Inspection on 28/01/08 for Blenheim Lodge

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Blenheim Lodge 01/07/08

Blenheim Lodge 16/05/06

Blenheim Lodge 10/10/05

Blenheim Lodge 23/05/05

Blenheim Lodge 02/02/05

Blenheim Lodge 01/06/04

Blenheim Lodge 01/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Blenheim Lodge North Road Minehead Somerset TA24 5QB Lead Inspector Ms Sue Hale Unannounced Inspection 28th January 2008 09:55 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blenheim Lodge DS0000016019.V358235.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 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. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blenheim Lodge Address North Road Minehead Somerset TA24 5QB 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) 01643 703588 linda@blenheimlodge2.wanadoo.co.uk WEST SOMERSET HOME (BLENHEIM LODGE) Limited Vacant Post Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one service user on respite care as detailed in a letter to Commission for Social Care Inspection dated 22nd October 2004 from Social Worker. 16th May 2006 Date of last inspection Brief Description of the Service: Blenheim Lodge is registered with the Commission for Social Care Inspection to provide personal care for up to 34 residents over the age of 65 years. A Board of Governors who serve voluntarily administer the home as a Charitable Trust. The registered managers post is vacant and the acting manager is Mrs Elizabeth Cooper. Blenheim Lodge is situated close to the town and seafront in Minehead. Blenheim gardens are nearby and enjoyed by many residents residing at the home. Accommodation is provided over three floors. A passenger lift is available to the first floor and there is a stair lift to the second floor. The home has three assisted bathrooms and two shower rooms available for service users. A call bell system is provided and grab rails have been installed in communal hallways. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this key inspection was to inspect relevant key standards under the Commission for Social Care Inspections ‘Inspecting for Better lives 2 Framework. This focuses on outcomes for residents and measures the quality the service under for general headings. These are; excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcomes are given in the report. The inspection took place over the course of one-day in January 2008 and was undertaken by two inspectors. (9 hours). The inspection took place shortly after the registered manager had left. The home completed an Annual Quality Assurance Assessment (AQAA) and surveys were sent out to residents, relatives, staff, GPs and health and social care professionals. The results of surveys are incorporated into this report. There were 29 people living in the home and one person in hospital on the day the inspection. The home has agreed a voluntary stay on admissions until the staffing levels have increased and there have been some improvements in the way the home is managed. The home does not have any equality and diversity policies in relation to residents. 14 residents completed written surveys all identified themselves as British with 12 stating that they were Christians. The current fee is £450 per week but this doesn’t include an additional fee that the home says is ‘dependant on care needs (after assessment)’. The home did not disclose any information about how much this was likely to be. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 6 Visitors are made welcome in the home and can visit at any time. Pressure relieving equipment and other aids and adaptations were provided to people according to individual needs. All the residents spoken to on the day of the inspection were satisfied with the care they received the home, one resident said Im very well cared for here’. People said that they were satisfied with their accommodation. One resident said that ‘staff are exceptionally kind’. The activities organiser has worked hard to develop a varied programme of events and this is proving popular with residents. Residents spoken to said that ‘there was enough going on’ in the home. The home has a complaints policy that is displayed in the hallway for residents and visitors to see. The home displays information on how to contact Age Concern and Care Aware on the homes notice board. Residents are able at their own expense, to have a phone put in their private room. Residents are encouraged to personalise their private rooms and the home was clean and fresh on the day the inspection There was liquid soap and paper towels available in all the communal and residents rooms for staff to wash their hands to reduce the risk of cross infection. Regular residents meetings are held and people are able to contribute freely to both the agenda and discussion. What has improved since the last inspection? What they could do better: The statement of purpose must be reviewed and updated and contain all the information required in the Care Home Regulations 2001. It must be made clear in the statement of purpose and the homes documentation and policies and procedures that the home does not provide nursing care. The use of nursing terms to describe staff roles is inappropriate. The practice of referring to care staff in nursing terms is misleading and likely to lead to confusion about the homes registration to provide personal care only. The use of the term ‘sister’ to purport that the person is a qualified nurse whilst working in a personal care setting and whilst no longer registered with the Nursing and Midwifery council is contrary to the Care Standards Act. