Inspection on 25/04/05 for Blenheim Care Centre

This inspection was carried out on 25th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Blenheim Care Centre 06/10/08

Blenheim Care Centre 08/10/07

Blenheim Care Centre 19/06/06

Blenheim Care Centre 17/10/05

Blenheim Care Centre 13/01/05

Blenheim Care Centre 01/06/04

Blenheim Care Centre 04/12/03

Blenheim Care Centre 01/07/03

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

CARE HOMES FOR OLDER PEOPLE Blenheim Care Centre Ickenham Road West Ruislip Middlesex HA4 7DW Lead Inspector Clare Henderson Roe Announced 25 , 26 & 28 April 2005 th th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blenheim Care Centre Address Ickenham Road, West Ruislip, Middlesex HA4 7DW 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) 01895 622 167 01895 622 240 blenheim@lifestylecare.co.uk Life Style Care Plc Mrs Mary Elizabeth Horsfield Care Home 64 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 beds for service users with a physical disability requiring nursing care. 2. 12 beds for service users in the category of old age requiring nursing care. 3. 10 beds for service users with dementia requiring nursing care. Of these beds, 5 may be used to accommodate service users with dementia requiring personal care or nursing care. 4. 22 beds for service users falling within the category of old age requiring personal care. 5. 12 beds for service users with Dementia requiring personal care. Date of last inspection 13th & 17th January 2005 Brief Description of the Service: Blenheim Care Centre purpose built Care Home providing care for 64 service users. There are 5 separate living units divided as follows: 8 beds for Young Physically Disabled, Nursing. 12 beds for the Elderly Frail, Nursing. 10 beds for Dementia Care, Nursing, of which 5 may be for nursing or personal care. 22 beds for Elderly, Personal Care. 12 beds for Dementia Care, Personal Care. The units are designed to provide a warm, comfortable and safe environment consisting of single accommodation with en-suite toilet and hand washbasin facilities and fitted telephone sockets. The use of mobile phones is permitted. Each unit has a spacious lounge. There is an enclosed garden and some service users bedrooms and a communal lounge open out onto it.The home is located on the Ickenham Road next to West Ruislip underground station and visitors’ car parking is available. The Registered Manager is Mrs Mary Horsfield and the home also has a Support Manager. There is also a Regional Manager for the home. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out as part of the regulatory process. A total of 26 hours was spent on the inspection process. The Inspector carried out a tour of each unit of the home, and inspected service user plans, staff files and maintenance records. 10 service users, 7 visitors, 14 staff and a visiting healthcare professional were spoken to at the time of inspection. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. Previous timescales have been included in this report for requirements that are still outstanding. What the service does well: What has improved since the last inspection? What they could do better: The Service Users Guide needs review to meet the Care Homes Regulations 2001. Although the corridors on the ground and first floor had been redecorated, there are several areas that require redecoration and in some cases refurbishment, to include suitable flooring, and these need to be addressed as an ongoing project, not just as a result of a CSCI inspection. The staff employment records continue to show shortfalls and this situation cannot be allowed to continue as it places service users at potential risk. Whilst it is acknowledged that the individual units and departments are well managed, there is need for better communication and interaction between the heads of each unit plus the heads of department to ensure a cohesive overall management of the home, and a management system to address this needs to be put in place. The introduction of formal supervision for the registered nurses Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 6 should also help improve communication. The Registered Manager needs to ensure that the home is run to meet the National Minimum Standards for Older People, plus those for Adults (18-65) as relevant to the YPD unit, and have a good working knowledge of these and the Care Homes Regulations 2001, so that she can be proactive in her approach to managing the home. 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. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 7 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 Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 8 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) 1 & 3. The home does not provide intermediate care. The Service Users Guide needs reviewing to ensure that service users and their representatives have an accurate picture of the care, facilities and staffing provision offered by the home. The assessments carried out for prospective service users are comprehensive and should ensure that service users are accommodated appropriately within the home, thus meeting their assessed needs. EVIDENCE: The Service Users Guide has been given to each service user who is able to manage it and a copy is in the service user plan for the other service users. The actual content of the Service Users Guide needs some review as it does not contain all the information required. The Registered Manager said that she would address this. For prospective service users, a copy of the Social Services needs led assessment is obtained and then the Registered Manager and/or senior member of staff on the appropriate unit carries out a pre-admission Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 9 assessment to ascertain if the home can meet the assessed needs of the service user. Some completed pre-admission assessments were viewed and they were comprehensive and fully completed. