Inspection on 01/08/06 for Bloomsbury House

This inspection was carried out on 1st August 2006.

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

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

Other inspections for this house

Bloomsbury House 18/11/08

Bloomsbury House 08/08/07

Bloomsbury House 28/11/05

Bloomsbury House 06/05/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bloomsbury House Anchorage Road Sutton Coldfield West Midlands B74 2JP Lead Inspector Amanda Lyndon Key Unannounced Inspection 1st August 2006 09:50 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 Bloomsbury House DS0000063254.V306055.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. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bloomsbury House Address Anchorage Road Sutton Coldfield West Midlands B74 2JP 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) 0121 355 3255 0121 308 8091 Senex Ltd Ms Vanessa Hammond Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 28 November 2005 Brief Description of the Service: Bloomsbury House is a large three storey Victorian house, providing residential care for 15 people for reasons of old age only. The Home is situated in Sutton Coldfield, close to the town centre, transport links and local amenities. Decoration, furniture and fittings are of a high standard in the Home. There is off road car parking to the front and rear of the Home. There is a pleasant garden in which residents can relax. Access to the Home has been made easier with the provision of a ramped access to the side of the house. All bedrooms are single, and are fitted with an en-suite toilet and hand washbasin. The Home has a passenger lift. Communal space is provided in a large lounge to the front of the Home, and a dining room. There is a no smoking policy at the Home. Aids and adaptations are available to assist residents with physical disabilities and handrails are provided throughout the Home. There are two assisted bathing facilities and a shower, however there is a small step up in to the shower tray. Staff are available to provide assistance in any of the Homes’ assisted bathing facilities. There is a notice board displaying information of interest to residents and visitors in the reception area of the Home and details of any forthcoming events are on display in the dining room. As of 1st August 2006 the weekly fee to live at Bloomsbury House is between £395 and £420 and this includes a “top up” for residents funded by social services. Additional charges include hairdressing, dry cleaning, private chiropody and newspapers. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced fieldwork visit undertaken by two Inspectors when there were thirteen residents living at the Home. The Registered Provider assisted the Inspectors during the inspection. Information was gathered by speaking with residents and staff, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. Prior to the fieldwork visit the Manager had completed a pre inspection questionnaire and returned it to CSCI, and this gave some information about the Home, staff and residents which was taken into consideration. An action plan was promptly received in response to the immediate requirements made at the time of the visit and these issues were addressed in a timely manner. What the service does well: Residents are well supported by the staff to meet their health, welfare and personal care needs. Medical advice is sought promptly as required to ensure that the health of residents is safeguarded. Residents are generally cared for in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. Opportunities for religious worship are available. Residents are supported by the staff to maintain contacts with their friends and family and visitors are made to feel welcome at the Home and this ensures that residents feel comfortable within their home environment. One resident said “It is very relaxed here, my family visit and bring their dog”. Residents are able to exercise choice over their daily lives and this promotes their independence and individuality. One resident said “ I go to bed at whatever time suits me”. Residents are provided with an attractive, homely and clean environment. Residents personalise their bedrooms to reflect their individual tastes and interests to ensure that they feel comfortable in their surroundings. One resident said “I love Bloomsbury House”. Another resident said “ I feel comfortable in my room, having my own toilet is very useful”. One resident said “ I am very happy with the cleanliness here” The Home does not use agency staff and this ensures continuity of care. One resident said “The staff are very nice and friendly here”. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Written documentation about the support required by staff to meet the needs of residents with mental health needs was poor and this may prevent them from receiving the specific care that they require. One resident had dirty fingernails and this does not uphold the dignity or health of residents. The management of medication was poor at times and this does not safeguard residents. There were limited activities on offer at the Home and there were no opportunities for residents to go out side of the Home unless with their families. Residents must be consulted about the development of an activities programme to ensure that they are socially and mentally stimulated. Residents and staff said that time was not allocated in which to escort residents on trips outside of the Home. