirement For safe storage of medicines monitor the temperature of storage room and then, if necessary, take appropriate action. Maintenance and redecoration of bathroom is required. Ensure that adequate equipment is provided so that the needs of service users can be safely met. (Reasonable steps have been taken to address this requirement, issued as an immediate requirement notice at the last inspection. However, this will remain as outstanding, originally set on 05/07/04 until the work has been undertaken and completed) Along with all other items as specified in Schedule 2 of the Care Home Regulations ensure that two references are also held on staff files. Ensure all fire safety tests and fire drills, in accordance with Fire Precautions Regulations are carried out, and outcomes recorded. Timescale for action 31/01/06 2. 3. YA24 YA29 23 12, 13, 16, 23 31/01/06 31/01/06 4. YA34 19 31/12/05 5. YA42 23 31/12/05 Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA16 Good Practice Recommendations It is recommended that on care plans it is documented that due to their level of disability residents do not have their own key and do not have unrestricted access to and from the home. (This was recommended at the previous inspection.) Identify the involvement of healthcare professionals in relevant care plans. Apply to the NCPVA training in Adult Protection. Include on financial care plans who is the appointee for each resident and specify arrangements in place to enable residents to access and spend their own money. 2. 3. 4. YA19 YA23 YA23 Blenheim Avenue Care Home DS0000008633.V266077.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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