Inspection on 29/10/07 for Blenheim House

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blenheim House 14/11/06

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 Lois Tozer Key Unannounced Inspection 29th October 2007 10:00 Blenheim House DS0000023192.V347154.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.V347154.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.V347154.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 Pending registration Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 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, with the basement floor opening onto a paved rear garden. The bedrooms are on the ground and first floors. There is a lounge on the first floor, and the kitchen and dining room in the basement area. A new manager, Emma Roberts was appointed in September 2007, and is also responsible for Westbury House, a larger home nearby. The basic fee for this home ranges between £718 per week to £1044 per week. For more information about the home, fee etc please contact the home at westbury.house@robinia.co.uk Previous inspection reports are available from the home. Blenheim House DS0000023192.V347154.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 took place on 29th October 2007 between 10:00 and 4:45pm. The manager has been in post about 2 months. She, service users and staff assisted with the inspection process. Three people currently live at the home, two gave face-to-face feedback. Care manager surveys were sent out but none had been returned before this report was written. Some activities were taking place during the visit, and observations formed part of the evidence collected. The communal areas of the house, office, and two bedrooms were shown to us during the visit. The inspection process consisted of information collected before and during the visit to the home. We also saw information such as assessment and care plans, duty rota, risk assessments and service users medication administration records. Lots of work is in progress, and much of this visit centred on discussing the managers and service users plans. The manager completed the Annual Quality Assurance Assessment prior to the visit, which gave us an indication that the manager clearly recognises where improvements are needed in the home. What the service does well: What has improved since the last inspection? Visits by the ‘registered provider’ are much more thorough. The are starting to look at the service from the residents point of view. Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 6 Person centred plans are being developed so people have a big say. For example, in a meeting, people said they didn’t want the kitchen locked off at night. This was assessed, and now remains open. The statement of purpose being reviewed. People have had a period of time to get used to changing the smoking area. This used to be inside, but is now under a canopy outside. More promotion of skills, so people are more responsible for their personal care. Health action plans are being completed. A new kitchen has been fitted with non-slip flooring. The main lounge has been redocorated. Staff training is now more diverse. i.e. intensive interaction, valuing people, person centred planning and active support. 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. The summary of this inspection report can be made available in other formats on request. Blenheim House DS0000023192.V347154.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.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is adequate. People know that their aspirations and needs will be supported, but need to be clear on what the aims and objectives of the home are. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at the home have done so for a long time. They have had reviews in the last 12 months, and these have given a baseline for support needs. Much of the information is being put into support plan, and the manager is seeking additional help to make sure particular needs are met, where these are outside the scope of the staff team expertise. People living at the home have become much more involved in this process since the last inspection. Some people are not clear on the aims of the home, and said they felt staff should do tasks for them, as they were paid to do so. This was discussed with the manager, who agreed to review the statement of purpose and develop clear aims and objectives that people could understand and work within. This should be clearly laid out in an accessible way in the contract (or individualised service user guide). Blenheim House DS0000023192.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. Person centred support is taking place, and individuals are developing, but greater focus on responsibilities that accompany rights and development should reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff and manager have a commitment to person centred planning approaches, and although there are still some old, clinical style plans in place; the reviewed versions are more developmental. The danger of having two systems in place together is it will be unclear what people should be following. People have stated their hopes and dreams for the future, and most of the people in the home are moving forward to reach their aspirations. A resident showed us their hand drawn long-term goal plan, describing the numbered stages they had achieved. Others need a different style of support. A person told us that they did not have enough structure in their day and needed boundaries. They said that they often rejected their own plans, so made little Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 10 progress. The daily notes do not come from the person’s perspective, but from an account given by staff, and changing this style should be considered. Staff have respected decisions made by people, but have had a tendency to place a great deal of focus on individual rights, but not individual responsibilities. The new manager is tackling this, so to improve equality within the service user group and between staff and service users. She plans to improve people’s decision-making skills further by developing house rules that have been agreed by the group. Review of some support plans may involve the support of a psychologist, which the home has direct access to. Risk management has, in some areas improved, with clear focus on person development. Some risk assessments state clearly what steps need to be taken to support an activity, with consistent approaches aiding progress. Many others still remain focused on avoiding risk, which does not reflect the actual, more enabled lives lived by the people in the home. A daily risk assessment for each person is conducted, but these are not being used to inform development. The manager and team are committed to improvement and involving people fully, and aim to improve the system and make it more meaningful. Blenheim House DS0000023192.