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 7 A service user guide that includes all the information required by the Care Home Regulations and the national minimum standards should be available for prospective and current residents. The information about complaints in the terms and conditions of residency needs to be revised to reflect the national minimum standards. It should also make clear that Blenheim Lodge provides personal care only and not nursing care and serious consideration should be given to taking out the use of the term ‘matron’ and ‘sister’ in the contract. All staff including the acting manager need to be clear about the homes registration and this must be taken into account when undertaking pre admission assessments. This must also be taken into account when residents needs increase and cannot be met at the home. Care plans should cover all the recommended topics and give clear guidance and advice to staff on how peoples care needs are to be met. Care plans should be reviewed monthly with the involvement of the residents if at all possible and updated if necessary. Information should be available to staff about specific medical conditions such as diabetes and Menieries disease. All care records must be kept securely in line with the regulations and the requirements of the Data Protection Act. All residents should be supported by staff to maintain their oral hygiene on a daily basis. Resident’s hairdressing must not take place in the sluice room as this poses a risk of cross infection. Training in clinical procedures is the responsibility of the district nursing service and staffs competency to undertake such procedures must be regularly assessed. The use of dental tablets should be risk assessed to make sure residents are able to manage these safely without the risk of ingestion. Medication practices at the home are unsafe and potentially puts residents at risk. Staff involved in administering medication should undertake refresher training. The complaints policy should make clear that complainants can contact the Commission for Social Care Inspection at any stage of a complaint. Any adverse incidents in the home such as the recent spate of thefts from residents must be thoroughly investigated and the results of the investigation recorded. Such incidents must also be reported to the Commission for Social Care Inspection under the Care Homes Regulations 2001. The advocacy policy should make it clear that self advocacy is not always possible and that residents and relatives have the right to seek advice from external agencies. The policy should include the contact details of such Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 8 agencies. The adult protection policy should be updated to reflect current good practice guidance and the home should obtain copies of the Department of Health guidance ‘No Secrets’ and the Somerset Safeguarding Adults Procedures. All staff including the acting manager, and the governing body should receive training in adult abuse awareness to make sure that they are able to identify abuse and are aware of the correct procedures to report this. Any allegations of abuse must be referred via locally agreed procedures to Adult Social Care, Somerset County Council. All members of the governing body should have a satisfactory POVA first and CRB disclosure on file. There should be sufficient electrical sockets in resident’s private rooms and communal rooms so that extension leads and trailing wires do not present a potential risk to residents and staff. All residents should be offered a key to their private room and lockable space within their room to keep valuables safe. The laundry must be redecorated and re organised to reduce the risk of cross infection. All hazardous substances must be stored appropriately to reduce the risk of harm to residents. A review of the poor storage facilities throughout the home should be undertaken as soon as practicable. An assessment of the dependency of residents must be undertaken to make sure that there are enough staff to meet resident’s social, care and health needs. All new staff should be undertaking the common induction standards. All staff must undertake training in fire safety, first aid, moving and handling and health and safety. A staff training programme should be developed to make sure all staff have the skills and experience to provide good care. Efforts should be made to increase the numbers of staff qualified to NVQ level 2 or above. The acting manager should obtain an up-to-date copy of the care homes for older people national minimum standards so that they are aware of the current regulations and national minimum standards relating to running a care home. Valuables stored on behalf of residents such as rings and watches should be stored in the safe and a record kept and staff should not use their own store loyalty card when shopping for residents. The practice of residents making donations to a staff fund at Christmas should be urgently reviewed. All staff should be made aware of the confidentiality policy and that residents and the homes business should not be discussed outside work. The homes policies and procedures need to be updated to reflect current good practice advice and should be reviewed and updated yearly as necessary. The Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 9 homes documentation should clearly reflect that the home provides personal care only and that all staff are employed as carers not qualified nurses. The acting manager must provide evidence that the homes portable electrical appliances, the homes hard wiring systems and the passenger lift have been tested and are safe for use. 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 Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Standard 6 is not applicable to the service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The statement of purpose does not give readers all the relevant information about the home. Using nursing terms such as matron and sister to describe care staff in the statement of purpose and contract is misleading. The home was unable to produce a service user guide. Residents are given a basic terms and conditions of residency. Pre admission assessments are not thorough and do not always take into account the homes registration. EVIDENCE: Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 12 The home produces a statement of purpose that includes basic information about the home, sample menus, details about how to make a complaint, and about some of the things such as hairdressing and activities that are offered to residents. The statement