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 7 One resident said “There doesn’t appear to be enough staff on duty as some of the residents here require a lot of one to one care”. The menus were repetitive and did not identify all of the food available at the Home and this may prevent residents from having a wholesome diet. One resident said “The food is uninspiring here”. Prospective staff recruitment checks were poor at times and this does not safeguard residents. Other than the satisfaction questionnaires distributed twice yearly, there are limited opportunities for residents to put forward their views about the service provided at Bloomsbury House as house meetings are not held regularly. Residents who had chosen for the Home to hold their personal allowances for safe keeping are not always able to access this money in the absence of the Registered Manager. 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. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 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 Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 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): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures are robust and this ensures that prospective residents can make informed decisions about whether they would like to live at the Home and ensures that they know before admission that their care needs could be met whilst living there. Care reviews provide residents with the opportunity to put forward their views about the care that they are receiving whilst living at the Home and ensure that their changing individual care needs could be met. EVIDENCE: A statement of purpose had been produced and this required further development to include all information as identified by regulations in order to provide prospective residents and their families with adequate information about the services provided at Bloomsbury House. A comprehensive service user guide was available and this included some of the views of the residents living at the Home in order to give prospective Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 10 residents an insight in to what it would be like to live at Bloomsbury House. Minor adjustments to this are required in order to include all required information. The statement of purpose and service user guides were available in a large print format for people with poor eyesight. Each resident is issued with a comprehensive contract identifying the terms and conditions of their stay including the services provided that were included and excluded from the weekly charge and the room number to be occupied. Contracts were signed by either the resident or their representatives in order to confirm that they agreed with the content of these. Contracts issued by Social Care and Health were available. Prospective residents are encouraged to visit the Home and have a meal in order to sample what life would be like if they came to live there thus be able to make an informed decision about whether they would like to live at Bloomsbury House. Comprehensive pre admission assessments are undertaken during this time and this ensures that residents know before admission that their care needs could be met living there. Residents come to live at the Home on a twenty-eight day trial period in order to decide whether they would like to live at Bloomsbury House on a permanent basis. Following the trial period a care review is undertaken to ensure that residents’ individual care needs were being met at the Home. Intermediate care is not provided at Bloomsbury House. Respite care can be arranged if there is a vacant bedroom available. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are generally good. However written documentation in respect of the support required by staff to meet the mental health needs of some residents is poor and this may prevent them from receiving the specific care that they require. Medication is administered in a generally safe manner, however some poor practices in respect of this may put residents at risk. Staff generally care for residents in a respectful manner and this ensures that their dignity and self-esteem are maintained. EVIDENCE: Since the last fieldwork visit improvements had been made in respect of the care planning system. The care plans were organised and easy to read. On admission to the Home comprehensive assessments of residents’ individual care needs were undertaken and these identified the preferred routines, likes/dislikes of residents and identified any physical disabilities and health needs that they may have had. Care plans were derived from this information Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 12 and these identified the support required from staff to meet the physical health needs of residents whilst respecting their preferred routines. Care plans had been written in respect of the interests and hobbies of individual residents and a number of care plans include detailed life histories of residents which provided the staff with information of interest to discuss with the residents and was beneficial when planning care. Care plans were written and reviewed with the involvement of the resident and their representatives and this ensures that the residents’ preferred daily routines are maintained. Daily reports included good detail of the activities that residents had engaged in during the day, any visits from external professionals and any support given