Inspection on 14/11/06 for Blenheim House

This inspection was carried out on 14th November 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blenheim House 29/10/07

Blenheim House 16/01/06

Blenheim House 16/08/05

Blenheim House 21/03/05

Blenheim House 13/10/04

Blenheim House 11/02/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Blenheim House 28 Blenheim Road Deal Kent CT14 7DB Lead Inspector Kim Rogers Key Unannounced Inspection 14th November 2006 09:50 Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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 House DS0000023192.V312743.R01.S.doc Version 5.2 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 House DS0000023192.V312743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blenheim House Address 28 Blenheim Road Deal Kent CT14 7DB 01304 362534 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) The Robinia Care Group Ltd Mr Michael Gregory Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Blenheim House is part of the group of homes owned by Robinia Care South East Limited. The home is registered for three people with learning disabilities. The property is a terraced house in a residential area of Deal, within easy walking distance to the main town, beach and leisure facilities. The property has three storeys, on the first floor there are two bedrooms, a bathroom, toilet, and smoking room, The ground floor consists of an en suite bedroom, lounge and office. There is a dining room and kitchen in the basement, which leads out to the garden. The garden has a paved area, with steps and some planted shrubs. Mr Michael Gregory is the Registered Manager who is also responsible for both Westbury House. The fee for this home ranges between £1491.06 per week to £1697.21 per week. For more information about the home, fee etc please contact the Provider. Westbury.house@robinia.co.uk Previous inspection reports are available from the home. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit was unannounced and carried out by one inspector over about 4 hours. The manager, Mr Michael Gregory, service users and staff assisted in the process. Three people currently live at the home, and all gave some feedback. People were coming and going in and out of the house and were doing activities with the staff. Two service users went sea fishing with staff just after the inspector arrived. A service user gave a tour of the home, and with permission, some bedrooms were seen. The inspector spent time with a service user in private, spoke to and observed staff and interviewed and observed the manager. Some work was done before the visit including talking to and surveying care managers and service users. The manager supplied a pre inspection questionnaire, with details of domestic checks and various other data about the home. A selection of records about service users, and some other documents such as staff recruitment files was seen. What the service does well: Service users said ‘ the staff are good’ ‘My room is big’ ‘You get to cook food’ ‘I look after my own money’ ‘I would like to move onwards’ From observations staff and the manager respect service users and encourage their participation. The home is very clean and has a homelike feel. Furniture is a good quality. Service users have access to all areas of the home. Hobbies and interests are well supported. The manager is open, approachable and friendly. He is keen to think of different ways to support people. A care manager commented that Michael Gregory is a good manager. Service users said they look after their own money with support. Service users have been involved in developing their own individual guidelines, which is good practice. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 6 Service users said they are confident that staff would act on any complaints they made. 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. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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 House DS0000023192.V312743.R01.S.doc Version 5.2 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): 1,2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Information about the home is not fully accessible to service users. Service users know their needs will be assessed but can’t be sure their aspirations will be assessed. EVIDENCE: The home’s service user guide has been reviewed by head office. Although the guide is produced in colour some of the pictures and font size are small, which would make it difficult for some service users to understand. Most of the service users have moved in from other Robinia homes. The manager said there are no pre admission assessments at the home for any of the three service users. There was some historical information but this was out of date and sketchy. Because of the lack of formal pre admission assessments it is hard to know if considerations were made before people moved in. For example, if staff have the skills needed, compatibility with others and staff numbers. The manager agreed to carry out assessments in line with the standard in the future and keep them at the home. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Needs are supported but personal goals are not planned for. Service users are supported to make choices and decisions. The assessment of risks could be improved to consider quality of life issues and must be more effectively reviewed. EVIDENCE: Each service user has a service user plan or care plan. These are quite clinical and based on a person’s deficiencies. After reading a service user plan the inspectors did not get a feel for who the person is, where they came from and where they want to be. Service users have a second file full of photos and pictures, which are person centred. Service users have taken an active part in developing these individual plans. Unfortunately these are not fully implemented. Personal goals talked about by service users are not all reflected and supported in care plans. Staff need help to move this good start on. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 10 Some people have an accessible version of their plan showing where they were and where they want to be. Some barriers to the life they want had been identified. Unfortunately there were no clear time bound plans to support and reduce these barriers. Risks have been assessed but reviewing has been ineffective, so it was not clear if strategies to reduce risks were working. Changing behaviours (reducing or increasing risk) are missed, so a person cannot be sure they are supported to be as independent as they can be. Some individuals are actively supported in positive risk taking. Currently, quality of life is not the main consideration for risk assessment, but the manager has a plan to review the process using the community learning disability team template. The manager has made referrals for extra support and advice to help meet service users needs. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have opportunities to take part in activities and to be part of the community. Relationships are supported and service users rights respected. Service users are involved in planning and preparing meals. EVIDENCE: When the inspector arrived two service users were preparing to go sea fishing with staff and left shortly afterwards. Service users said they generally have enough things to do. One talked about cycling and walking, which staff support. One service user said he enjoys his work experience as a kitchen assistant. Service users talked about personal goals of jobs and careers. These were not all reflected and planned for in service user plans and this was discussed with Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 12 the manager. The staff need help to support service users to plan for the lives they want and would benefit from person centred planning training. Service users access community facilities and feel part of the community. Service users said they take part in planning and preparing meals and go food shopping. The kitchen is fully accessible to all service users. One service user has a pet rabbit and told the inspector about his hobbies that staff support. Hobbies are well supported. All service users are supported to keep in contact with their families. Family and friends are welcome to visit the home at reasonable times. All service users have a key to their bedroom. Some environmental restrictions have been made in service users best interests, which are kept under close review. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 13 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users personal care needs are met but more emphasis on promoting independence is needed. Health needs are generally met but service users would benefit from individual health action plans. A risk assessment relating to a health matter needs improving. Medication practice is adequate. EVIDENCE: There is a limited amount of personal care support information in each person’s plan just a tick sheet to record when things like a bath or shave have happened. Development to increase service user independence and find out how they want to be supported needs improvement, and this will increase opportunities. A risk assessment relating to a person’s personal care needs reviewing. The manager agreed to do this. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 14 There are basic plans in place to support health needs but no detailed assessments or health action plans. For some just a record of health appointments was in care plans. The review process of the plans is not effective. Documents showed that the local community learning disability team and other health professionals had given valuable support and advice. Although it seemed to be carried out, it had not become part of the support plan, so might not be monitored, as it should. Medication is stored securely and administration records were in order. Service users come to the office for their medication. Some work has been done to try to give service users more responsibility for their medication. This should continue. Booklets have been provided to service users in an accessible format. These give information about the medication they take and this is good practice. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 15 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users know their complaints will be listened to and acted on. Guidelines to support and manage some challenging behaviours should be reviewed to ensure consistency and the right support. Service users are protected from abuse. EVIDENCE: All three service users said they would talk to various members of staff or the manager if they had a problem or complaint. One service user said he was confident that staff would take action if he complained. The inspector saw the records kept of complaints. It was clear that staff had taken action to investigate and address complaints. Staff attend training on safeguarding vulnerable adults. Some service users may at times present challenging behaviours. This can be a barrier to the life they want. Therefore clear individual guidelines based on positive behaviour support techniques are needed. The manager must ensure that these guidelines are developed with service users and kept under review. The manager must also ensure that any physical intervention used is in accordance with the guidance from the Department of Health. Service users said they look after their own money with support. Service users have been involved in developing their own individual guidelines, which is good practice. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 16 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): 24,25,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a clean, comfortable safe home. EVIDENCE: The home was very clean and well maintained on the day of the visit. Service users are supported to clean their own rooms and do their own laundry. All three bedrooms are single rooms and have a wash hand basin. One has en suite facilities. Rooms are personalised and one service user said he was very happy with his room. One bedroom was extremely hot and stuffy which could affect the person’s health and well-being. The manager said the person likes it like this. All communal rooms are accessible to service users so people can come and go as they please. Restrictions in place (front and back door) have been imposed in service users best interests following assessments. Facilities for staff sleep in and storage of belongings is good. A maintenance team of two was at the home during the visit fixing the stairs to the basement. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Recruitment checks are robust. Service users and staff would benefit from training in person centred panning. The supervision of staff needs improving to be in line with the minimum standard. EVIDENCE: Staff have access to statutory training courses through the company training manager. The training has a focus on health and safety rather than learning disability issues. Service users want to develop their skills sand move on however staff have had no training in skills teaching and active support techniques. Staff were observed supporting service users positively and inclusively. However, this is not reflected in care plans so relies on word of mouth at handovers. Service users talked of their personal goals and aspirations but these were not all recorded and planned for. A start has been made on developing person centred plans and some people have been involved in Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 18 developing their own. This needs to be moved on and the manager agreed that staff need person centred planning training to enable them to do this. Such training is strongly recommended. Staff need help to enable them to support service users to make and reach personal goals. New staff are registered on an induction in line with the standard. There was sufficient staff on duty during the visit to enable service users to have the support they need. At night there is one sleep in staff. A staff file was sampled. References and checks were in order. Some supervision records were seen but the number fell short of the standard. Staff issues were discussed with the manager. The manager uses procedures and systems to deal with any staff issues. It is important that this is recorded and the manager agreed to do this. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is well run but the quality assurance system needs developing. Health and safety could be jeopardised by the lack of audit and monitoring. EVIDENCE: The registered manager has several years experience in working with people who have a learning disability. He has been with the company for about 10 years and is also a registered manager of a larger home nearby. He is currently working towards a National Vocational Qualification in care and management, but has no specific learning disability qualification. The manager was observed interacting with service users and staff in a positive, appropriate manner. There is evidence that a competent manager adequately runs the home but the management of the home is jeopardised by ineffective audit, monitoring Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 20 and quality assurance systems. A responsible person other than the manager has not carried out monthly visits as often as required. The manager carries out regular checks of records but currently does not formally record this. Ways to improve this were discussed. Views have been sought from service users and stakeholders by way of comment cards. These comments are kept in a file and have not been developed into any sort of improvement plan. Service users views should underpin the review and development of the service. A requirement was made to address this. Health and safety is well promoted, but as already expressed, can be overtly cautious. Better systems are needed, especially around review of care planning and risk assessments. Better planning will keep people safe but also increase opportunity. The pre-inspection questionnaire confirmed that the domestic certificates and checks were in order. Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 2 X X 2 1 Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 12,13 Requirement Standards 6, 7, 9, 18. Consult with service users (through person centred planning) and improve service users opportunity for independence and fulfilment. The manager must ensure that individual guidelines to support challenging behaviours are in place, up to date, consistent and reviewed regularly. Service users consent must be sought for any physical interventions that may be used. This should all be in accordance with the guidance form the Department of Health. Improve quality assurance processes seeking and taking note of the service users opinions. The manager must ensure that risk assessments are effectively reviewed to safeguard service users. Timescale for action 30/04/07 2 YA23 12,13 31/12/06 3. YA39 24 28/02/07 4. YA9 12,13 31/12/06 Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 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. 2 Refer to Standard YA1 YA35 Good Practice Recommendations Ensure that information for service users is accessible to them. Provide staff including the manager, with person centred planning and active support training. Conduct training audit based on the needs of the service users. Carry out individual health assessments and develop health action plans. Staff supervision should be in line with the standard. 3 4 YA18 YA36 Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Blenheim House DS0000023192.V312743.R01.S.doc Version 5.2 Page 25 - 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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