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 10 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, 10 & 11 Service users individual needs had been identified and overall the service user records were comprehensive, thus ensuring that the service users needs are identified and met. Medications are generally well managed, with some shortfalls identified which could be a risk to service users. Staff are courteous to service users and personal support is generally provided in such a way as to promote and protect the service users privacy, dignity and independence. Issues with maintaining service users own clothing and ensuring service users are examined in their own rooms need to be addressed as this compromises service users individual care and breaches privacy protocol. Systems in place for the care of the dying aim to maximise the respect for service users privacy and dignity. EVIDENCE: Individual service user plans were available and samples were viewed. Overall these were comprehensive and gave a clear picture as to how the service users identified care needs were being met. Service users plans had been reviewed monthly and whenever a new problem had been identified, a new care plan had been formulated to address this. There was evidence of service user and/or representative involvement in the service user plans, some of which were recent and others some months old, and it is recommended that further Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 11 reviews with service users and/or their representatives be offered. Daily records were available and detailed the care provided. Risk assessments for falls had been completed and there was evidence of updates. The documentation viewed for wound care to include pressure sore risk assessments was comprehensive, identified each wound individually with the plan of treatment to be followed, plus recorded the progress of each wound. Assessments for moving and handling, nutritional screening and continence management were in place in most instances. Some shortfalls in assessments identified on the ground floor were addressed at the time of inspection. Bedrail assessments had been carried out in most cases, although one was completed at the time of inspection. The importance of ensuring that bedrail assessments are completed prior to their use was discussed. Consents for the use of bedrails had been obtained. The records indicated input from the GP, optician, physiotherapist, chiropodist and psychiatrist, plus other healthcare professionals. The home has two GPs providing cover, and there are sometimes difficulties with holiday and absence cover for one GP, which the home is in the process of addressing. Medication records were sampled on each unit. Generally these were well managed and on the personal care dementia unit, work had been done in conjunction with the GP to reduce the use of night sedation, and the results had been successful. On some medication administration record (MAR) sheets omissions in signing were noted. Also, there were some minor discrepancies between the number of doses signed for and the number of tablets administered, and the staff on the units concerned said that they would address this. On one unit the dates of opening had not been written on the liquid medications. The dispensing pharmacist provides one label on the box for eye drops and it is recommended that a label for the actual bottle also be requested. An instruction of ‘as directed by your doctor’ was seen for one medication and the need to address this with the GP to get full instructions included was discussed. Medications are securely stored and staff on the personal care units receive training in the care and administration of medications. On the nursing units, a registered nurse administers the medications. The dispensing pharmacist carries out 6 monthly audits and also provides advice to the home. The British National Formulary publications seen were 2 years old, and the Registered Manager said that new copies had been ordered for each floor. Staff were seen speaking with service users in a gentle and courteous manner. In one case, a service user did not have their own slippers on, and there were items of clothing found in a wardrobe that did not belong to the service user. Comment was also made regarding a service user being examined by a Doctor in the day room. These issues were discussed with the Registered Manager and these situations need to be addressed, to preserve service users privacy and dignity. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 12 The home has clear procedures in place for the care of the dying. As a service users condition deteriorates, the situation is discussed with the service user, their representatives, the GP and the home staff and wherever possible the home will continue to care for the service user, with additional specialist care input, for example, the Macmillan Nursing Service and Palliative Care Team. The wishes of the service user and their representatives regarding their care in their final stages of life are recorded and reviewed accordingly. Service users can stay at the home in their final days if they so wish. Relatives and visitors can stay with service users and correspondence from grateful relatives demonstrated that the home is able to provide a good standard of care at this difficult time. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 13 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, 14 & 15 The activities provision is generally good and service users have a choice of whether they wish to participate, thus respecting their wishes. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: Service users past interests and hobbies are ascertained, and the activities coordinator works to provide activities and outings that are of interest to each service user group. Care plans for service users leisure activities had been completed, and in some cases were quite general and in need of personalising to the individual, and opportunities for the activities co-ordinator to discuss the social and leisure interests of service users with the staff on the units and become a more integral part of each unit was discussed. An activities diary is completed for each service user. Service users spoken with said that they are asked about their interests and are given the opportunity to join in outings and activities, with their wishes being respected. There is an open visiting policy and visitors spoken with said that they were made to feel welcome at the home. Also, that if there are any accidents or incidents then the next of kin/representative is contacted. Service users can Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 14 choose whom they wish to see and their wishes are recorded and respected, plus the Registered Manager said that in the past the home has facilitated resolution of family conflict. The bedrooms viewed were often very personalised and service users are encouraged to bring in some of their personal effects to provide a homely environment for them. Service users are encouraged to exercise personal autonomy and choice as far as they are able to do so. The food provision at the home is generally of a good standard. There is a menu that offers choice at each meal. Lunchtime is the main meal of the day on most units, however the YPD unit has a cooked meal every evening as several of the service users attend day centres and so have a packed lunch. The chef has a list of each service users likes and dislikes and also any special diets for medical or religious purposes. If there are any problems with the supply of foodstuffs, then the menu is amended accordingly to reflect this, and to provide a suitable alternative. The lunches on the inspection days were sampled and were well presented and tasty, and the meat content was well cooked and tender. Service users spoken with said that they have a choice of meals. There are set mealtimes, but if a service user is absent or does not wish to eat at that time, alternative arrangements can be made. The kitchen was well maintained, cleaning schedules were in place and all other records were up to date. Concerns raised about any aspect of the food provision are promptly addressed. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 15 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, 17 & 18 The home has a satisfactory complaints system with evidence that service users and representatives are listened to and action taken to address their concerns. Service users rights are protected and service users are able to exercise their legal rights directly. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a clear complaints procedure and copies of correspondence for each complaint is kept on file to evidence the process followed when addressing a complaint. Complaints are addressed promptly, and should there be any delay, then this is communicated to the complainant in writing with the reasons for the delay given. The home has access to advocacy services from Age Concern and Rethink, and advocates do visit service users at the home. Service users can participate in the voting process, and postal votes can be arranged. The home has a copy of the Hillingdon Protection of Vulnerable Adults (POVA) documentation, and the homes procedures dovetail with the Local Authority information. Staff spoken with were clear that they would report any POVA concerns to the unit leaders or to the Registered Manager, and were aware of other agencies they could contact, for example, the Local Authority. One situation was discussed at the time of inspection, but this has since been reviewed with the Hillingdon Adult Protection Manager and no POVA issues were identified. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 16 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 & 26 The home does not have forward planning to ensure that décor and furnishings of each room are reviewed prior to a new admission, thus not always providing a homely and comfortable environment for service users. Supplementary heating is currently in place due to ongoing heating problems, and this presents potential risks to service users. Malodours, usually associated with the need to replace flooring, provide an unpleasant environment for some service users to be in. Measures for infection control and for minimising any COSHH risks to service users have been identified and are to be acted upon in the interests of safety of the service users. EVIDENCE: The corridors on the first and ground floors have been redecorated since the last inspection. Some carpets are also being replaced, and the need to ensure that the flooring used is suitable to meet the care needs of the service users was discussed. Several of the bedrooms are in need of redecoration, and in one instance a new service user had been accommodated in a room that required redecoration plus new flooring due to malodour. Whilst it is acknowledged that both jobs were actioned during the week of inspection, there must be forward planning in place to ensure that the décor and Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 17 furnishings in all vacant rooms are reviewed and any remedial action necessary taken prior to a service user being admitted into the room. The home has an ongoing problem with the heating, and additional heaters have been brought into areas where the heating system is not adequate. Staff were not aware of any risk assessments for these additional heaters and the Registered Manager said that she would get them completed and displayed. Some of the skirting boards in the bedrooms had been temporarily replaced, as new pipe work had been routed behind them, and work on this is also to be completed. The heating system needs to be fully reviewed to ensure that the problem is fully addressed before the autumn. There were some stale odours noted in communal areas, and also some malodours in individual bedrooms, mainly caused by continence issues and the need