Inspection on 10/07/07 for Bluebell Nursing Home

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Bluebell Nursing Home 25/02/09

Bluebell Nursing Home 06/08/08

Bluebell Nursing Home 26/02/08

Bluebell Nursing Home 30/05/06

Bluebell Nursing Home 03/10/05

Bluebell Nursing Home 06/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Bluebell Nursing Home 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP Lead Inspector Ms Sue Kinch Unannounced Inspection 10th July 2007 10:00 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 Bluebell Nursing Home DS0000062757.V345338.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. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Nursing Home Address 45 - 53 St Ronan`s Road Southsea Hampshire PO4 0PP 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) 023 9282 3104 023 9282 6109 suecollins@whnh.com Techscheme Ltd t/a Bluebell Care Home Post Vacant Care Home 51 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0), Terminally ill (0), Terminally ill over 65 years of age (0) Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability over 65 years of age (PD) 2. Dementia (DE) (15) The maximum number of service users to be accommodated is 51. Date of last inspection 18th January 2007 Brief Description of the Service: The Bluebell Nursing Home is situated along St Ronan’s Road, Southsea and is close to the pier and seafront, a predominant feature of the area, which is well serviced by local bus companies. Local facilities are sparsely situated, although Southeas main shopping centre is a short journey from the home. The nursing home is comprised of five period town houses combined to create a single building, with three separate floors and two mezzanine floors. The home has undergone significant environmental improvements, which are nearing completion. The current charges for stays at the home range from £411.74 to £650 a week. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information sent to the Commission for Social Care Inspection (CSCI) since the last visit. This information included an Annual Quality Assurance Assessment (AQAA) and written and verbal comments from six relatives. Verbal feedback was also obtained from five professionals who have been recently involved in the home to varying degrees. A site visit to the home was made on 12th July 2007. During this visit the inspector spoke with approximately 10 of the residents, some with relatives, and observed the interactions between residents and staff. The inspector also spoke with one of the directors, an assistant manager and six members of staff on duty. Some areas of the home were viewed to consider the furnishings and fabric of the building and documents relating to the running of the home were sampled. At the time of the visit the previously registered manager had left and the assistant managers were reported by the director to be running the home with his support. Plans were also on place to start a new manager six weeks after the inspection. Since the last key inspection of May 2006 a random inspection was undertaken 18th January 2007 to monitor progress in respect of requirements. Some progress had been made but some requirements were repeated. This is referred to in the relevant sections of this report. What the service does well: The company has continued to invest in the upgrading and development of the service and this is now reported by the director to be nearing completion. The service users, staff and relatives commented positively on the improving standard of the environment. An additional day room was nearly ready for use. The staffing levels in the home are adequate to meet peoples’ needs and the director is willing to increase staff numbers should the dependency of service users warrant this. The service users and relatives comments about the food and the variety of food offered continue to be positive and complimentary. The chefs produce wholesome meals and there are numerous choices from which the service users can choose should they not want the main menu. The chef speaks to all residents every day about their preferred choices for that day. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bluebell Nursing Home DS0000062757.V345338.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 Bluebell Nursing Home DS0000062757.V345338.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for assessing prospective resident’s needs means that staff are able to meet people’s needs on admission. EVIDENCE: At the inspection of 18/1/07 it was found that the requirement made at the previous inspection, to ensure that the pre-admission assessments included the prospective residents’ psychological, emotional and mental health needs when deciding if the home can meet their needs, had been met. At this inspection a staff member said that information is received before starting to work with a new person. Admissions were discussed with a new resident who remembered being visited before coming to the home and was satisfied that their personal needs could be met. A sample of two sets of pre admission records were not viewed during the site visit but were requested to be sent to the CSCI office after. This information Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 10 was provided and demonstrated that pre admission assessment work takes a place and includes information from other relevant professionals. The home does not provide intermediate care. Bluebell Nursing Home DS0000062757.V345338.