Inspection on 25/09/07 for Bliss Residential Care

This inspection was carried out on 25th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Bliss Residential Care 16/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Bliss Residential Care 23 Cobham Road Westcliff On Sea Essex SS0 8EG Lead Inspector Diane Roberts Unannounced Inspection 25th September 2007 09:00 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 Bliss Residential Care DS0000067960.V351744.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. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bliss Residential Care Address 23 Cobham Road Westcliff On Sea Essex SS0 8EG 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) 01702 351267 01702 333512 fatihtekin_vet@hotmail.com Mr Fatih Tekin Mr Erbil Gulhan Manager post vacant Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2007 Brief Description of the Service: Bliss Care home is situated in a residential area near to the seafront. The home provides care and accommodation for fourteen residents. Accommodation is over three floors with access provided by a shaft lift. The home has a communal lounge with a separate dining area. There is a small hard standing garden. Residents use their own bedrooms for privacy. There is limited parking to the front of the property, but there is parking close by in the roads. A mainline railway station, local shops and bus routes are close by. The home has a statement of purpose and a service users guide available and the current fees are £344.40 for a shared bedroom and £425.00 to £465.00 for a single room. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the annual inspection programme for this home. The registered manager was available on the fieldwork day of the inspection. The inspection focused upon all of the key standards. A full tour of the premises was undertaken, records were reviewed and staff spoken too. Evidence was also taken from the Annual Quality Assurance Assessment completed by the management of the home and submitted to the CSCI. 2 residents, 2 relatives and 3 staff were spoken to during the inspection. Relatives completed feedback sheets and these comments were taken into account when writing the report. Due to the dependency levels of the residents completion of feedback surveys was not possible and whilst it was possible to speak to some residents, feedback was limited. Comments were also received from healthcare professionals who work with and visit the home. Whilst it is noted by the CSCI that care standards and standards in general have improved at the home since the new proprietor/manager took over, there remains a significant amount of work to do and progression from the last inspection is somewhat limited. It is of concern that the management of the home have yet to put in place key systems that would help to ensure that outcomes for residents improve. These are outlined below. The manager needs to have a proactive approach to management and not be reliant on the CSCI inspecting the home and highlighting shortfalls. This was discussed with the manager, who it is acknowledged, is keen to provide a good service. The CSCI expects a significant improvement at the next inspection of this home or consideration would be given to enforcement action. What the service does well: The staff team at the home is stable and there is no agency use. The manager is committed to providing a well-trained staff team and the level of training provided is generally good. Residents get on well with the staff team and relatives are happy with the standards of care and services provided. Medication management at the home is good. The provider continues to steadily upgrade the premises, improving bedrooms and communal areas. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process needs to develop further so that residents can be assured that their needs can be met in full by the home. EVIDENCE: The manager has a pre- admission assessment system in place. The manager of the home or his deputy undertakes these assessments. The assessment documentation is basic and needs to be developed so that all relevant areas of need are assessed. As the home is primarily for people with dementia the assessment should also be developed further to encompass this aspect of care and be more person centred focusing on strengths and abilities as well as need. The assessment also needs to confirm as to whether the assessor feels that the home can meet the needs of the individual resident. This was discussed with the manager. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 9 Assessments seen had been completed in full but as they were basic, the information was limited. In addition to this the home does access referral information from social services and hospital referral forms for step down residents. Residents were seen to have contracts in place that had been signed by relatives or representatives. The manager states that he is currently working on updating the service user guide and statement of purpose. The service users guide was seen in residents’ rooms. On inspection, work is still needed on the format of this document and this was discussed with the manager, as he needs to target the resident group in the home. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the basic standard of care at the home is acceptable, care management needs to develop further and be person centred in order to improve outcomes for residents. EVIDENCE: The manager has a care planning system in place and three care plans and associated records were inspected. The care planning system was seen to be very basic and contained limited information about the individual. The information noted in the actual care plans was appropriate but not in sufficient detail for a residents care needs to be met in full, in a person centred way. It was also noted that significant information from the assessment process had not been transferred to the care plan and was therefore lost as staff, on discussion, were not aware. There was very limited information on the individual and on the whole care plans did not contain residents’ personal preferences or reflect their lifestyles. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 11 Night care plans were seen to be more person centred giving information on night time routines, personal preferences and choices. Basic care plans were in place for all standard care needs, such as washing and dressing, communication etc. It was noted that additional care plans outside of the standard format were not seen and from records, such as daily notes, there are care needs that staff are dealing with that have no care plan in place. This relates to issues such as pain control. There was no evidence in the care plans that residents or their relatives had been involved in the care planning process and this is a concern as the residents primarily have dementia and cannot always communicate fully with the staff. There are no personal histories which would help staff identify with the individual and no person centred planning that identifies the strengths and abilities that the resident may have. Care plans were not always dated. Reviews were generally noted to be up to date but there was evidence that care plans had not always been reviewed in a meaningful way, as further care plans had not been added when required or changes made in line with occurrences and developments in the daily notes. Some reviews were seen to be better than others. Daily notes were variable in quality with some being quite informative regarding the residents and the care provided and others giving very limited information. From observation, records and discussion with staff it is clear that the residents are receiving a basic standard of care with staff being very task rather than resident orientated and gaps in the care provision are evident. The care provided tends to be reactive rather than proactive. Residents are also admitted to the home for ‘step down’ placements from local NHS services. The care plans for these residents need to be developed so that the care provided is orientated towards the resident going home. The care plans did not contain any information relating to this by the promotion of independence, promotion of self worth and confidence etc. The manager states, in his annual quality assurance assessment, that ‘we promote residents freedom and self care at the home and small tasks with supervision help this develop’. There is little evidence of this approach in the home. From records and discussion with staff, there is evidence that residents are seeing their doctors in a timely manner. Supplying surgeries did comment that the staff do need to pick up items such as blood taking request forms in a more timely manner and return specimens promptly as well. Residents also have access to opticians and districts nurses. The district nursing team commented that they felt referrals were timely and that staff did act upon any instructions given. Evidence of a regular chiropody service was a little inconsistent at times and the manager was unsure of the current arrangement and said that he would Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 12 review this. Records showed that the weighing of residents was inconsistent at times and this needs addressing. The care plans have a range of risk assessments in place. Again the information on some of these assessments was limited with insufficient detail on what the risk actually is and if there is a risk, how it would be managed. Identified risks also do not link into the care planning system. Residents noted to be at a high risk of pressure sores did not have any action noted as to subsequent district nurse involvement and no pressure relieving devices were noted to be in place for these people. It may be of value to review the use of the assessment tool and review these and ensure that referrals are made where needed to ensure a proactive approach. The district nursing service commented that they have not had any referrals for pressure relieving equipment. Manual handling and nutritional risk assessments were seen to have been completed well but again, risks noted, especially in relation to nutrition, need to be detailed in a care plan. From the care plans, discussion with staff and the manager, there is a limited understanding by the team at the home of the diverse needs of residents and the individual nature of residents care provision. Interaction between staff and residents was seen to be generally friendly and respectful but a member of staff was noted to feeding people when standing over them and staff spoken to about residents could give very limited information about them as an individual. On discussion with staff there is evidence that the would respect a residents wishes but there is limited evidence within the care records that consultation and assessment has taken place to ascertain residents views and wishes. Since the last inspection the manager has change the medication system over to a monitored dosage system The system was inspected and the recording/MAR sheets were seen to be neat and clear. It was noted that the medications had not been checked in for this month but on review of past records it had been done. The manager stated that this was an oversight on his behalf. The manager reported that he has had some issues with the supplying pharmacy, which has resulted in residents’ medication running out early or missing. The mangers diary evidences his efforts to address this and a date is also booked for the supplying pharmacy to come to the home to discuss matters further. The manager feels that the service from the pharmacy is steadily improving. At the current time the manager is not holding any controlled medications but does have the facilities to do this should the need arise. The attending doctors surgery commented that the team needs to ensure that they pick up prescriptions in a timely manner and ensure that they do request all the items needed. The district nursing team stated that they did not have any concerns regarding medication provision at the home. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 13 Records show that the nearly all the staff have up to date training in the safe handling of medication apart from the manager. He should consider attending this training. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of resident led social care at the home combined with a limited meals service does not provide good outcomes for residents. EVIDENCE: The current care planning system gives limited information on residents’ preferences regarding daily routines and care provision. Information contained in the night care plans is generally good. The lack of a person centred approach overall gives only limited information and does not help the home to evidence that residents social care needs are being assessed and met. Some residents do have some preferences on hobbies listed but the records do not show that these interests/ needs are being met. The social side of care in this home needs work. The manager states in his annual quality assurance assessment that ‘Person centred activities are implemented to existing daily activities and more choices available for residents. Residents share roles and small duties at home which make them useful and involved’. It is disappointing to note there is limited evidence of this actually happening. The Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 15 manager goes on to say that they could improve ‘person centred activity programmes and offer more alternatives to our residents’. Relatives who commented said that they occasional saw bingo going on but rarely saw other activities taking place. Since the last inspection the manager has purchased a minibus with a tailgate, which is positive. Records do show that since they have had the bus only two groups of residents have been out for a drive down to the seafront, a few minutes away. This asset could be better utilised as no other outings have taken place. Activity records are available but they do not relate to residents assessed needs. The majority of activities are group led and there is not enough balance with individual activities. The home does not employ and activities cocoordinator at the current time relies upon care staff to undertake this role. This is not unacceptable in a home of this size but the care staff may require some guidance/training and time away from cooking and other duties, such as laundry. The manager in his annual quality assurance assessment states that further training for staff on activity programmes would be helpful to meet the needs of people with dementia’. Activities recorded are generally basic and do not evidence that there is a constructive approach with goals to met specific needs. Activities include bingo, hairdressing, music played, hand massages, manicures, sing a longs and piano playing. It was good to see that residents had taken part in painting canvasses for the home and many of these are displayed on the walls. This type of activity should be encouraged. Whilst there are some activities going on there is limited evidence to show that they are meeting the needs of residents, especially those residents with dementia. At the current time the home does not have a dedicated cook. The care staff undertake all the cooking duties for fourteen residents. Whilst the manager has menus in place these are not followed as care staff just choose meals at random to cook off the menu on a day-to-day basis and this relates to what is available in the home. There is therefore a limited overview on the food provided and it does not allow for an approach, which would help to ensure that residents have a balanced diet. The home could do with a dedicated cook who is keen on providing balanced meals for elderly people and home baking and cooking. A nutrition record is maintained which gives a good record of how much residents have eaten but also evidences that no real choice is offered apart from at breakfast and occasionally evenings. Residents care plans give very limited information on their personal preferences in relation to food and mealtimes. On discussion with staff they were unsure what could be offered as an alternative for lunch should a resident express a preference. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 16 Lunch consisted of shredded chicken casserole, boiled potatoes and frozen mixed vegetables. Banana whip was provided for desert. Residents who could not manage the shredded chicken were seen to have their meals liquidised all together, which does not allow residents to taste individual foods and experience different soft textures. These shortfalls in the food provision were discussed with the manager, who is quite keen to employ a cook at the home but has experienced difficulty in recruiting. The home does not have a dining room and residents eat off small tables, which did not appear to be an issue for any resident. Again, whilst staff were interacting well with residents during the mealtime, staff were standing up leaning over to feed residents which can be intimidating and rushed. Resident did not have access to condiments but plenty of drinks were observed to be available throughout the day. Relatives who commented said that it was good that the team at the home laid on birthday teas when required. Food stocks were seen and it was noted that a significant amount of processed food is in use. This should be reviewed because of the high salt, fat and sugar contents of some of these items. More home cooking would improve the residents diet and improve outcomes. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to deal with concerns and complaints and adult protection in an open manner and to help ensure positive outcomes. EVIDENCE: The manager has a complaints procedure in place. It must have the full contact details of the CSCI listed. This procedure does need to be displayed so that residents and visitors to the home can see this document. Consideration also needs to be given to the format in order for the resident group at the home to have every opportunity to understand it. Since the last inspection there have been three complaints, which have been responded to appropriately and within timescales. It is recommended that the manager improve his logging system in order to provide an audit trail of the investigation and action taken. The home has received compliments from relatives and comments positively regarding staff dealing with relatives, on good standards of care provision and recent improvements to the home. At the current time the manager does not have any information available on advocacy services and it is recommended that this be put in place for residents and relatives. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 18 The manager has good clear adult protection policy in place, which is easily available for staff. On discussion the manager shows an appreciation of the subject. Training records show that nearly all the staff, except the manager have attended this training. The manager needs to attend this training so he is aware of current thinking and can guide staff if need be. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home quite well decorated and clean. A proactive approach is needed to maintaining standards and addressing premises issues in the home. EVIDENCE: A full tour of the home was undertaken with the manager. Since the last inspection the proprietors have continued to upgrade the premises and have plans in place to carry out further work. As well as decorating work, new furniture and furnishings have been purchased. Work continues and there are still areas for improvement. The manager does have new carpets for the hallway on order. On touring the home it was a concern to note several issues which, if the manager regularly reviewed the premises, he should have noted and Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 20 addressed. The manager needs to have a proactive approach to the upkeep of the home and its contents to ensure that issues are addressed rather than the inspection process highlighting them. For example, two upstairs rooms did not have any hot water, some sinks do not have thermostatic controls and there is a risk of scalding, the quality of some of the pillows and bed linen was poor and items were being stored on the outside fire escape. It was also noted that, despite being highlighted as a risk at the last inspection and the manager stating that ‘the fridge did need replacing, but was working’ in his annual quality assurance statement, the fridge was still not working and the thermometer showed it way above temperature and items contained in it were warm. This approach to the management of the home was discussed with the manager. Whilst it is noted that the manager attended to these shortfalls on the day of the inspection, these items should have been attended to previously. Overall the home was noted to be clean with an odour noted in one room that was due for redecoration and re-carpeting. Toiletries were noted in the bathrooms that did not belong to specific residents and this must be addressed from an infection control and dignity aspect. Records show that just over half of the staff have attended infection control training so they should be aware of these issues. Bliss has a homely feel and the overall décor is satisfactory. The home has a small deck to the rear but this is primarily used for laundry as the laundry lead off from this area. The manager states that he has plans to refurbish the laundry. Apart from the fire escape fire safety arrangements were in order with all equipment being tested and maintained, a risk assessment in place and fire drills have taken place, although these should be more regular. Records show that six of the ten care staff have received fire training, the others have not and this needs to be addressed. The manager has also not attended fore safety training. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the staff team is stable, shortfalls in relation to recruitment and staffing levels can potentially affect outcomes for residents. EVIDENCE: Since the last inspection the staff team has settled down and become quite stable and there is no agency use. The manager states that he is now providing 3 staff on an early shift and late shift and two staff at night, one awake and one asleep. On examination of recent rotas in the home it clear that the manager has increased the late shift to three staff, although on occasions one member of staff does go off an hour or two early. From the rota supplied, it is evident that staff undertaking a late shift stay on and do a sleep in night shift and may be down to work an early the next morning. This can be unacceptable if the staff member in question has had to work during the night. It was also noted that staff are doing two long, all day shifts in a row with a sleep in night in between, which also has the potential to be unsuitable. The manager must review this practice and ensure that he is providing staff that are competent to undertake their duties at all times. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 22 Relatives who commented said that the staff team were very good and caring. They said that they were approachable but felt that when there were only two staff on during the day this was insufficient. The manager states in his annual quality assurance assessment that 3 out 10 care staff have an NVQ level 2 or above. He states that he continues to encourage this training. The manager also states that he is going to undertake NVQ Level four this year. Staff recruitment procedures were reviewed and staff files checked at random. These were found to be disorganised and key documents were not in place. One file checked had only one reference, no photo and no POVA check or CRB on file despite the fact that the carer in question was working full time in the home on an unsupervised basis. The manager stated that they had sent off for the CRB but mistakes on the application meant that it had been returned to them and had to be sent off again. A second file had no references and although the staff member had a CRB in place this was dated one month after they had commenced work at the home. These significant shortfalls were discussed with the manager and the risks to residents pointed out. It was noted that both the files checked showed that application forms had been completed and both staff had received an induction. The current induction provided is a basic induction linked to the home and not the Skills for Care induction. This was discussed with the manager who stated that he did have some information on this scheme but had yet to progress this in the home. On discussion, the manager was not aware of the Code of Professional Conduct and did not have copies in the home to give to staff. The manager was advised about this document. The manager submitted training records to the CSCI for the staff team and is very aware of the need to provide a trained staff team and this is reflected throughout his annual quality assurance assessment. The records show that there is an ongoing training programme and this was confirmed by care staff. There are good levels of compliance with first aid and manual handling. Most of the staff have attended food hygiene training and health and safety and those who have are not are booked on a course. There are some gaps in relation to fire safety training, which need to be addressed. The home primarily cares for people with dementia and four staff out of the ten have attended a course of the subject. Four further care staff are booked to attend another course on the care of people with dementia. The manager needs to ensure that the staff have the appropriate skills, following this training and those skills are utilised in planning the care for the residents in Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 23 the home. It may be of value for the manager to arrange training on person centred care planning. Training records show that the manager has not attended any training and this needs to be addressed so that he can guide the staff and ensure the training is of value. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the manager is keen to provide a good service, management systems are not fully in place in the home to enable this to happen. This is currently affecting outcomes for residents, which could be better in many areas. EVIDENCE: Since the new proprietors/manager have taken over standards in the home have improved. Relatives and the district nursing services concur with this. This is also acknowledged by the CSCI. During this inspection however it is clear that the manager, who is yet to be registered with us, has a significant amount of work to do in order to bring the home to the required standards. Shortfalls in relation to care management and provision, the meals service, Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 25 staffing and recruitment and the premises etc give cause for concern. The manager needs to equip himself with the skills and management tools to manage this home in an effective way so that outcomes for residents improve. The manager is holding staff meetings but could only supply evidence of one meeting in September. A wide range of topics were discussed but it is of concern that the staff team are having to discuss how to wash residents and how to wash residents faces when this basic information/guidance should be covered at the time of induction. The manager has basic quality assurance system in place that consists of relatives’ satisfaction questionnaires. This needs to be developed. Quality assurance was discussed in detail with the manager and the need to develop systems in order to address shortfalls was also discussed. The questionnaire that has been developed for relatives was satisfactory. The manager is also trying to hold regular relatives meetings to promote good communication and ensure that people are happy with services provide at the home. Minutes of the last meeting were available for inspection. From the minutes and from comments received to the CSCI, relatives are happy with the standards of care provided