of purpose was not dated but it was evident that it contained some out of date information. It did not include the name or qualifications and experience of the registered provider, the admission criteria was unclear, the complaints procedure does not make clear that complainants are able to contact Commission for Social Care Inspection at any stage of a complaint and it does not include the number and size of rooms in the home. The statement of purpose does state that the home provides personal care only but also emphasises throughout that a registered nurse runs the home and that the three care managers are all registered nurses. However, one member of staff referred to as a ‘sister’ does not have a current nursing registration and cannot therefore work or call themselves a nurse. The language used throughout the home and the homes documentation referred to the manager as ‘matron’, carers who have current or expired nursing qualifications are known as ‘sisters’. This could clearly give residents and visitors a false impression that nursing care is provided and some residents spoken to on the day of the inspection believed that basic care was provided by carers but that nurses would be available if they needed them. A service user guide was requested but had not been received at the time of writing this report. The AQAA completed by the home stated that the home undertook intermediate care. However, the home does not provide intermediate care but has some allocated rooms for respite care it was clear that the difference between intermediate and respite care was not understood by the home. The home provided us (the Commission for Social Care Inspection) with a copy of the terms and conditions of residency that is given to people when they move into the home. It includes the number of the room the resident will occupy, that the first four weeks is a trial period, who is responsible for fees, what is included in the fee and what items the residents are responsible for themselves. As stated elsewhere in this report the information about complaints in the contract needs to be revised and updated to reflect the national minimum standards. The contract also refers complainants to matron/home manager and is signed by matron/administrator/sister. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 13 We looked at the care plans of two residents who had recently moved into the home. Both residents had a pre admission assessment on file. However, on one assessment the resident had a diagnosis of dementia and the pre admission assessment stated that staff would need dementia training and an understanding of dementia. The training matrix seen on the day of the inspection clearly showed that the majority of staff have not undertaken dementia training. Although the resident had dementia the care plan entitled ‘mental/psychological; was blank. There was no care plan in place to give advice and guidance to staff on the person needs due to their dementia. On one file checked the resident had an existing medical condition but the file did not contain any information about this condition or advice and guidance to staff in relation to this. It was evident from talking to some members of staff that they were unclear about the homes registration and that they had little understanding of why it was necessary to reassess some resident’s needs as their dependency and needs had changed. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning is inconsistent and does not involve the people who live there. Residents have access to health and medical care. Medication practice at the home potentially puts resident’s health and welfare at risk. EVIDENCE: We looked at three residents care plans in detail. Care plans contained information about residents, weight records, falls risk assessments, nutritional risk assessments and information about medication being taken. The assessment was scored on a dependency level but there was no explanation of what the scores meant i.e. low, medium or high and no advice or guidance to staff on what to do with the scores. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 15 There was no evidence that residents or their relatives had been involved in care planning and some residents spoken to were unaware that staff wrote things down about them or that they should be consulted about how they wished their care to be delivered. None of the people spoken to had been asked to sign their agreement to a care plan. The majority of the assessments had not been reviewed as planned on the record for some months so that the assessments did not necessarily reflect the resident’s current needs. The care plans did not cover all the topics recommended in the national minimum standards and did not give clear guidance to staff on how to meet identified needs. On two files checked residents had medical conditions but there was no information on file about this to give staff advice and guidance on how to care for these people. There was also no risk assessment related to this medical condition. It was clear from talking to the acting manager and from looking at care files that some resident’s needs exceeded the homes registration and that the staff do not have the skills and training to meet these peoples needs. When we (the Commission for Social Care Inspection) went round the home we observed that many residents’ toothbrushes were dry and one was covered in fluff leaving it unclear if residents were supported by staff with oral hygiene. Dental tablets were seen in many residents’ rooms and the acting manager was unaware of the risk of ingestion of these and the potential risk to less able residents. It was evident in discussion with the acting manager that advice and training on some clinical procedures such as maintaining catheters and colostomy bags had been undertaken by the acting manager rather than the community nursing service. There was no records of which staff had been trained in these procedures or if and how their competency had been assessed. The acting manager stated that the Stoma nurse had been to the home but there was no record of any advice or