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 good. This judgement has been made using available evidence including a visit to this service. The health and personal needs of the people using the service are met with an increased willingness among management to involve other professionals in care decisions. People living at the home can rely on a well-managed and organised medication system. People living at the home are treated with respect and dignity and their right to privacy is upheld. EVIDENCE: A sample of care plans and risk assessment folders were viewed for a sample of five residents. As found at the random inspection of 18/1/07 there was evidence that these had been reviewed and, key areas of health and care needs were assessed and planned to be met. This included management of pressure sores. Care staff had access to these plans and in a group confirmed that they used them regularly and said that main issues are passed over at Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 12 handovers at the end of shifts. Care staff were seen to be recording daily notes in the files at the end of the shift. In one room where a person was bed ridden a member of staff showed how the needs of that person are recorded regularly throughout the day such as fluids, food and turning .The staff member also confirmed that the nursing staff regularly monitors recording. Where sampled there was evidence of recent involvement of health professionals and records of medical visits made by doctors and district nurses. Some of the information recorded in care plans is brief and could be extended to increase details of the support to be given such as in the moving and handling guidance. A member of staff knew how to support someone with moving and handling and they said that this was on their day-to-day work list. The full details were not viewed on the care plan. Short social histories missing from care plans at the inspection in May 2006 were noted to be in the care-plans observed but with little evidence of how individual people are to be supported socially and emotionally on a day-to-day basis. This is discussed further in the next section of the report. The staff were noted to have been organised into teams for each shift at the random inspection in January 2007 and this has continued so that two staff are allocated to each group making them more accountable for their actions. Staff said that that this system worked well. Discussions have been held with relatives, staff and external professionals about the care and health at the home and most were satisfied that these needs can be met although in written feedback two out of three relatives were not confident that needs would always be met. One relative was confident that a new health issue arising for their relative would be addressed. A visiting professional said they felt welcomed and that nurses in the home sought advice and opinions. Another commented that they had found one nurse less receptive to external support but that overall liaison was improving. The approach to external health professionals was discussed with one member of staff who was very positive about the support provided. Elements of the medication procedures were observed and discussed with one of the assistant managers who are in charge of ordering medication. A sample check was made of the controlled drugs which were stored appropriately in a double locked facility. Where sampled checks of stocks were in line with the records that are double signed. However, it was not possible to read the label on one liquid medication and the assistant manager agreed to have it replaced. A recent report from a local pharmacist check of the medication the system was available and this did not highlight any action points. Medication was discussed with a member of care staff who said that it was always the nursing staff who administer it. At the random inspection 18/1/07 a new requirement was made. The management was required to evaluate the impact changes to night shift Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 13 practices had on the medication rounds. (Changes had been made to have two staff working together to do this.) Details of findings were asked to be forwarded to CSCI. The manger at the time did so and an audit had showed that patients received their medication on time. At this inspection the director explained that he was reviewing the practices again and was considering the medication tasks to be shared by the night and day staff. A further requirement was not made at this inspection Residents and relatives contributing to this inspection answered questions about the treatment of residents and whether dignity and respect is maintained .The majority of comments were positive. One visitor said that the atmosphere in the home had changed and that staff are helpful and friendly. One relative said that they treat her relative ‘with respect and show concern for her’. Another said ‘They let him be himself’. Another relative said that although they generally found the care good they sometimes found one member of staff to be ‘officious’ and ‘brisk’ in her manner with the residents. This was not noted during the inspection. One resident said that staff are ‘polite and respectful’. Another resident said that ‘staff are all right’. Another family found the staff friendly and caring. During the inspection the staff were noted to be supportive and caring towards the residents. Bluebell Nursing Home DS0000062757.V345338.