Inspection on 08/08/07 for Bloomsbury House

This inspection was carried out on 8th August 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

Bloomsbury House 18/11/08

Bloomsbury House 01/08/06

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 Mrs Amanda Hennessy Key Unannounced Inspection 8th August 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bloomsbury House DS0000063254.V344057.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.V344057.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.V344057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2007 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 residents have their own room with an en-suite toilet and hand washbasin. The Home has a passenger lift. There is a large lounge and separate dining room at the front of the Home. 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 baths with a hoist enabling people with mobility difficulties to use it and a shower, however there is a small step up in to the shower tray. 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. The weekly fee to live at Bloomsbury House is between £352.9295 and £440 and this includes a top up for residents funded by social services. Additional charges include hairdressing, dry cleaning, private chiropody, toiletries and newspapers. Bloomsbury House DS0000063254.V344057.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 an one day visit undertaken without any notice by one Inspector. At the time of the visit there were twelve people living at the Home. The Registered Provider assisted the Inspector during the inspection as the Home Manager was on leave at the time of the inspection. Information was gathered by speaking with residents and staff, case tracking, examining care, medication and health and safety records and observing general life at the home. A tour of the Home was undertaken. Prior to the 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 with this information being taken into consideration during the visit. What the service does well: People who come to live at the home have a comprehensive assessment of their needs before they come to live at the home. This gives people assurance to know before admission to the home that their individual care needs are known by the staff and will be met at the Home. Residents all have a plan of care which they are involved in agreeing and reviewing, and which ensures that their preferred routines are maintained. Each resident is consulted about whether they would like to have a key to lock their bedroom door in order to maintain their privacy. Residents are able to maintain contacts with their friends and family and visitors are made to feel welcome at the Home. One relative said “I’m happy with the care that my mother receives. The staff are lovely and I and know when I’m not here she is being well looked after and is safe.” 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”. The home has a comprehensive complaints procedure and the resident are confident that their concerns will be listened to. The Home has a quality assurance programme that includes surveying residents about their views of life at the home and improving the standard of care provided. Residents’ views are incorporated in to the service user guide Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 6 and this ensures that prospective residents have an insight in to what it would be like to live at Bloomsbury House. The home is maintained to a high standard and is homely and clean making it a pleasant place for residents to live. Residents are able to personalise their bedrooms to reflect their individual tastes and interests to ensure that they feel comfortable in their surroundings. One resident said “I ‘m happy here”. The Home does not use agency staff and this ensures continuity of care. A resident said “The staff are very nice and friendly here”. The home is “family run and family owned” and its ethos reflects these values. Residents are assured that they have good access and relationship with the homes proprietors and manager. What has improved since the last inspection? What they could do better: Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 7 Care records need to comprehensively identify the residents’ life within the home and be more robust to ensure they are completed appropriately and safely. Care plans must include all residents needs and should be updated at least monthly or more frequently if their needs change. Although staff supervision has increased there is a need to ensure that it is undertaken more frequently. Fresh food is frequently frozen but the date that it is frozen and date it must be used is not recorded, which does not give assurance that residents are protected from the risk of out of date food. There is a need to seek advice from Environmental Health about the safe and appropriate storage of food. Prospective staff recruitment checks are inconsistent and are not all fully undertaken and do not safeguard residents. 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. Bloomsbury House DS0000063254.V344057.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.V344057.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2, 3,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required information about the home is available. The home gives people an opportunity to visit and assesses their needs before they come to stay, enabling people to assess whether the home would be suitable for them and will meet their needs. EVIDENCE: The home has a statement of purpose and service user guide that provide valuable information about the home and have recently been updated. It was nice to see that the service user guide also included the views of residents who live at the home. Both the statement of purpose and service user guide need minor amendment which should include room sizes to include all required information. The statement of purpose and service user guides are both available in a large print format for people with poor eyesight. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 10 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.V344057.