for new, suitable flooring as previously reported on. Used gloves had also been left on one wash hand basin and these were disposed of at the time of inspection. On the dementia personal care unit, the bathroom cabinets had previously been converted into shelving for ornaments, but a COSHH issue with the storage of the service users liquid toiletries had been identified. It was agreed that the doors be put back on the units and that toiletries identified for each individual would be stored therein, with the cabinets being kept locked except when in use. The management of the continence care systems in a manner to minimise the risk of infection was discussed with the Registered Manager. The laundry room was clean and tidy. The laundry assistant was able to explain the system for sorting and ensuring washing is carried out at appropriate temperatures in line with infection control. The home has copies of the Department of Health Guidelines on the Control of Infection in Residential and Nursing Homes and also has its own policies and procedures for infection control. Unlabelled laundry is kept for identification, and the need to ensure that clothing is identified accurately for each service user was discussed. Sluice facilities are available on each unit. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 18 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 & 29 Staffing is generally to a level to ensure that service users needs are met. Shortfalls identified on one unit would indicate that the needs of the service users could not be fully met on the days concerned. Ongoing shortfalls in the standard of vetting and recruitment practices could potentially leave service users at risk. EVIDENCE: On examining the staffing roster for April 2005 it was identified that on three occasions a nurse trained in their country of origin but without a recognised UK nurse qualification had been left in charge of the dementia care nursing unit. This was discussed with the staff and the Registered Manager and it was stated that the situation was an emergency and the home had tried to provide adequate cover. Also, that another registered nurse had provided additional cover for the majority of the shift hours, but this had not been identified on the roster. A Regulation 37 notification was completed for the CSCI at the time of inspection. The staffing on the other units was appropriate. It was reported that on some units staff frequently change shifts and some are choosy as to whom they will work with. In addition, a second registered nurse to work opposite the unit leader on the YPD unit was still to be identified. This does not promote teamwork and continuity of care. In addition, the home employs many staff on part time contracts, and it is acknowledged that this is a longterm arrangement for this home. The possibility of reviewing this situation as vacancies arise, in order to provide a better balance between full and part time posts, was discussed. The Registered Manager was aware of the need to provide continuity of care and to have a robust staff rostering system in place. The home was clean and tidy, with the odours noted being related to the need Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 19 for flooring replacement. The home has adequate numbers of kitchen, laundry and domestic staff, with agency cover being arranged for any absences. Following the identification of shortfalls in staff employment records at the last inspection, the home has introduced a matrix for checking that all required staff employment details and checks have been carried out. It was noted that for 4 members of staff, one or both references were not indicated as having been received. This was followed up at the home and the shortfalls were identified. This is a repeat finding and the need to ensure that all required checks and documentation are in place prior to employing a member of staff was again reinforced, and correspondence has taken place with the home on this matter. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 20 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, 32, 35 & 36 The Registered Manager is appropriately qualified to manage the home. She is supported by the senior staff on each unit to provide a good standard of management of the individual units and departments. The Registered Manager needs to develop a clear system of interaction and teamwork between each unit and department to bring overall cohesion and continuity throughout the home. Not all staff caring for service users receive regular supervision, which could lead to communication and continuity shortfalls, in turn affecting service user care. EVIDENCE: The Registered Manager is a first level registered nurse and has recently completed the NVQ level 4 Registered Managers Award. She is aware of the need for periodic training and updates to ensure her knowledge, skills and competence is kept up to date whilst managing the home. During the inspection and on speaking with service users and staff on each unit, it was clear that as individual sections, the units are well managed and Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 21 working well. However, the need for effective communication between the Registered Manager and the heads of each unit and department, to promote teamwork and cohesion was discussed. This should include all the identified heads of departments so that each area can work in a proactive way to improve overall communication and interaction between each department. The Registered Manager said that she would introduce heads of department meetings as a first step towards meeting this need. The service users finances were examined with the home Administrator. Life Style Care PLC has a ‘z’ account into which service users monies are paid, and therefore service users funds are being pooled. Clear records of income and expenditure are kept and receipts for any payments made are also retained. Any expenditure is then taken out of petty