by staff. However it is recommended that alternative paperwork be sought on which to record this information in order to formalise these. Comprehensive moving and handling risk assessments were undertaken and other personal risk assessments were undertaken including the risk of falls and the risk of residents developing sore skin. There was evidence that preventative action was taken in respect of any risks identified in order to safeguard residents. Nutritional risk assessments were undertaken to ensure that residents were well nourished and residents were weighed regularly to ensure that they maintained a healthy weight. Formal care reviews were undertaken involving residents, their family, the Home’s staff and Health and Social Care Professionals to ensure that all of the resident’s individual care needs were being met whilst living at Bloomsbury House. Copies of care plans and care reviews written by the residents’ Social Workers were available for reference. One resident said “I love Bloomsbury House”. Residents are able to retain their own General Practitioner on admission to the Home(if the GP is in agreement). Residents have access to a range of Health and Social Care Professionals who visit the Home including district nurses, community psychiatric nurses, social workers and chiropodists and a good rapport has been built up between these and the Home’s staff. There was evidence that medical advice is sought promptly following accidents involving residents or episodes of ill health and this safeguards residents. It was pleasing that comprehensive guidance of the action to be taken by staff in the event of a resident with diabetes becoming unwell was available for reference. However, on one occasion there was no written evidence available that the staff had followed a Doctor’s instructions regarding the collection of a urine sample from a resident who was unwell and the staff on duty were not aware of whether this had been undertaken as requested. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 13 Designated staff are being trained to undertake blood sugar recordings of diabetic residents in order to safeguard the health of these residents. Staff escort residents on hospital visits if they do not have friends or family to accompany them and this provides security and companionship for residents. Despite Bloomsbury House not having a category of registration for residents with mental health needs, on the day of the field work visit a number of residents had such additional needs and required significant specific support in these areas. It appeared that one resident was unsettled and this may have a negative impact on both the well being of themselves and other residents living at the Home. During the morning of the visit, one resident had chosen to wear a hat and coat and was continuously asking where her family member was, whilst walking back and forth to the window. This is despite the fact that her visitor routinely did not visit until the evening. However the Registered Provider stated that this was not the case and that the resident was now more settled than previously. Regular care reviews were undertaken and input from community psychiatric nurses was received. However written plans of the specific strategies required by staff to provide support to residents with mental health needs were not available and as a result of this some residents continued to be unsettled and other residents had become distressed. One resident said “There doesn’t appear to be enough staff on duty as some of the residents here require a lot of one to one care”. Staff met during the inspection agreed with this. Systems in place for the management of medication were generally good and all staff responsible for this had undertaken accredited training. However some poor practices were identified. Prescriptions were not being checked by the Home’s staff prior to the medication being dispensed and photocopies of the prescriptions were not kept in order to ensure that the correct medication and quantities of such were being dispensed. Staff had not signed and countersigned all hand written entries on to the medication administration charts and this may result in a medication administration error and the actual dose of medication administered regarding variable doses was not always recorded which prevents accurate audit trailing and monitoring of the effectiveness of the prescribed treatment. Prescription items requiring refrigeration were stored separately however the container being used for this did not have a lockable facility and vulnerable residents may be at risk if they access this. Immediate remedial action was taken by the Registered Provider in order to safeguard residents. Staff were generally caring for residents in a respectful manner and most were greeting residents by their preferred names and this ensures that their Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 14 confidence and individuality are maintained. Each resident is consulted about whether they would like to have a key to lock their bedroom door. A number of residents had chosen to have a private telephone line in their bedrooms. One resident appeared to have dirty fingernails and this does not promote the dignity or health of the resident and this was brought to the attention of the Registered Provider. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities and leisure opportunities do not meet the needs and expectations of all residents living at the Home. Residents are able to exercise some choice over their daily lives. However further consultation with residents in respect of their individual preferences must be undertaken in order to respect their individuality and maintain their independence. Special diets are provided for reasons of health or culture. However the menus were repetitive and did not identify all of the choices on offer and this may prevent residents from receiving a wholesome diet of their choice . EVIDENCE: Records available identified that a limited range of activities were on offer including bingo, colouring and painting, sing a longs and exercises and hairdressing. The Inspectors were advised by the Registered Provider that a written record of other activities provided was not available. There were limited opportunities for residents to go out side of the Home unless with their families as staff stated that the staffing levels did not allow for this and external entertainers do not visit the Home. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 16 A number of relatives and staff stated that most of the residents living at the Home were not interested in activities, however an activities programme must be devised in consultation with the residents in order for residents to decide what activities they would be interested in. It is recommended that time be allocated for activities, and ideas for activities, especially for residents with mental health needs be sought. Holy Communion is available every fortnight and there are opportunities for residents to visit the local Church of England if they choose to do so. The Registered Provider is aware of how to provide opportunities for worship for people of other faiths, however this is not required at the current time. Residents are encouraged to attend clubs and day centres if they choose to do so. There is a flexible visiting policy and friends and relatives are welcome to have a meal at the Home for a small charge. One resident said “It is very relaxed here, my family visit and bring their dog”. There are no rigid rules or routines and residents are generally able to exercise their control over their daily lives. Residents are supported to choose clothing appropriate for the time of year, their culture and gender and a number of female residents had chosen to wear jewellery. Resident can choose what time they go to bed at night, however are not always assisted out of bed at their preferred time in the mornings. One resident said “ I go to bed at whatever time suits me”. Another resident said “ The staff get me up early but it doesn’t make much difference to me, they give me a cup of tea”. Residents must be consulted about the time that they would like to be assisted out of bed in the morning and the staff must respect these preferences. A number of residents choose to stay in their bedrooms instead of using the communal lounge for reasons of privacy, independence and to be in a quieter environment. Most residents choose to be served their meals in the dining room. However, they have the option of having their meals in their bedrooms if they prefer. The meal options for lunch on the day of the fieldwork visit were either faggots or steak and kidney pie with potatoes and frozen vegetables. There was chocolate gateau for pudding and fresh fruit was available in fruit bowls in the dining room. The service user guide stated that only fresh produce was used in meal preparation and this must be amended to reflect the meals served. The menus did not identify that a choice of meals was always available and the meals on offer were repetitive at times at both lunch and tea times. The menus Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 17 did not identify that cooked breakfasts were available, however these can be served by request and did not identify that a suppertime snack meal is available. There was no evidence that the menus were devised in consultation with the residents however staff said that residents could request whatever meals they choose. Special diets are available for reasons of health or cultural preferences. The main meals of the day were well presented however the portions of the soft diet were mashed together in a bowl before being served to residents and this was not visually appetising and did not enable residents to decide which of the components of the meal they would like to eat. Being served their meal in this manner does not uphold the dignity of residents. The dining room was quiet during the lunchtime meal and there were limited social interactions between residents. Staff were generally assisting residents with their meals in a respectful and sensitive manner. One resident said “The food is uninspiring here”. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure on display is comprehensive and accessible to residents and their visitors should they need to make a complaint. Staff knowledge in respect of adult protection procedures is good and this safeguards residents. EVIDENCE: Since the last inspection CSCI have not received any concerns, complaints or allegations about the service provided at Bloomsbury House and there had been none made directly to the Home. A comprehensive complaints procedure was on display in the reception area of the Home. One resident said “I would talk to the senior carer if I had any complaints, but I have lived here for a long time and I have had no need to”. The complaints procedure identified within the statement of purpose, service user guide and residents’ contract did not state that the complainant could refer to CSCI at any stage in the complaint process and this may prevent the appropriate people from being notified. Staff, with the exception of new staff had undertaken training in respect of the protection of vulnerable adults and the adult protection procedure included local Multi Agency Guidelines. Bloomsbury House DS0000063254.V306055.