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home have a plan of their care although plans are not always complete and updated when required which does not give total assurance that all their needs will be met. Medication practices are generally good and safeguard residents. EVIDENCE: All residents have a plan of care that identifies their needs and their preferred routines, likes and dislikes- such as the time they get up and whether they like breakfast in their room or in the dining room. Information about people’s preferences for their leisure time and previous interests are also included in their plan of care with records such as;“ I like to watch TV in my room”. Care plans are written and reviewed with the involvement of the resident and their representatives when ever possible. Care plans seen however had not Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 12 been updated regularly. One care plan seen had not been updated since the 30/4/07 and another since 19/5/07, although a record on the 19/6/07 saying“ Developed a small pressure sore” was recorded and there was no change to their plan of care to manage, heal and reduce the risk of this pressure sores developing further. Although records were not adequate staff spoken to had a good knowledge of the care needs of residents giving added assurance that they would be able to meet their needs. Daily reports were frequently written on sheets of A4 paper taken from a note book, records were not timed and there were frequently gaps between the next entry. Records not only looked unprofessional but are constructed in a manner which could be subject to change and addition at a later time. There are records of visits by Doctors, Dentists, Opticians and District Nurse. Unfortunately staff do not routinely or consistently record visits and those records seen did not always identify what advice they had given. The home residents have risk assessments for moving and handling, falls, pressure sore formation and other personal risk assessments, such as short term memory loss although as previously identified these are not updated when required. For example the resident whose records identified that she had a small pressure sore on the 19/6/07 risk assessment for the formation of pressure sores had not been updated to reflect this. Nutritional risk assessments are also undertaken to ensure that residents are well nourished. Risk assessments are not always accurate as the resident had not been weighed. Records seen identified that that staff were unable to weigh some residents with comments such as “too unsteady to weigh”. One resident had not had their weight recorded since 15/10/06 despite their last recorded weight being just five stone seven and a half pounds, and their risk of malnutrition considerable. The proprietor did say that staff could undertake measurements of arm circumference although they must have training to ensure that this is undertaken correctly, or alternatively the home has “sit on scales” which are more appropriate for people with increasing frailty and to ensure that they maintain a healthy weight, and staff take required timely and appropriate actions. Formal care reviews are 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 are 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 relative spoken to said : “Staff always ring me to tell me when my mother is unwell. She did had fall at home before she came here and must have been on the floor at least twelve hours but I know that staff are always around here.” Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 13 The home does have a number of people who have developed dementia as part of the ageing process. Records seen show that the home does take appropriate actions when people needs deteriorate beyond which they are able to manage. Arrangements have been made for one resident whose dementia had deteriorated and they now need nursing care 24 hours a day. Other residents have short term memory loss and need continual reassurance. It was also noted that some residents with dementia remained in their room. However another residents care plan identified: “ Can sing and upset other residents, if this is the situation take her into the dining room or back to her bedroom where other residents will not be affected”. The home is not registered to accommodate people with dementia and there is a need to review the needs of other residents to ensure that they receive appropriate care and that other residents are also not distressed. Systems in place for the management of medication are generally good and all staff responsible for this had undertaken accredited training. A requirement to ensure that there is a record of the receipt for all medicines received into the home has been addressed. A need identified at the previous inspection for two staff to confirm all hand written entries on to the medication administration and a record of the actual dose of medication administered regarding variable doses has not been undertaken. Staff do not record the date of opening of “short life” items. These improvements are required to ensure safe administration of medicines, accurate audit trailing and monitoring of the effectiveness of the prescribed treatment. Prescription items requiring refrigeration are stored in a medication fridge within the treatment room, although there was no record of temperatures that these medicines are stored at. The proprietor was also advised to record the temperature of the treatment room. Staff greet residents by their preferred names which is recorded in their care record. 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. Bloomsbury House DS0000063254.V344057.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): Standards 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. There are no rigid rules or routines and residents are able to exercise some choice over their daily lives. Activities and leisure opportunities are limited and further review is required to ensure that the needs and expectations of all residents living at the Home are met. A menu is available with a choice of meal at each mealtime. EVIDENCE: The home has a limited range of activities which include bingo, colouring and painting, sing a longs, exercises and hairdressing. The Manager is looking at ways that social opportunities can be extended and during the morning of the inspection residents were given the opportunity “to sample” an exercise session which will be held regularly if successful. It was disappointing that there was minimal staff interaction with staff only coming into the lounge to take residents into the dining room and offer them a drink and for the majority of the day there were no staff in the lounge. The Proprietor did come into the lounge several times during the day to assist the Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 15 Inspector. When in the lounge it was evident that she had a good relationship with the residents and she asked people in the lounge if they would like her to put the television on for them, which they declined. It was a shame that staff did not spend more time in the lounge with residents or ask if they would like the radio or other music on which would have provided some background interest. One resident said; “ Its very quiet and this morning seems to have dragged.” The Manager has been addressing concern highlighted at the previous inspection that there are limited opportunities for residents to go out side the home unless they have their families with them. All residents have been registered with “Ring and Ride” although to date no residents have taken up this opportunity. 