cash and the service users income and expenditure records adjusted accordingly. There was no evidence of interest payments having been made to service users since the last inspection. The pooling of service users funds is unacceptable and this is an ongoing shortfall. This matter is being reviewed by the CSCI Performance Relationship Manager in order to clarify the situation and ensure that service users finances are managed in accordance with the Care Homes Regulations 2001. A requirement is not set in this report due to the discussions taking place. This situation will continue to be monitored. Staff at the home do not act as appointees for any service users. There is a clear system of formal supervision in place for the staff on the personal care units, and staff spoken with said that they receive supervision every two months and find it a very positive experience. On speaking with staff on the nursing care units it was apparent that the nursing staff do not receive formal supervision. Also, because of the changes of staff on some of the units, formal supervision had not been always been carried out for all the carers at 2 monthly intervals. These shortfalls were discussed with the Registered Manager who said she would ensure that all staff caring for service users, to include nursing staff, received supervision on a 2 monthly basis. Also, that she would ensure that all staff carrying out supervision receive appropriate training to do so. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 22 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 x x x x x x 2 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 3 3 3 2 x x 2 2 x x Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5, 6 Requirement The Service Users Guide must be reviewed to include all information required under the Care Homes Regulations 2001. A copy must be provided to each service user and to the CSCI. Full assessments to include nutritional and continence assessments must be in place for each service user. These must be reviewed whenever there is a significant change in the service users condition. Prior to bedrails being used, a risk assessment must be carried out to identify the need for their use and to show that this is the appropriate safety intervention to minimise the risk of harm to the individual. (previous timescale 18/02/05 not met) All medications must be signed for at the time of administration. The date of opening must be written on all liquid medications (previous timescale 17/01/05 not met) Full administration instructions must be included for each medication dispensed. Service users must be dressed in Timescale for action 01/07/05 2. 8 17 01/06/05 3. 8 13(7) 01/06/05 4. 5. 9 9 13(2) 13(2) 28/04/05 28/04/05 6. 7. 9 10 13(2) 12(4) 01/06/05 01/06/05 Page 24 Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 13(3) 8. 10 12(4) 9. 19 23(b)&(d) 10. 19 12(1)(a) 11. 19 12(2)(p) 12. 26 13(3) 13. 14. 26 26 13(3) 13(4) 15. 27 18 their own clothing. Each service users clothing must be clearly and accurately labelled and returned to the correct room after laundering. Visits from healthcare professionals must be carried out in the privacy of the service users own bedroom. An audit of the home must be carried out to identify the areas in need of redecoration and refurbishment, to include flooring. A copy of the audit plus an action plan with timescales to complete the work identified must be forwarded to the CSCI. The timescales must not exceed 01/09/05. Prior to any service user being admitted, the allocated bedroom must be audited and any remedial work to include redecoration and flooring and furnishings review and, where identified, replacement must be carried out. The radiators must be maintained in working order. (previous timescale 10/02/05 not met) Where additional heaters have been installed, risk assessments must be in place to identify the risks and the action to be taken to minimise these risks. All clinical waste, to include used gloves, must be appropriately disposed of. Action must be taken to minimise any risks posed to service users. This must include safe storage of toiletries. There must at all times be staff working on each unit of the home with appropriate qualifications and experience to meet the needs of the service 28/04/05 06/06/05 20/05/05 01/09/05 06/05/05 28/04/05 28/04/05 01/06/05 Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 25 users. 16. 29 19 Schedule 2 Staff records must contain the information required by the Care Home Regulations 2001. Failure to meet this requirement may lead to enforcement action being taken. A robust system must be introduced to ensure good communication, interaction and team work between each unit and department in the home. All staff providing care must receive formal supervision a minimum of 6 times per year. Staff carrying out supervision must be trained to do so. A system for this must be implemented. 16/05/05 17. 32 12, 21 01/06/05 18. 36 18 01/06/05 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. 3. 4. 5. Refer to Standard 7 9 27 27 27 Good Practice Recommendations That the service user plan be reviewed with the service user and/or their representative at agreed intervals. That the dispensing pharmacist be asked to provide administration instruction labels for both the outer box and the inner container for eye drops and ointments. That a system be put in place to ensure that changes to the staffing roster are only made in exceptional circumstances. That discussion take place with staff to identify and seek resolution to any teamwork issues. That a registered nurse be identified to work on the opposite shifts to the unit leader on the YPD unit to allow for better continuity of care. Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 26 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 Blehheim Care Centre G61_s10926_Blenheim Care Centre_v213130_250405 Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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