training given. It was clear from looking at residents care files that they are supported to access their GP, the district nursing service, optician, chiropodist and dentist whenever necessary. Pressure relieving equipment was in place according to individuals needs. The home has sit on scales to be able to be able to weigh residents who are unable to weight bear but it was unclear if these had been calibrated to check their accuracy. We looked at medication practice within the home. The home did not have an up-to-date medication policy or a copy of the Royal Pharmaceutical Society guidelines for the administration of medicines in care homes. We found that the administration of prescribed creams was not recorded, hand transcribed entries on the medicine administration record (MAR) had only one signature, there was a significant number of gaps on the MAR sheet, on several hand Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 16 transcribed entries there was no record of the quantity of medicine received and in some cases no date. Some entries on the MAR sheet used a letter without defining what it meant. The inspectors were told that many residents rarely take medicines at the time they are given by staff and that this is a particular issue at teatime when staff sign that medicines have been given that these are retained by residents to take later. There is therefore no proof that these medicines have been taken as prescribed. Controlled drugs were kept appropriately and records checked were found to be correct. Staff were observed to treat residents with respect and was seen knocking on the door of residents private rooms. However, some staff were seen going into rooms before residents had the opportunity to respond. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were satisfied with the activities provided at the home. Some routines in the home were flexible to suit resident’s preferences. The hairdressing environment potentially puts residents at risk of infection. Visitors are made welcome in the home. EVIDENCE: The home arranges church services four times a month so that the residents can choose to continue with their religious worship. A daily activities programme was on display and included flexicise, quizzes, music and afternoon tea, visiting pets and videos. On the day of the inspection several residents were enjoying flexicise with the activities organiser. There are sometimes trips out organised. All the residents spoken to on the day the inspection said that Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 18 there was enough going on and that you could choose to join in if you wanted to.13 residents responded to the survey with 7 saying there was always something Residents spoken to told us that they were able to get up and go to bed at times to suit themselves and could also spend time in their rooms if they wanted to. Residents confirmed that they could have visitors at any time and relatives surveyed said that they were made to feel welcome in the home by staff and one person commented that they were always offered refreshments when they visited. The inspectors observed in some resident’s rooms that hairbrushes and combs were dirty and needed cleaning or replacement. A hairdresser visits the home weekly. However, the room used for the hairdressing was the sluice room, which on the day of the inspection contained clinical waste bags, did not contain a bin, and although liquid soap was available the paper towels were not accessible. On the day of the inspection there was a choice of two main meals but the majority of residents had the first choice and it appeared that staff assumed that residents would take responsibility for telling them if they wanted an alternative to the main choice. 14 residents completed a survey about whether they liked the meals at the home 5 said that they always did, 6 that they usually did and 3 that they sometimes liked the meals at the home. One resident said that they had special dietary requirements in the kitchen staff helped them as far as they could within financial constraints’. One resident described the food as ‘reasonable’ and another resident said that ‘you have a choice and on the whole the food was quite good’. We were told that there is frequently no choice of drinks at mealtimes and that this was to suit the routine of the kitchen staff. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints are not always taken seriously and not thoroughly investigated. Current advice and guidance about adult protection and whistle blowing is not available to staff. Protecting the people who live in the home is not always taken seriously and potentially puts people at risk. EVIDENCE: The home has a complaints policy that gives the timescales within which a complaint would be investigated and includes the contact details of the Commission for Social Care Inspection. However, it does not make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. All the residents surveyed said that they knew how to make a complaint and this was confirmed by people spoken to on the day the inspection who said they felt confident that they could talk to a member of staff if they had any concerns or complaints. 9 relatives surveyed said they knew how to make a complaint, with seven respondents saying the home had always responded appropriately to concerns, one saying that the home usually did with three responses returned blank. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 20 The information provided by the home on the AQAA stated that the home had received six complaints since the last inspection four of which were substantiated and two of which were currently under investigation. The complaints related to a drug error, an injury sustained by a resident in the passenger lift that meant the person needed to go to hospital, a resident who hadn’t been given a drink, lack of communication with a residents family in relation to a medical problem, the proposed move of a resident to another home and remarks made to a resident about another home. The level of recording and investigation of complaints was poor, we were unable to determine the outcome and in some cases investigations had not taken place. There was a lack of outcomes for complainants. Two of the complaints should have been reported to us under regulation 37 of the Care Homes Regulations 2001. The home had also recorded an allegation of verbal abuse by a member of staff towards a resident and a colleague. The previous manager had investigated this and the person concerned had been suspended during the investigation. The Commission has referred this to Somerset Adult Social Care under the safeguarding vulnerable adults procedures. We noted that there were five instances of thefts from residents between December 2006 and August 2007. The thefts were reported to the police but the recording of these incidents was poor, there was no record that an investigation had taken place and they had not been reported to the Commission for Social Care Inspection. This Commission has referred this to Somerset Adult Social Care under the safeguarding adults procedures. The adult protection policy is dated 2002 and does not reflect current good practice advice or locally agreed Somerset wide procedures. The home did not have a copy of the Department of Health ‘No Secrets’ guidance or a copy of the Somerset safeguarding vulnerable adults procedure. The home has a policy on the management of violence by residents dated 2002, this needs updating to reflect current good practice advice and to make it clear to staff that verbal and physical aggression by residents may be involuntary rather than deliberate. The home has a restraint policy dated 2002 that states that staff are all trained in restraint including breakaway techniques. The acting manager stated that the home does not physically restrain residents and that no staff are trained in restraint. The homes advocacy policy states that the home support self advocacy and the policy does not include the contact details of local advocacy services or the Commission for Social Care Inspection. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 21 The home has a whistle blowing policy dated 2002 but this did not include the contact details of the Commission for Social Care Inspection or Public Concern at Work. Staff do not start work at the home until a satisfactory POVA first check has been received. However, none of the governing body who have free access to the home has satisfactory POVA or CRB checks in place. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy and residents satisfied with their accommodation. Access to some areas of the home including residents private rooms are restricted due to their use for storage. The home requires continued updating and refurbishment. Residents do not have anywhere secure or private to keep valuables. The laundry area is poorly maintained and poses a potential risk of infection. EVIDENCE: Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 23 The home was generally clean, tidy and smelt fresh on the day of the inspection. On the top floor of the home there were signs of water ingress on the ceilings. Some areas of the home need updating due to wear and tear and would benefit from being made more homely. One relative commented that the ‘cleanliness of their relatives room could be improved’. A resident commented that the ’home needs money spending on it’. Resident’s rooms were clean and tidy and they are able to personalise them and bring in small items of furniture within space constraints. Not all residents had bedside lamps. Several en suite shower rooms, toilets and communal shower rooms throughout the home were unusable as wheelchairs, walking equipment and other items were stored in them. It was observed that not all radiators in the home were guarded to make sure the residents were not at risk of scalding. It was observed that extension leads were in use throughout the home in resident’s private rooms and communal areas with one lead having 4 plugs in use. A residents meeting had discussed the advantages of having a loop system provided in communal areas of the home but there was no evidence that this had been considered. In the kitchen the inspectors observed that dirty mops, brooms and cleaning products were stored in the same cupboard as fresh food. This was brought to the immediate attention of the cook. However, this issue had also been raised by an environmental health officer in July 2007 and it was evident no action had been taken. Liquid hand wash and paper towels were provided for staff in resident’s private rooms and communal bathrooms. It was also evident that gloves and aprons are provided to reduce the risk of infection. In one bathroom the shelf had become water porous and needed replacement. Some tiles had come off or were cracked in bathrooms and need replacement. The laundry was in poor condition; the flooring is ripped, porous and needs replacing. There was washing powder over the floor and no clear distinction between dirty and clean areas to reduce the risk of cross infection. Dirty laundry had also been left on the floor. The bin was open topped presenting a risk of cross infection. The laundry machines are domestic in type. The paintwork on the walls and skirting need redecoration. Clean spare bedding was stored in the laundry, this needs to be stored elsewhere. Hazardous substances were stored in an unlocked cupboard. The wood area around the hand basin has become porous and bowed and the sealant needs replacement. The laundry is next to the staff toilet and the division between the two rooms has not been sealed properly and the toilet is visible from the laundry. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment was generally good and protects residents from the risk of abuse. The practice of not undertaking POVA and CRB checks for the governing body potentially puts residents at risk. Current staffing levels are too low to meet the needs of the people living in the home. The home does not always support or encourage the development of a competent staff team. EVIDENCE: A staff rota was seen. The acting manager acknowledged that the home was short staffed and that all staff were working long hours to cover the shortfall. One member of staff said that staff often ‘don’t leave the building until well after their shift has finished’. The acting manager said that advertising for staff would be taking place that week. The staff rota did not indicate who was a Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 25 qualified first aider on each shift; this was identified in the last report but had not been addressed. Fourteen residents completed a survey 6 of whom said there was always staff available when needed, 8 of whom said there was usually staff available when needed. One relative commented on the ‘regular turnover of carers and their consequent lack of experience’. A resident surveyed said that it would be ‘nice if new staff were taken round and introduced to each patient’. It was observed on the day of the inspection that staff were very busy and contact with residents was task centred rather than spending quality time with people who live at the home. As previously stated in outcome group 1, although the home provides personal care only it employs registered nurse, the acting manager, and senior staff are referred to within the home by staff and residents as ‘matron’ and ‘sisters’. However one member of staff referred to as ‘ sister’ does not have a current nursing registration and should not be referred to as a qualified nurse. Some carers told us that other carers who have previously had careers as nurses ‘had to be referred to as ‘sister’ and this was part of the hierarchy of the staff team. We looked at the files of 2 staff that had started work since the last inspection and the file of a staff member who had recently been subject to disciplinary action. One file checked contained terms and conditions of employment, a job description, copies of training certificates, a photograph, a satisfactory POVA first and CRB disclosure, a record of the interview, an application form, a character reference, and a reference from the persons previous employer. The second file contained a satisfactory POVA first and CRB disclosure, two references, an interview record, an application form, terms and conditions of employment but no photograph. Proof of individual’s identity was kept separately to their staff files. The interview record asks and records if applicants have children and their ages. We also looked at the training file of 6 members of staff. One file was blank, only one person had current moving and handling training or fire safety training. Four members of staff had completed some training in 2006. A training matrix was seen on the day of the inspection that indicated that the majority of staff do not have current training in basic topics such as fire safety, moving and handling, health and safety and first aid. It also showed that foundation training in such topics as adult protection and dementia had not been undertaken by the majority of staff. A copy of this training matrix was requested 3 times after the inspection but the home had not produced it at the time of writing this report.50 of staff surveyed felt that the induction and training was sufficient and relevant, and 50 felt that it was not. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 26 There was no evidence that new staff undertake the skills for care common induction standards. One member of staff had completed the in house two page induction. All the staff files checked showed that staff do not start work until a satisfactory POVA first check has been received. However, as noted in outcome group 4 none of the governing body have POVA First or CRB checks in place to make sure that residents are safeguarded from the risk of abuse although they have free access to the home as part of their role. Some staff spoken to felt that the home was short staffed and that this meant they were unable to provide the level of service they felt residents needed. Some staff also raised concerns and queries in relation to the homes registration and the dependency level of some residents. A resident spoken to said that ‘staff listen and act when they have time. However, this is generally not possible’. The home currently employs 28 care staff. Information supplied by the home stated that 10 were qualified to NVQ level 2 or above with 1 person currently registered on a NVQ training course. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is poorly managed and lacks direction in some areas of service provision. Resident’s finances are not safeguarded by the homes practice and procedures. Staff are not provided with current, up to date information and guidance. Health and safety is not taken seriously and potentially puts residents and staff at risk. EVIDENCE: Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 28 The home does not have a registered manager at present, an acting manager has been appointed and the post has been advertised. The homes copy of the Care Home for Older People, which details the regulations and national minimum standards, was several years out of date. We looked at some residents finance records. It was clear that when some staff had done shopping for residents they had used their own store loyalty card. Receipts were retained on individual files including those issued by the hairdresser. It was evident on two records checked that residents had made donations of £10 and £50 towards a Christmas fund for staff. It was also evident on one resident’s financial record that a considerable number of ‘baby wipes’ had been purchased it was unclear why this particular resident had to purchase these items themselves. The financial records checked were found to be correct. Please refer to outcome group 4, which details a series of thefts from residents which took place in 2007. Residents meeting are held periodically and minutes taken although it was unclear if the minutes were circulated to the residents. The previous manager had started to hold staff meetings but these did not include all levels of staff. We spoke to four members of staff, some of whom had concerns about the recent changes at the home. Some staff spoken to and surveyed saying that they thought that the organisation of