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. A singer/ entertainer had visited the home and records seen suggested that this had been appreciated. The Manager has said that due to the cost of entertainment she is considering charging a small fee to residents for entertainment for this. There is a flexible visiting policy and friends and relatives are welcome to have a meal at the Home for a small charge. 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. Residents can choose what time they go to bed at night, get up in the morning or spend their day. 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. The majority of 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 menus are planned two to three weeks in advance and include lunch, tea and supper. A choice of meal is provided at each meal. Special diets are available for reasons of health or cultural preferences when required. The meal options for lunch on the day of the fieldwork visit were either cold turkey with chips, salad and peas or buttered cod with chips or potatoes and vegetables. There was yoghurt or fresh fruit for pudding. The Proprietor said that there had been a change of planned meal from turkey casserole due to the “yoga demonstration” that had delayed staff. Staff were observed to assist residents with their meals in a respectful and sensitive manner. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 16 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): Standards 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. Staff knowledge in respect of adult protection procedures is good and this safeguards residents. EVIDENCE: The home has a comprehensive complaints procedure which is displayed in the reception area of the Home. The complaints procedure is also included within the statement of purpose, service user guide and residents’ contract. The home has had one complaint since the previous inspection which was also sent to the Commission for Social Care Inspection and related to concerns highlighted by District Nurses. Residents spoken said they know who to raise their concerns to. One resident said “I would talk to the Manager if I had any complaints”. Staff undertake training in respect of the protection of vulnerable adults and the adult protection procedure included local Multi Agency Guidelines. Staff spoken to were clear of actions that they would take if any allegations of abuse were made. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 17 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): Standards 19, 20,21, 22,23,25,26. 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. EVIDENCE: Bloomsbury House is homely and well maintained, furniture, decoration and fittings are of a good standard. The home has an attractively decorated dining room at the front of the Home with table linen of a good standard. The lounge is nicely decorated and residents stated that they were comfortable in there and like being able to see out of the window and see the street outside. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 18 There are suitable aids and adaptations at the Home, handrails are fitted in corridors and near to toilets and raised toilet seats are also provided, in order to meet the needs of residents with physical disabilities. The Home are not able to accommodate residents who are unable to stand unaided as no hoisting equipment is provided. If a resident is unable to stand following a fall, assistance is sought from emergency ambulance staff. There are two assisted bathing facilities for residents requiring help with bathing. The shower has been identified for replacement as there is currently a small step into it and may be difficult to use for some people who have mobility difficulties. The new shower will be able to be used with the use of a shower that people can sit in and be wheeled into the shower. Records seen show that there is sufficient hot water within safe temperatures for residents. Residents’ bedrooms are all single, have ensuite facilities, are 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 is available in bedrooms. 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 “ they keep the home very clean” A hygienic and effective system for the laundry of residents’ personal clothing and bed linen is in place. There are appropriate facilities for the disposal of clinical waste to protect residents and staff. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number and skill mix of staff does not consistently meet residents needs. Staff recruitment procedures are poor at times and may put residents at risk. Staff receive required training giving assurance that they will be able to perform within their job roles in a competent manner. EVIDENCE: There are three staff on duty during the day and one waking and one sleeping staff during the night. The home does have a cleaner for three hours each day although care staff cook residents meals and undertake all laundry duties. Whilst staffing levels may meet residents needs at times during the day there is no assurance that this is consistently the situation. The home has several residents with dementia who require ongoing reassurance alongside personal care and so it is not surprising that staff had been delayed preparing lunch on the day of the inspection. It is essential that there are sufficient and appropriate staff to meet both residents care needs. One relative did say however “The staff are lovely and I am happy with the care that my mum receives here”. Staff files sampled did not include all required information to safeguard the homes residents. The Proprietor was able to provide some additional Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 20 information two days after the inspection and confirmed that another member of staff whose staff file was also incomplete had not yet commenced work. Despite information forwarded by the Proprietor there remained two staff who did not have two written references as required. It was also a concern that there was no record that references had been authenticated and one person had references addressed to “whom it may concern” another member of staff had a reference from a family member which is also inappropriate and does not provide assurance that recruitment and selection procedures are safe. The previous inspection also highlighted that recruitment and selection procedures at the home were poor and did not safeguard the homes residents. Staff files seen did not contain interview notes as recommended at the previous inspection. One staff member had had a police caution recorded on their criminal record check but there was no record that the Manager had discussed this with the member of staff concerned. Records that pre employment health declarations are undertaken to ensure that prospective staff members are fit to work at the Home were available. 