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, comfortable and well-maintained environment. Some aids and adaptations are provided to meet the needs of residents with physical disabilities. Residents’ bedrooms contain personal items in order for residents to feel comfortable in their surroundings. EVIDENCE: The internal environment of Bloomsbury House was well maintained, homely and decoration, furniture and fittings were of a good standard. The carpets in a number of areas of the Home were in need of cleaning and the appropriate equipment in order to do this was available. The garden at the back of the Home was well maintained and attractive. There was an attractively decorated dining room at the front of the Home that was homely in appearance and table linen was of a good standard. The lounge was nicely decorated and residents stated that they were comfortable in there. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 20 Suitable aids and adaptations were provided at the Home, handrails were fitted in corridors and near to toilets and raised toilet seats were provided, in order to meet the needs of residents with physical disabilities. The Home were not able to accommodate residents who were unable to stand unaided as hoisting equipment was not provided and this was not identified within the statement of purpose. If a resident is unable to stand following a fall, assistance is sought from emergency ambulance staff. There are two assisted bathing facilities and a shower room that was appropriate to meet the needs of residents living at the Home. Residents are required to negotiate a small step up in to the shower and this may not be suitable for all residents living at the home, this is reflected in the statement of purpose and the service user guide. Full assistance is provided by care staff depending on the assessed needs of the resident. Residents’ bedrooms varied in size, were nicely decorated and contained personal items that reflected their individual tastes and interests in order for them to feel comfortable in their surroundings. A lockable storage facility was available in bedrooms. One resident said “ I feel comfortable in my room, having my own toilet is very useful”. The temperature within the Home was comfortable and suitable radiator guards had been fitted to all radiators in order to safeguard residents. The Home was found to be clean and fresh and hygienic hand washing facilities were suitably located. A cleaning schedule was in place to ensure that the Home was kept hygienically clean. One resident said “ I am very happy with the cleanliness here” A hygienic and effective system for the laundry of residents’ personal clothing and bed linen was in place. Residents’ personal toiletries and a bar of soap were found in the communal bathroom and if used by another resident may result in cross infection. The Registered Provider disposed of the bar of soap at the time of the inspection. Full clinical waste bags were left on the floor and this poor practice may cause the spread of infection at the Home. Bloomsbury House DS0000063254.V306055.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are supported by an appropriate number of staff at times, but staff allocation must be reviewed to ensure that residents’ individual care needs and social care needs are being met. Staff recruitment procedures were poor at times putting residents at risk. Staff receive training to ensure that they perform within their job roles in a competent manner in order to meet the needs of residents. EVIDENCE: The staffing rotas identified that the Home were working within approved minimum staffing levels, however staff allocation and job routines must be reviewed to allow for supervision of residents with higher dependency needs and to allocate time for activities, including trips out side of the Home. There are currently no staff vacancies at the Home and the staffing team reflect the majority of the culture of residents living there. One resident said “The staff are very nice and friendly here”. Senior staff provide on call support to the person in charge of the shift and this ensures that they can seek advice if required or support in the event of an emergency in order to safeguard residents. Staff files sampled did not include all of the information required by regulations and this does not safeguard residents. On the day of the fieldwork visit, it was evident that two members of staff had commenced employment at the Home Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 22 without satisfactory Protection of Vulnerable Adults checks. Following the field work visit the Registered Provider confirmed in writing that this had not been the case and the result of the checks had been obtained by the Home prior to the staff members commencing employment. No references were available in respect of one member of staff currently working at the Home, this is of grave concern and puts residents at risk. This matter was brought to the attention of the Registered Provider and an immediate requirement was made. Following the