CARE HOMES FOR OLDER PEOPLE
Blesma Home 539 Lytham Road South Shore Blackpool Lancashire FY4 1RA Lead Inspector
Mrs Christine Marshall Unannounced Inspection 5th January 2006 11:00 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 Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 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. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Blesma Home Address 539 Lytham Road South Shore Blackpool Lancashire FY4 1RA 01253 343313 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) blesma01@tiscali.co.uk British Limbless Ex Servicemen`s Association Mrs Jacqueline Longden Care Home 49 Category(ies) of Physical disability (49) registration, with number of places Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: BLESMA in Blackpool is owned by the British Limbless Ex-Servicemens Association. It is registered for 49 persons with physical disability. There are some short stay holiday/respite beds available at the home. All rooms have en-suite facilities and the home is furnished to a good standard. There are specially adapted vehicles to accommodate wheelchairs and a full entertainments programme is arranged. The home is situated in the South Shore area of Blackpool and is close to a good number of shops, banks and a post office. The grounds are well kept and there is parking space for visitors. Mrs Jacqueline Longton manages the home. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. The inspection took place during the late morning and afternoon and was carried out by the home’s designated lead inspector. The people living at the home wish to be known as Members. The inspector undertook a full tour of the home, including bedrooms, lounge and dining areas, laundry and bathrooms. All areas were clean, hygienic and pleasantly furnished. The policies, procedures and administration records for the management of the home were examined. Comment cards were received from members, relatives and GPs prior to the inspection; all were very positive and showed that everyone is satisfied with the care that they receive. The inspector spoke with many people living at the home, the home’s manager, nurses, care and domestic staff. What the service does well:
There is a very friendly feel to the home and members from all cultures are welcomed. Equality and diversity of care is an integral part of the home’s philosophy. The general fabric and furnishings of the home are of a good standard and the home is kept clean and hygienic. The carers were found to be very friendly and professional in their approach to care and the residents spoken to said that the staff were all very caring and considerate. Daily routines for the people living at BLESMA are flexible and the members said that they enjoyed their own personal routines and lifestyles, as well as a full activities programme at the home. Members’ and relatives’ comments included “This home should be given 6 stars.” “Nothing is too much trouble for the manager and staff.”
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 6 “First rate care and very friendly and helpful staff.” “You will have to go a long way to find anywhere as good as this.” All of the members said that the food is very good they were very satisfied with the quality and variety of meals that are provided. There are well-kept gardens around the home. There is a licensed bar for the members and their guests. A large network of people support the home to promote independence and encourage social outgoings for the members; this is lead by a Support Group who work in conjunction with the manager. Everyone was very friendly, welcoming and co-operative throughout the visit, and showed that there is a very good team approach to the care given to the members. What has improved since the last inspection? What they could do better:
The home’s pre-admission assessment should be reviewed to include all aspects of care that are in the National Minimum Standards (NMS) guidelines. This would make sure that a full picture of care needs is gained before a person enters the home. The care plan system should be reviewed. Daily reports are currently very brief and do not give a clear picture of the care that each person has received. These should be written in accordance with the Nursing & Midwifery Council Guidelines for Record Keeping. Each entry should contain the time of writing any report or comment. All records should contain sufficient information so as to fully identify the care that has been given and that a monthly, full review has taken place. Any disposal of medicines should be recorded in line with the Royal Pharmaceutical Society of Great Britain guidelines, so that a full audit of medicines can be followed. This will make sure that medications are accounted
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 7 for and not lost or misused. Oxygen cylinders should be chained to the wall for safety and security, as these are highly flammable. The treatment room temperature should be recorded daily to make sure that any medicines, creams or lotions are stored at the right temperature. Bedrooms with vinyl flooring should be fitted with carpet, which is more comfortable and homely. The laundry room should have the floor re-painted to make sure that cleanliness and hygiene is maintained. The home’s recruitment process is in need of reviewing and each staff recruitment file must contain all of the records that are stipulated in Schedule 2 of the Care Homes Regulations 2001 (amended 2003). This will make sure that the people who live at the home are protected through a robust system of checking any person applying to work at the home. A training matrix should be developed so that the manager or visiting official can see at a glance which staff have had training and when any updates are due. This will make it easier for the manager to keep track of her training programmes. The home needs to implement a quality monitoring system that involves the feedback of any surveys that are sent out to the members or their relatives. This will show the people living at the home that their best interests are being monitored. 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. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 8 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 Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Information gathering about an indivdual is insufficient at this time. The home needs to gather enough information about each prospective member, to ensure that their needs can be met. EVIDENCE: There is a pre-admission assessment done for each member before they enter the home, either for permanent or respite care. However, on examination these assessments do not always include things like any history of falling down, social activities and hobbies and some sensory things like hearing or sight problems. The manager said that the welfare team, who currently do the assessments, is reviewing this. Members were able to confirm that they had undergone an assessment before they entered the home. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 The members’ health and social care needs are met and people are treated with dignity and respect: They are supported in their daily lives. EVIDENCE: Care plans are written records of the care that are given to each person that lives at the home and three care plans were looked at; each of these plans was fairly basic and daily reports were very brief. Although each had been regularly reviewed to make sure that the right care was being given, comments on this review were sparse. Advice was given to the manger in respect of following the Nursing & Midwifery Council guidelines for record keeping, who readily agreed. A number of members said that they knew about their care plans and that they were happy with these. Members also said that although the home’s GP visited the home twice weekly, they had the choice of other GPs if they wished, and that they had regular visits to the chiropodist, dentist, optician and also hearing aid services.