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. People have a great deal of say in how they wish to run their lives, but some aspects of support could improve to help people achieve their potential. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a great deal of personal freedom and can choose their activities both within and away from the home. Support to maintaining focus on long-term goals is being reviewed, as very able people are not developing to their full potential. A person said that they ‘waste time in bed’ and thought they ‘could do with some help to do things better, and maybe get a job’. Discussion with staff and records showed that support is given, but potentially, staff in their enthusiasm to support, are taking too much responsibility for the activity. Some people are supported exactly as they need, and this has resulted in more personal freedom and confidence. Being close to town, people get to walk in, or catch a public bus. There is a car available, but staff Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 12 try to encourage use of the excellent public transport links. Some people travel independently. Relationships are well supported, and a clear ethos of equality and diversity surrounded this area. Family contact is supported as per the resident’s wishes, and opportunities to meet a wider range of people through pubs, clubs, and social events often takes place. As mentioned before, people’s rights are respected, people confirmed staff are very respectful and support them in they way they wish, and this was observed during the visit. However, for some, this has bypassed the responsibilities aspect that they, as citizens, need to take. The manager has started to review this situation, and will be returning to the statement of purpose, contract and individual development plan, with psychologist support. People use the kitchen each day to cook their own meals. Records show that healthy options are encouraged. Blenheim House DS0000023192.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People know that their personal and healthcare issues will be well supported, but need assurance that the medication they require will be available without delay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home need little or no direct personal support. The verbal prompts and reminders needed are clear in the individual plan. Each person has a ‘Health Action Plan’ (HAP), and two people said that they had been involved in filling theirs out. Records from visits to health specialists are well recorded, but not in the HAP, so this separates information, making more paperwork. Some records (such as weight) are being kept, but no noted action as weight changes. People need to know that records being kept are for a reason, and decisions made if a record is really necessary and what to do with it if it is. Some people like to look after their own health matters, which is good, but staff are unaware of the outcomes from medication reviews, or if they need to offer different support. Some in-depth work with people around the HAP Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 14 would be beneficial so they are fully aware of what to do if changes are made to their medication regime. A supported medication administration system is in place, which is a recent arrangement. It has been risk assessed, with a view increasing independence in stages. Records are in good order, and staff have had training and are assessed as competent at least yearly. Refusals are well recorded, and advice has been obtained from the GP as how to handle frequent refusals. The support implemented seems to be working. One person has access to paracetamol pain relief, but the others do not, which needs reassessment, so it is available as a homely remedy if needed, for example, in the middle of the night. There is an ‘as required’ protocol in place that requires staff to seek permission to administer from the ‘on call’ manager. This has caused delays in giving a prescription medication, and the protocol has not been reviewed. The manager agreed to fully review this, acknowledging that a very clear individual protocol needs to be in place so staff can respond to peoples needs rapidly. Blenheim House DS0000023192.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People feel safe and that their views are listened to. The complaints procedure should be made more accessible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A simply written complaints procedure is in place, and two residents described the process. They confirmed that staff listen, and take any concerns they have seriously. One person said they felt annoyed that the maintenance department came into their bedroom without asking permission. The issue of who has keys to the home needs to be resolved, and people need to know that they can lock their room when out without others then getting in. We suggested the individual make a complaint, as the complaints log book showed that issues had been speedily resolved. The procedure itself is not communally accessible or to people who cannot read well. This was discussed, and staff do help people to understand what it is all about. The manager felt that she would be able to tailor a procedure to suit the individual needs and display this communally. All staff have had adult protection (POVA) training. Staff seen and spoken to during the visit were courteous, involving and aware of preserving dignity. Staff were clear about the process of whistle-blowing. Blenheim House DS0000023192.V347154.