fieldwork visit, the registered Manager stated that a verbal reference had been obtained in respect of this person, however this had not been provided in writing. A reference in the personnel file of one staff member was not relating to that person and as a result of this, only one reference had been obtained and this was not from the individual’s last or most recent employer. Interview notes were not kept and there was no evidence that any gaps in employment history had been explored and this may put residents at risk. Pre employment health declarations are now undertaken to ensure that prospective staff members are fit to work at the Home. New staff complete comprehensive “Skills For Care” induction training to ensure that they have the appropriate knowledge to work competently within their job roles. Staff had undertaken training relevant to their job roles including nutrition and falls prevention and plans are in place for staff to undertake training in dementia care. 35 of the staff had the NVQ Level 2 Award in Care and a further nine staff were currently working towards this and this will ensure that staff have the appropriate knowledge to provide a good standard of care. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The system for resident consultation is poor at times and does not provide residents with the opportunity to put forward their views about the service provided at Bloomsbury House. However there were some systems in place to monitor the quality of service on offer to the residents. The system for formal staff supervision was inadequate and this may prevent individual training needs and work performance issues from being identified which may have a negative effect on the care provided for residents. Maintenance checks of equipment used at the home are undertaken and staff are trained in health and safety issues to ensure that residents’ safety and welfare are protected. However residents’ health and safety are at risk until some health and safety issues are addressed. EVIDENCE: Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 24 The Registered Manager had recently completed NVQ Level 4 in Management and Care and has had much experience within her job role. Positive comments were made by staff met during the fieldwork visit about the management style of the senior staff and management team and this promotes a harmonious staff team and enhances staff morale. Minutes of the last residents and staff meetings were not available and staff said that these had not been arranged for a period of time. Service satisfaction questionnaires had been distributed to residents and their families recently in order to obtain their views about the services provided at Bloomsbury House. An annual report of the findings of the resident service satisfaction questionnaires and other internal auditing systems must be produced and be accessible for residents in order to continually improve the standard of service provided. The Home do not manage the personal finances of residents however they have the facility to hold small amounts of money on the residents’ behalf if they choose to use this service. There were currently two residents who chose to use this service however the Registered Provider was unable to access this on the day of the field work visit as she did not have the key for this facility. Staff said that formal staff supervision sessions were not arranged at the Home however there were opportunities to speak with the Registered Manager if they needed to. Formal staff supervision records were not available at the Home. All care staff must receive formal supervision at least six times each year in order to identify their individual training needs and be given the support and guidance to work competently within their job roles. Staff had undertaken training in health and safety issues including fire safety, food hygiene, moving and handling and emergency first aid. A fire drill had been undertaken recently. This ensures that staff have the appropriate knowledge to act competently in the event of an emergency and safeguard residents. Fire risk assessments had been updated and reviewed and health and safety audits are undertaken in order to identify any risks that may be harmful to residents living at the Home. Health and safety checks of equipment used at the Home were undertaken regularly to ensure that they were safe to use. Records of accidents involving residents were available, however the system for the storing of these needed further consideration, there was no evidence that they were audited or monitored by senior staff and they did not identify the action taken following an accident or the overall outcome. However the daily reports identified that the appropriate medical advice is sought promptly following an accident if required. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 25 A bottle of bleach was found in the ground floor communal bathroom and this would be a serious risk to the health of vulnerable residents if accidentally swallowed. Substances harmful to health must be stored securely at all times The door was missing from the cupboard being used to store cleaning products and must be replaced despite the residents not having access to this area of the Home. A risk assessment was not written in respect of a resident who had a near accident when they went outside of the Home on their own and CSCI were not informed of this incident. Bloomsbury House DS0000063254.V306055.