at the home. The manager states in his annual quality assurance assessment that ‘ they need to improve the internal auditing systems at the home’. The manager does hold personal monies on behalf of residents and these were checked at random and found to be in good order. It is recommended that the manager updates the recording system and undertakes a regular audit with two people checking. The manager has a health and safety policy in place and staff have been attending training on this subject. The manager has yet to develop environmental risk assessments and safe working practice risk assessments. These were discussed. Care records inspected show that whilst staff note accidents in individual residents care notes they are not recorded, as required, in a formal accident book. This was discussed with the manager, as this also does not allow for a review of accident patterns etc or fulfil the legal requirement. Certificates for the maintenance and safety of equipment and fittings in the home were inspected at random and found to be in good order. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 26 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 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 1 X 1 X 3 X X 2 Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Timescale for action The assessment procedure needs 31/12/07 to be developed so that it covers all the required areas to be assessed, be more person centred and relates to the specialist category of the home. 31/12/07 Residents must have care plans in place that record in sufficient detail the needs of the residents and how those needs will be met. All identified needs must have a care plan. Consultation with residents or their representative over care plans must also take place. This is a repeat requirement in parts. Where risks are identified on risk assessments, it must be clear what action is being taken, if any to address that risk. This especially applies to the risk of pressure sores and nutrition. Residents must also be weighed regularly. Residents’ diverse needs and individuality need to be DS0000067960.V351744.R01.S.doc Requirement 2. OP7 Reg 12 and 15 3. OP8 Reg 13 30/11/07 4. OP10 Reg 12. 30/11/07 Bliss Residential Care Version 5.2 Page 28 5. OP12 OP13 Reg 12 and 23 appreciated more by the team at the home in a person centred way and care must be provided in a respectful way – with reference to feeding. The registered providers must ensure that suitable arrangements are made for all residents to receive a varied programme of `in house` and community based activities that meet their individual and group needs. That consultation with residents or their representative over choice of activities is evidenced 31/12/07 6. OP15 16 7. OP19 23 6. OP27 Reg 18 This is a repeat requirement. The meals service at the home 30/11/07 needs to improve so that residents can benefit from a varied and nutritious diet, which is of a good quality. All parts of the home must be 31/12/07 keep in a good state of repair – this relates to hot water provision and bed linen and the replacement of faulty equipment. The registered providers must 30/11/07 ensure that there are suitable staff ratios for all residents to receive personal care and activities and the staff must be competent to undertake their duties. This is a repeat requirement in parts. A robust recruitment system 30/11/07 must be in place to ensure that residents are protected. Training needs to be provided to 30/11/07 all staff in relation to fore safety to ensure that residents and staff are as safe as possible. The manager needs to put in his 31/12/07 application to be registered with the CSCI and ensure that he has DS0000067960.V351744.R01.S.doc Version 5.2 Page 29 7. 8. OP29 OP30 19 18 9. OP31 9 Bliss Residential Care 10. OP33 24 11. OP38 Reg 16 the right skills and experience to manage the home effectively. Quality assurance systems need to be developed in the home in order to improve consultation with residents and interested parties and to ensure that the home improves and develops positively. The registered providers must ensure that Hot water complies with the health and safety legislation and requirements regarding hot water being no more than 43 degrees. This is a repeat requirement. Any accident must be recorded in a formal accident book as this is a legal record required under health and safety legislation. 31/12/07 31/12/07 12 OP38 13 30/11/07 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 OP1 Good Practice Recommendations The registered providers must ensure that a new Statement of purpose and service user guide reflects the changes in accommodation, staff ratios and change of name of the premises and is in an appropriate format for the resident group. Through care planning and resident consultation, the team must ensure that as far as possible residents exercise choice and control over their lives. The CSCI contact details need to be put on the complaints procedure. Toiletry items should be specific to each resident and not stored in communal bathrooms, as this can be an infection control risk. NVQ qualifications should be continued to be encourage with staff so that a competent care team can be DS0000067960.V351744.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. OP14 OP16 OP24 OP28 Bliss Residential Care 6. OP35 developed. Consideration should be given to updating the recording systems for residents monies and undertaking a regaulr audit. Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Bliss Residential Care DS0000067960.V351744.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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