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 11 The members also remarked that they were more than happy at the home and that the staff were very kind; they also said that their privacy and dignity is always looked after. The medication policies and procedures make sure that the members are safe. Nurses give out all medicines and the manager monitors the medication systems regularly. However, the disposal of any medicines needs to be documented and the treatment room temperature should be recorded daily to make sure that any medicines are stored at the correct temperature. Oxygen cylinders should be chained to the wall of the treatment room, because they are highly flammable. Some members take responsibility for their own medicines and the manager and staff support them in this. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Members benefit from nutritious well balanced food served to them in a pleasant and comfortable environment that supports choice and special dietary requirements EVIDENCE: The members all agreed that the food at the home is very good; they said that there is plenty of choice and good quantities. The lunchtime meal looked very appetising. Special diets, such a diabetic, are catered for. Members needing help with their meal were given this in a dignified way. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Members are able to voice their complaints and know who to speak to if they have any concerns. EVIDENCE: There is a written complaints procedure for the members and their relatives. The members spoken to said that they had no complaints at all. There has been one complaint to the home, which was responded to and found to be not upheld Members also said that they could get in touch with their relatives, solicitors or anyone else that they might need for help, if they wished: There are advocacy information leaflets and advice available, which is for anyone who is without relatives and needs someone to speak on their behalf. Staff confirmed that are given training on abuse awareness, which ensures that the members are protected and supported. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Members are provided with clean, homely and pleasantly furnished surroundings and bedrooms are personalised and comfortable; this means that people feel at home with their photographs and belongings around them. EVIDENCE: Each bedroom is personalised with pictures, photographs and small items of furniture. There are adequate toilets and bathrooms throughout the home. All lounges, dining areas and bedrooms are very comfortable and furnished to a good standard: There is an ongoing refurbishment programme in place. There are aids and adaptations such as grab rails in toilets and special lifting and bathing hoists for the residents who need help with their mobility. There
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 15 are also assisted baths for members that cannot get in and out of the bath without help. Laundry systems make sure that there are no problems with cross-infection and the laundry area is kept clean and tidy. The laundry room floor however is badly scraped and marked and needs to be re-painted to promote cleanliness and hygiene levels. Some rooms have vinyl flooring fitted. All rooms should ideally be fitted with carpet, which is more comfortable and homely. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The members’ care needs are met through good levels of staff, who have the appropriate qualifications and experience necessary to give a good care service. Recruitment of staff does not always follow correct procedures and this compromises the ability of the home to demonstrate it employs only suitable people for the job EVIDENCE: The list of staff on duty showed that there are good levels of nurses, carers and domestic staff on duty at the home. Carers were very friendly and helpful and showed that there is a very good mix of people in place. National Vocational Qualifications (NVQ) training programs are in place and 50 of staff have achieved this. Staff recruitment files did not all contain records that are required under Schedule 2 of the Care Homes Regulations 2001 (amended 2003) The recruitment policies and procedures must be followed to make sure that the members are in safe hands.
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 17 The manager was given advice by the inspector about Criminal Records Bureau (CRB) checks and the Protection of Vulnerable Adults (POVA). A sample of staff training and personal files showed that staff training programmes are in place. Advice was also given about developing a training matrix that would show at a glance any individual staff training needs and updates. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home makes sure that the best interests of the members are protected in that their health and safety is promoted. EVIDENCE: The manager is a Registered Nurse who holds the Registered Managers Award. There is a policy and procedure for a quality monitoring system in place, however this is not fully implemented. The manager said that consideration is currently being given to the Investment in People (IIP) quality system. Members and relatives meetings are held every three months and the minutes of these meetings are sent to every member.
Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 19 Policies are in place for the protection of members from any financial abuse. Those members who participated in the inspection said that they either looked after their own money or their relatives did it for them. All records are stored in locked filing cabinets and staff look at them only when they need to find out about that particular person’s care needs. The Health & Safety check records and equipment servicing certificates, and all were current. Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 20 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 21 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 2 3 Standard OP3 OP7 OP29 Regulation 14 15 17 Requirement Pre-admission assessments must include all aspects of daily living activities. Care plans must contain adequate information about the care that is being provided. Recruitment files must contain all records specified in Schedule 2 of the Care Homes Regulations. A quality monitoring system must be developed. Timescale for action 28/02/06 28/02/06 28/02/06 4 OP33 24 28/04/06 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 2 3 Refer to Standard OP9 OP24 OP26 OP30 Good Practice Recommendations All medicines that are disposed of should be recorded. Oxygen cylinders should be chained to the wall of the treatment room. Bedrooms with vinyl flooring should be fitted with carpets. The laundry floor should be repainted. A training matrix should be developed.
DS0000006028.V271628.R01.S.doc Version 5.1 Page 22 Blesma Home Blesma Home DS0000006028.V271628.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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