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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 3 x 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 2 1 x 2 Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 28 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, 5 Requirement The statement of purpose and service user guide must include all information required by regulations and must reflect the services and facilities provided at Bloomsbury House. Written plans of the specific strategies required by staff to provide support to residents with mental health needs must be available. A comprehensive record of any action taken following a Doctor’s visit must be maintained. Staff must ensure that residents are supported to maintain their personal hygiene to an acceptable standard. The medication process must be fully auditable. • Prescriptions must be checked by the home’s staff prior to the dispensing of the medication • The actual dosage administered in respect of variable doses must be recorded (Previous time scales of 30/06/05 and 31/01/06 not met). All hand written entries on to DS0000063254.V306055.R01.S.doc Timescale for action 01/11/06 2 OP7 15 01/09/06 3 4 OP8 OP8 12(1) 12(1) 01/09/06 01/09/06 5 OP9 13(2) 01/09/06 6 OP9 13(2) 01/09/06 Page 29 Bloomsbury House Version 5.2 7 OP12 16(2)(m)( n) 8 OP14 12(2) 9 OP15 16(2)(i) 10 11 OP15 OP16 12(2)(4)( a) 16(2)(i) 22 medication administration charts must be signed and countersigned. Residents must be consulted and an activities programme must be developed including activities both inside and outside of the Home. Residents must be consulted about the time that they would like to be assisted out of bed in the morning and the staff must respect these preferences. In consultation with the residents, the menus must be revised to include more variety of wholesome meals, identify all choices available and include detail of the food available at breakfast and supper times. The portions of pureed food must be served separately. The complaints procedure identified within the statement of purpose, service user guide and contract must be updated. Carpets throughout the Home must be cleaned. Personal toiletries must be removed from communal bathrooms. 15/10/06 01/09/06 31/10/06 01/09/06 30/09/06 12 13 OP19 OP26 23(2)(d) 13(3) 16(2)(k) 01/09/06 01/09/06 14 OP27 15 16 OP28 OP29 Clinical waste bags must be stored appropriately whilst in use 18(1)(a) Staff allocation and job routines 15/09/06 must be reviewed to allow for supervision of residents with higher dependency needs and to allocate time for activities, including trips out side of the Home. 18(1)(c 50 of care staff must have 01/12/06 )(i) achieved NVQ level 2 in care 19(1)(b)(c Staff members must not 01/08/06 ) commence employment at the Home without two satisfactory authentic written references (one DS0000063254.V306055.R01.S.doc Version 5.2 Page 30 Bloomsbury House being from the last or most recent employer) The Registered Provider received this in the form of an immediate requirement (Previous immediate requirement timescale of 28/11/05 not met) The Registered Manager must ensure that the management approach of the home encourages residents to express their views and wishes and residents meetings and discussions must be documented. (Previous timescales of 30/06/05 and 28/02/06 not met) An annual report of the findings of the resident service satisfaction questionnaires and other internal auditing systems must be produced and be accessible for residents. (Previous timescales of 01/09/05 and 31/03/06 not met) Residents’ personal money held for safekeeping must be accessible to residents at all times All care staff must receive formal supervision at least six times each year The system for the recording and auditing of accidents involving residents must be reviewed. Health and safety risk assessments in respect of the premises, food handling and staffing require an issue and review date. (Timescale of 03/03/05 not met) Substances harmful to health DS0000063254.V306055.R01.S.doc 17 OP32 12(2)(3)( 5)(a)(b) 30/09/06 18 OP33 24 31/12/06 19 OP35 16(2)(l) 01/09/06 20 21 22 OP36 OP38 OP38 18(2) 13(4) 13(4) 31/10/06 15/09/06 01/10/06 23 OP38 13(4)(a) 01/08/06 Page 31 Bloomsbury House Version 5.2 (c ) must be stored securely at all times The Registered Provider received this in the form of an immediate requirement. CSCI must be informed of any accidents or incidents affecting the health or welfare of residents The Registered Provider received this in the form of an immediate requirement Individual risk assessments must be undertaken about residents who are at risk if out side of the Home on their own and remedial action in respect of this must be undertaken. 24 OP38 37 01/08/06 25 OP38 13(4)(b) 01/09/06 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 3 4 Refer to Standard OP7 OP12 OP29 OP30 Good Practice Recommendations Alternative paperwork should be sought on which to record “daily reports” in order to formalise these. Time should be allocated for activities, and ideas for activities, especially for residents with mental health needs should be sought. Interview notes should be kept and any gaps in employment history should be explored. Training records should include the content and duration of each training session, together with an indication of when updated training will be necessary. Bloomsbury House DS0000063254.V306055.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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