the home was chaotic. This was confirmed by looking at the records of a recent fire drill when the person in charge did not know what to do. There was a record that the temperatures of water outlets are tested weekly and that appropriate checks are made to reduce the risk of legionella in empty rooms. COSHH data sheets were dated 1999, 1998 and 2003; these had not been reviewed or updated for some years. There were no COSHH risk assessments available. The homes insurance certificate was on display and is valid until July 2008. Evidence was seen that a clinical waste contract was in place; the stair lift and hoists had been regularly serviced, There was no evidence that the passenger lift had been serviced, that a qualified person has tested portable appliances or that the home had a current five-year hardwiring certificate. The home has a confidentiality policy that is contained in the staff handbook and given to all staff when they start work at the home. However, the Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 29 inspectors were told by several people that a recent adult protection incident that occurred at the home was common knowledge in Minehead. The homes policies and procedures are mainly dated 2002 and have not been reviewed or updated to reflect current good practice advice, guidance or the national minimum standards. The supervision policy should be updated to reflect the topics and frequency in the national minimum standards. Some care records were kept on the first floor in an unlocked room that could be accessed by anyone living or visiting the home. As detailed elsewhere in this report there have been serious incidents involving people of the home in relation to thefts, injuries and adult protection issues that were not referred to the Commission for Social Care Inspection or to Somerset Adult Social Care. The home had been visited by the Fire and Rescue Service in 2006 and issued with a non-compliance order relating to the fire risk assessment and staff training. There was no evidence that this had been complied with. Potentially serious issues were identified in relation to fire safety during the inspection; these have been referred to Devon and Somerset Fire and Rescue Service. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 1 2 X 2 X X 2 2 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 2 2 1 1 Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) (c) Schedule 1 (1) (2) (8) (14) (16) (17) Schedule 4 (2) 5(1) (2) Requirement The registered person must ensure that the statement of purpose includes all the information required. The registered person must ensure that a service user guide is developed and readily available to prospective and current residents. The registered person must ensure that anyone undertaking pre admission assessment is fully aware of the homes registration to provide personal care only. The registered person must unless it is impracticable consult with the residents and /or their representatives in relation to assessment, care planning and review. The registered person must keep the residents care plan under review. The registered person must ensure that staff support DS0000016019.V358235.R01.S.doc Timescale for action 31/03/08 2 OP1 31/03/08 3 OP3 14 (1) (a) (d) 25/02/08 4 OP7 15 (2) (bc) 01/03/08 5 OP8 12(1)(a) (b) 01/03/08 Blenheim Lodge Version 5.2 Page 32 residents with their all health needs. 6 OP8 13 (1)(b)(4)( c) The district nursing service must undertake training on clinical procedures. This must be recorded and staffs competency to undertake procedures is regularly assessed. Arrangements must be made to ensure that medicines are recorded when received into the home and also that records are made when medicines re given to people. Arrangements must be made to ensure that risk assessments are carried out when medicines are to be left with people for them to take at a later time. Arrangements must be made to ensure that the management of medicines in the home follows that defined in the homes medicines policy. Immediate requirement issued 8 OP12 OP38 9 OP16 16(2)(j) 13 (3) (4) 22 (1) (3) The registered person must ensure that resident’s hair dressing does not take place in the sluice room. The registered person must ensure that all complaints are fully investigated and that the complaints procedure is followed. The registered person must make arrangements to prevent service users being harmed or suffering abuse, or being placed at risk of harm and abuse. DS0000016019.V358235.R01.S.doc 01/03/08 7 OP9 13(2) 25/02/08 25/02/08 21/02/08 10 OP18 13(6) 21/02/08 Blenheim Lodge Version 5.2 Page 33 11 OP18 13(6) The registered person must ensure that all staff and the governing body receive training on adult abuse awareness. The registered person must make sure There are sufficient electrical sockets throughout the home. The registered person must make sure that all radiators are guarded are of guaranteed low surface temperatures. All pipe work should be guarded. The registered person must ensure in the laundry that there are separate areas for clean and dirty laundry, the flooring is replaced, clean bedding is not stored in the laundry area, a foot operated pedal bin is in place The registered person must ensure that the laundry is decorated to a reasonable standard. The registered person must look at the assessed needs of people living in the home to see if the current staffing levels are sufficient. Regulation 18(1)(a). 31/03/08 12 OP19 13(4) (a) (c) 23(2) (a) 13(4) (a) (c) 31/03/08 13 OP25 31/03/08 14 OP26 13(3) 31/03/08 15 OP26 23 (2) (d) 13(3) 31/03/08 16 OP27 18(1)(a) 01/03/08 17 OP29 Schedule 2 (7) 19(1)(b) (i) Schedule 2(1) 19(1)(b) (i) 18 (1) (a) (c.) (i) The registered person must 31/03/08 ensure that all the governing body have satisfactory POVA first and CRB checks in place. The registered person must ensure that a photograph is kept on each staff file. 21/02/08 18 OP29 19 OP30 All staff must undertake common 31/03/08 induction standards training. DS0000016019.V358235.R01.S.doc Version 5.2 Page 34 Blenheim Lodge 20 OP37 17(1)(b) The registered person must ensure that all records are kept securely. It is required that there are staff suitably qualified in delivering first aid on duty at all times. (Previous timescale of 16/12/06 not met). 