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 undertake training relevant to their job roles. It was good to hear that there are now 5o of the staff with a care qualification (NVQ Level 2 ), with addition staff also undertaking this qualification. Increased number of qualified care staff will ensure that staff have the appropriate knowledge to provide a good standard of care. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some management improvements although further improvements in areas such as recruitment and selection of staff and regular formal staff supervision are required. The developed of the quality assurance system has been a positive development for the home and gives assurance that residents are listened to. Health and safety procedures are generally acceptable although there is a need to ensure that when food is frozen there are appropriate safeguards in place to ensure that residents health is protected. EVIDENCE: Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 22 The Registered Manager has 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. The home has been developing its quality assurance system. It was good to see that both resident and staff meetings have been held since the previous inspection and minutes were available of these meetings. Residents and relatives have also been surveyed in regard to care and services that the home offers. The results of the surveys have been analysed and a report made of the findings. It was really positive to see how residents have been involved in developing and looking at ways the home may improve. 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. Records seen show that that there is a record of all transactions and two signatures confirm the transaction. Some receipts seen were torn off sheets from a small note book, although they had been individually numbered. It would be preferable if the home use a receipt book which is carbonated and numbers are sequential to give additional assurance that residents finances are being appropriately protected. There were some records to show that some staff have received supervision but generally staff do not receive formal staff supervision sessions at the recommended frequency. 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. Fire safety training and 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 have 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. There are records of accidents involving residents although the Proprietor is currently looking at ways all records including accidents may be improved. Cleaning products are stored in a cupboard within the food storage area and a need to relocate this cupboard was discussed with the Proprietor. The Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 23 Proprietor was also advised to ensure that information about substances that are hazardous to health (COSHH) are stored alongside these products to enable quick reference in the case of accident. The home currently freezes fresh food and although in the majority of cases this may be appropriate some food was being stored inappropriately. The Proprietor was recommended to contact Environmental Health for the advice on how long different fresh foods should be kept once they have been frozen. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 24 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 3 x 3 x 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 2 3 x 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 2 Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(2)(b) Requirement People who live at the home must have a plan of care that reflects their needs and is updated when their needs change. This will ensure that their health is safeguarded and their needs met. A comprehensive record of Health Professionals visits must be maintained. To ensure that residents needs and requirements are met and their health and wellbeing is safeguarded. Requirement extended to include all Healthcare professionals. Timescale of the 01/09/07 not fully met for records of Doctor visits. 3 OP8 12(1) People who live at the home must have proper provision for their health and welfare and have required care and when appropriate treatment. This will ensure that their health and welfare will be safeguarded. The number and roles of staff DS0000063254.V344057.R01.S.doc Timescale for action 01/09/07 2. OP8 12(1) 01/09/07 01/09/07 4 OP27 18)10(a) 01/09/07 Page 26 Bloomsbury House Version 5.2 5. OP29 must reflect the size of the care home, the statement of purpose and the number and needs of people who live at the home. 19(1)(b)(c Staff members must not 01/09/07 ) commence employment at the Home without two satisfactory authentic written references (one being from the last or most recent employer) Previous timescale of 28/11/05 and 01/09/06 not met 6 OP38 16(2)(j) Consultation must be made with the environmental health authority to ensure that suitable arrangements for maintaining satisfactory standards of hygiene within the care home. 01/09/07 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 OP7 Good Practice Recommendations Alternative paperwork should be sought on which to record daily reports in order to formalise these. Good practice recommendation not met since the previous inspection 2 3 4. OP8 OP8 OP9 People who live at the home are weighed regularly and the home has suitable equipment to ensure that this can be undertaken. Staff should record all visits of Health care professionals and the advice that they have given. All hand written entries on to medication administration charts should be signed and countersigned. Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 27 5 OP9 Good practice recommendation not met since the previous inspection The actual dosage of medicines administered when a variable dose is prescribed should be recorded. Good practice recommendation not fully met since the previous inspection Medicines should be stored within safe temperatures and there is a record of the medication fridge and the treatment room temperature where medicines are stored. 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. Good practice recommendation not met since the previous inspection. 6 7 OP9 OP27 8. OP29 Interview notes should be kept and any gaps in employment history should be explored. Good practice recommendation not met since the previous inspection. 9 OP36 All care staff must receive formal supervision at least six times each year. Good practice recommendation not met since the previous inspection Information about substances that are hazardous to health (COSHH) should be stored alongside these products to enable quick reference in the case of accident. The advice of Environmental Health is sought in relation to the freezing of fresh food produce. 10 OP38 11 OP38 Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Bloomsbury House DS0000063254.V344057.R01.S.doc Version 5.2 Page 29 - 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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