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. People like their home and feel comfortable, but want a say in who comes into the building without their permission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that there is a redecoration planned for the home. It is clean and comfortable, and very homely. People have their own rooms in the style they choose. All said they were happy with the house, but one person told us that the maintenance staff have keys to the home and come in when they are out. This was not something the person was happy about. Staff all have front door keys, but only one resident has a key. There is work taking place to sort this out and to remove the number pad on the front door, which is now considered, by the manager, to be unnecessary restraint. One room has an en-suite toilet. The communal toilet has no hand-wash basin, and although bathroom is next door, if in use, the only place for hand washing is Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 17 the kitchen, which must be acknowledged in the infection control protocol. The manager said that she would raise this with the company to be improved when they start the redecoration. Meanwhile, it may be advantageous to seek infection control advice and put in some temporary measure. Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. People are supported by staff that have the right skills and experience and relevant training. This means people get on well and feel safe with the staff in their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a small and stable team of 7 permanent staff, who reflect the age and gender of the resident group. Additional support comes from the staff team from a nearby home in the same group, who the residents know well. All have either obtained, or are undertaking NVQ qualifications. Residents said that the staff are easy to talk to, that they listen and they relate to them. Although residents have not been formally involved in recruitment, they are fully involved in the trial days. This way they have a big say in who works in the home, and make sure they share similar interests. The manager wants to get more service user involvement in recruitment, as working towards independent living means people need to practice this skill. All the right checks take place (references, police), and people have an induction that meets the Skills for Care criteria. Training around supporting people has really improved, and staff have had, or are soon to have training in actively supporting people, person centred planning and strategies for crisis intervention. Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 19 Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home is well run and the manager is accessible to staff and service users, which makes the environment a safe and pleasant place to be. To make sure residents development needs is at the heart of the home, the quality assurance process needs to develop further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is currently applying for registration. This is her first post of this type, and also involves managing a bigger home in the nearby area. She has been a deputy to the home for about 4 years and has a clear vision for the future of the home. She has care qualifications, and aims to achieve further training specific to the support and management of the particular persons who live in the home. To keep on top of these demanding roles, she maintains a clear journal, and uses this to make sure both homes get the input they need. Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 21 A quality assurance (QA) process is in place, and this involves visits by the representative of the registered provider. These have improved considerably, and seek the views of the people living in the home. A range of questionnaires has been given out, and user involvement meetings companywide are taking place. Keyworker and residents meetings occur frequently too. The manager has completed the CSCI Annual Quality Assurance Questionnaire to a good standard. All these parts are currently a series of data, which now need to be brought together to inform the development plan. Staff have delegated responsibilities for health and safety checks. The fire risk assessment in place may not be in line with the updated regulations, and should be checked against the guidance. A good level of staff have had statutory training, and there is always a first aid trained person available. The AQAA notes the infection control policy has action points to be carried out (no hand-wash basin in WC). Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 22 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 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 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 YA20 Regulation 13 (2) Requirement To safeguard people and make sure they get the right medication when they need it, review and improve the ‘As Required’ protocols. Advise CSCI this has taken place. To make sure the service meets the needs and expectations of the people living in it, continue to improve quality assurance processes seeking and taking note of the service users opinions. Seek guidance to develop a service development plan. Timescale for action 02/11/07 2 YA39 24 01/01/08 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 YA24 Good Practice Recommendations Considering both standards YA 22 and YA24. DS0000023192.V347154.R01.S.doc Version 5.2 Page 24 Blenheim House To provide a more secure environment, develop a really accessible complaints procedure and resolve the issue of maintenance staff having keys and letting themselves in without first seeking permission from service users. Blenheim House DS0000023192.V347154.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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