25/02/08 21 OP38 13 (4) (c) 25/02/08 22 OP38 23 (2) (c) The registered person must ensure that the passenger lift is serviced and certified by a qualified person as fit for purpose. 23(2) (bc) The registered person must provide an electrical hard wiring certificate to evidence that the home is safe. The registered person must ensure that all portable appliances tested and certified safe by a qualified person. The registered person must ensure that all hazardous substances are stored appropriately in locked areas. The registered person must ensure that all staff receives training in fire safety. Immediate requirement given 27/02/08 23 OP38 27/02/08 24 OP38 23 (2)(c) 27/02/08 25 OP38 13 (4) (a) (c) 25/02/08 26 OP38 23 (4) (d) 25/02/08 27 OP38 13 (5) 18 (1) (c) (i) 23(4) The registered person must ensure that all care staff have undertaken training in moving and handling. The registered person must ensure that a fire risk assessment that includes a DS0000016019.V358235.R01.S.doc 27/02/08 28 OP38 27/02/08 Blenheim Lodge Version 5.2 Page 35 means of evacuation is developed. 29 OP38 OP18 37(1) (e) (f) (g) (2) Schedule 4 (12) (b)(f) The registered person shall give notice to the commission without delay of any events in the care home adversely affecting the well-being of safety of a resident, any theft in the care home, and any allegation of misconduct by any person working at the care home. The registered person must ensure that all information relating to COSHH is up-to-date and relevant. Risk assessments in relation to the use of such products must be developed. 25/02/08 30 OP38 13(4) (c) 27/02/08 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 OP2 Good Practice Recommendations The information about complaints in the terms and conditions of residency should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. Serious consideration should be given to the use of nursing terms to describe care staff in the terms and conditions of residency. Care plan should cover all the topics recommended in national minimum standards 3.3. All care plans should be reviewed with the resident and updated as necessary on a monthly basis. The registered person should provide advice and guidance DS0000016019.V358235.R01.S.doc Version 5.2 Page 36 2 OP2 3 4 5 OP7 OP7 OP7 Blenheim Lodge to staff on what the dependency scores mean and any action that needs to be taken. 6 7 OP8 OP8 The registered person should ensure that the sit on scales are calibrated. Risk assessments should be in place for residents who use dental tablets. If a risk of ingestion is identified tablets should be kept securely. Reference material and information should be obtained in relation to specific medical conditions relevant to individual residents. It is recommended that G.P homely remedies written authorisation be reviewed annually. A staff signature list should be drawn up of all those who administer medication. A copy of the Royal Pharmaceutical Society current guidelines for managing medicines in care homes should be obtained and the medication policies updated to reflect current good practice advice. It is recommended that 2 signatures are obtained on any hand transcribed entries on MAR sheets The complaints policy should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. The advocacy policy should include the contact details of local advocacy services and the Commission for Social Care Inspection. It should also make clear that self advocacy is not always possible and that residents and their families have the right to contact external agencies. The home should obtain a copy of the Department of Health ‘No Secrets’ guidance. The home should also obtain a copy of the Somerset safeguarding adult’s procedures. The whistle blowing policy should be updated and include contact details of the Commission for Social Care Inspection and Public Concern at Work. 8 OP8 9 10 11 OP9 OP9 OP9 12 13 OP9 OP16 14 OP17 15 OP18 16 OP18 Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 37 17 OP22 Urgent consideration should be given by the registered person to addressing the serious storage issues of equipment within the home. Consideration should be given to providing a loop system in communal areas as requested by residents. All residents should be offered a bedside lamp. All residents should be provided with a lockable space in their private rooms. All residents should be offered a key to their private room. All bins should be foot operated with a lid in place. Significant efforts should be made to increase the number of staff qualified to NVQ level 2 or above. Consideration should be given as to whether the interview record complies with employment legislation. All staff should undertake Skills for Care Induction training. A training matrix covering basic and foundation training should be produced and a copy sent to the Commission for Social Care Inspection. All policies and procedures should be reviewed and updated to reflect current good practice advice and give clear up-to-date information to staff. All valuables such as rings or watches held on behalf of residents should be stored in the safe and receipts given. Staff should not use their own store loyalty card when buying items for residents. Residents should not be asked to contribute cash towards the staff fund at Christmas. Formal staff supervision should cover the topics detailed in the national minimum standards 36.3. The home should obtain and up-to-date copy of the Care Homes for Older People national minimum standards and regulations as soon as practicable. 18 19 20 21 22 23 24 25 26 OP22 OP24 OP24 OP24 OP26 OP28 OP29 OP30 OP30 27 OP33 28 29 OP35 OP35 30 31 OP36 OP37 Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 38 32 OP37 All staff should be made aware of the confidentiality policy and should not discuss residents or the homes business outside work. Blenheim Lodge DS0000016019.V358235.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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