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are offered an interesting diet taking individual needs into account. Relatives are welcomed. Choice and decision-making is encouraged but residents would benefit from a more creative approach to meeting social, emotional and recreational needs through more individualised assessment and planning. EVIDENCE: Many people living in the home are reliant on staff for mental stimulation. A social activities programme including entertainment, such as a harpist, bingo and singing is posted on the wall of the home and staff, residents and relatives spoke of these happening. There is a tick box sheet in each care plan to indicate if a resident has joined in an activity. These were undated and so the frequency of joining could not be measured. There is little recorded in care plans about of how individual people are to be supported socially and emotionally on a day-to-day basis. Brief social histories missing from care plans at the inspection in May 2006 were noted to be in the care plan documents viewed but these were not followed up with clear staff guidance about how to offer mental stimulation which would engage individual residents and there were no details of how individual needs are met. One resident Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 15 spoken with has sight impairment and needs assistance to move and was sitting alone in the bedroom room. This person likes music yet, there was no radio and the remote control for the television was not within reaching distance neither was the buzzer for calling staff. One of the staff spoken with said that there was time for a chat or a laugh with the residents but not time for other things like board games. One relative said that they though there was a lack of stimulation. Another thought that more entertainment would be an improvement. Relatives spoke well of the reception to them from the staff and said that they were welcoming when they visited the home. Those commenting felt that they mostly new key things that were happening to their relative and contact was assisted. During the inspection visitors were offered refreshments. Comments from visiting professionals about staff attitudes towards them were also mostly positive as commented on in the above section. Staff spoke of various choices that people living in the home made. One resident was assisted to get up much later than the others on the morning of the inspection. Others preferred to stay in their rooms. One resident was observed to be consulted about the food available for the day and residents said that this always happened. Many of the residents are immobile and rely on staff to assist. It was noted where checked that most of the residents had call bell buzzers near them and staff were mostly prompt in answering the large number of calls made during the inspection. In written feedback one relative said that their relative was ‘allowed the independence they were capable of’ another agreed that people were always supported to live the life they choose. Another said this ‘usually’ the case. From observation during the inspection though one area where choices could be improved is in mental stimulation as a number of people sat in the same chair all day in the lounge. Choices about where to eat were temporarily affected by not having a dining room but some people chose to remain in their rooms anyway. Food choices are available all the time in this home and residents are consulted on a daily basis. The meals provided are reflected in the menus and people living in the home have alternatives .One member of staff was viewed to be sensitively feeding a resident at lunch sitting at the same level and talking quietly while gently encouraging another resident to eat. She confirmed that alternatives would be tried if necessary. She confirmed that she would be recording the food intake for the person being fed and the chart was available and had entries for that day. All comments about the food at the home from the residents were positive. Separate kitchen staff provides all food and the head chef has completed a course in ‘Healthy Eating In Residential Care’ since the last inspection. Bluebell Nursing Home DS0000062757.V345338.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service and relatives mostly feel able to raise issues of concern and are confident that they will be addressed. The home has an adult protection policy and co-operates with procedures but must ensure that all incidents affecting the well being of the people living at the home and any allegation of abuse are reported to the commission and that all staff are trained and understand their role. EVIDENCE: The complaints procedure is posted in the front hall of the home. The manager reported that they had not had any complaints in the last twelve months and that in feedback from clients, service users or advocates say that they handle them well. The complaints log was not viewed on this occasion but six relatives were either spoken to or answered questions in the survey. In the three surveys not all of the respondents knew the formal complaints procedures but felt able to raise issues. All three said that the home had responded appropriately to concerns raised or none had been raised. A relative spoken with had raised a matter but did not feel that the issue was responded to consistently. One resident was not happy about an aspect of her care and was going to talk it over with a relative. Another relative said that there were no problems and another said that they could raise matters with the manager or the director if necessary. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 17 There is some knowledge among three staff spoken with during the inspection visit about adult protection procedures. However following allegations made in January 2007 when the home followed adult protection procedures it was found that there had been a delay in staff reporting matters. At this inspection records of training were asked for to assess how much training has been provided. However as training records are incomplete (see the section on staffing) this could not be assessed. The home needs to ensure that all incidents affecting the well being of residents are reported to the commission. At this inspection it was noted that an urgent admission had been made to hospital for one person and this had led to a second adult protection referral to social services since the last inspection. The home was reported to have been responsive to the investigation but had not reported this to the commission. The outcome of the second investigation had not yet been finalised at the time of this report. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home although having experienced disruption to their routines and noise, have benefited from the ongoing refurbishment of the home, which is mainly decorated to a good standard and clean apart from dust where current work is taking place. Measures need to be taken by management to ensure that staff have the relevant knowledge to be diligent in infection control procedures to minimise the spread of infection. EVIDENCE: The home has experienced a long period of refurbishment and improvement and this was continuing at the time of the inspection although reported by the director to be coming to an end. Most shared and private areas were clean but some areas were in the process of being decorated (rooms 24,25,26,33,34) and were less clean with dirty windows and frayed carpets. The majority of shared and private areas however had been recently decorated to a good standard throughout the home. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 19 There was much continual noise to the rear of the home during the inspection but it could not be heard everywhere. Only a small part of the garden was available for resident use because of the scaffolding erected and storage of building materials and the toilet near one bedroom was temporarily out of use. A new shaft lift had been installed and was about to be operable. This had been erected in the area previously used as a dining room and the residents were therefore temporarily without that facility. However, the new day room was finished and reported by the director to almost be ready for use. Work was taking place to improve the links between sections of the home outside bedrooms (24,25,26,33,34) and carpet edging was uneven and posing a tripping risk. Staff said that the majority of residents do not walk but agreed that one resident usually aided to walk could be at risk if they decided to walk alone. This was raised with the director who commented that the carpets would shortly be replaced but agreed to check action to ensure that the resident was not at risk. Mixed views were received from residents, staff and visitors about the disruption of the changes. Some staff said that they thought that some residents had enjoyed the laughter with the workmen and watching the coming and going of people. One resident said that the work had to be done and that there had been noise but they turned the TV up. Another said that work was going on but that it was not a big problem. A visitor said that the dust and noise had been a problem for some of the residents although they thought the home tried to keep the disruption to a minimum. Staff said that people had been moved to quieter areas at times. Residents spoken with who commented on building works accepted that refurbishment meant some disruption. Comments from relatives and professionals were that the home was generally clean. One regular visitor said that the home was much cleaner since the new owners had taken over and that the home smells fresher. Separate staff are employed by the home to keep it clean and were working during the inspection. The home was free of odours and staff were noted to be using disposable protective clothing. Infection control was discussed with three members of staff who had received training in infection control and confirmed that there were sluice rooms in use for cleaning commodes. However, it was not possible to ascertain how many staff had been trained in infection control from the incomplete training records. In the afternoon of the inspection the inspector was informed that approximately ten of the residents in the home had scabies and were about to be treated. The director was advised to report this under regulation 37. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by a large well-organised staff group of nurses and carers employed following full checks and deployed in sufficient numbers to meet needs. However although there is a programme of staff training there is still not enough evidence to show that they have all had the necessary training and support to meet the needs of people living at the home. EVIDENCE: At the time of the inspection there were two nurses on duty and eight care staff to meet the residents needs with additional ancillary staff to deal with all domestic tasks. Staff spoken with said that this was a normal number of staff providing care and each of the four teams had two carers. The director said that he was planning to increase the number in the weeks after the inspection to allow more time for supervision and for the training officer to have off shift time. Comments from relatives and professionals were that there seemed to be enough staff on duty. However, to address the issues raised in the sections above concerning meeting emotional and social needs staff levels may needs to be reviewed. Recruitment records were sampled for three staff recruited since the last inspection and it was found on this occasion that the pre employment checks required had been fully carried out. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 21 A requirement was made on 30/5/06 and repeated on 18/1/07 stating that the manager must support the training officer in the creating of a structured training matrix, that records training completed, staff training needs and renewal or update dates. It also said that the manager would need to implement a supervision programme in order to achieve and maintain an efficient training matrix. At this inspection a sample of training records were viewed. There were some records of new staff being inducted into the home but although started, records did not contain full details of the induction. The training officer said they are involved in moving and handling but have not been trained. Records for two other staff were in place to show that the last manager, who was reported by the training officer to have been a moving and handling trainer, had trained them. The records of staff training have been started but are not available for all of the thirty-five nursing and care staff in the home. Twenty-five records were available but the training officer agreed that work was needed to ensure that they were updated and reflected the training that staff are having. It was not possible to assess the total numbers of staff trained in key issues such as adult protection, moving and handling, infection control, first aid and fire or when refresher courses are planned. The training officer said that several staff are doing distance learning with a local college and this included dementia awareness, medication, infection control and customer relations and that all staff have completed or being NVQ assessed. On new rotas planned for forthcoming weeks there were entries indicating that staff would be released for NVQ work. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home has been disrupted by a change of manager with insufficient quality assurance in place to ensure that all policies and procedures including health and safety are fully implemented to support and protect people using the service. EVIDENCE: Since the last inspection the registered manager has left and CSCI was informed that the assistant managers were acting in this role until a new manager is appointed. A director is also involved in the management of the home such as in recruitment and day-to-day decisions. A manager was reported by the director to be starting six weeks after the inspection. Staff said that there are regular staff meetings and all staff are asked to attend. But although there is day to day support for staff working, there is insufficient verbal or written information to show that supervision, which a Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 23 requirement was made about in the last inspection report, is given to all staff regularly. At the time of the inspection neither of the two staff asked had recently had supervision and another person said that it was not currently being provided. There is evidence in the home that the management asks relatives and residents about the care at the home. The director holds some records that have been completed and said that residents and relatives are given the opportunity to comment in reviews of care held annually. Comments were received that the environment and atmosphere had improved in the home. However, at the inspection visit there was insufficient evidence to demonstrate that management of the home is consistent enough to ensure that all systems are followed routinely. Examples are identified in this report such as in relation to reporting incidents, health and safety, staff training and supervision. The director said that the home does not hold any money for the people living at the home and that invoices are given for services bought. A requirement made about risk assessments after the random inspection in January 2007 was subsequently reported as addressed by the manager. At this inspection it was noted that some risk assessments were in place and one brief one regarding the building work had been written in February 2007. However, some of the control measures required to be in place such as taped off areas were not and there was no reference to the garden or the corridors on higher floors that were being redecorated and carpeted. In addition although several areas of the building had been refurbished and the previous manager had said that the risks were monitored on a daily basis, there was no written evidence of this. This was discussed with the director at the time of the inspection who was informed that more detailed assessments were needed. A risk assessment for the maintenance person had also been written in February 2007. After the last inspection a requirement was made about ensuring that substances hazardous to health are stored in a locked environment. At this inspection this had been carried out and substances were not found in areas checked. Some of the records of service to equipment and systems were requested for observation. There was no current record of test of portable electrical equipment although the electrician carrying this out confirmed that it was ongoing. There was a fresh set of labelled equipment in one room checked but a full record is needed which the electrician said would be provided. A sample of records of in house checks on the fire system were viewed and these had been completed within the right frequency but there was no record of the annual full fire system check. The director said that this is also carried out by the electrician who is employed by the home. The need for a record was also discussed. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 24 During the inspection in the morning it was noted that the slope from the fire escape to the rear of the building had a piece of scaffolding through it decreasing the space for pushing wheelchairs through in an emergency. Mr Smith said that this had been measured to allow for this. At the bottom of the fire escape slope a pile of laundry sacks blocked further movement in the escape route. This was pointed out to the director who instructed laundry staff to move it. This had been done when checked later in the day. Records of moving and handling training are inadequate to assess the amount of training that staff had received in health and safety issues. Moving and handling training was discussed and the home’s previous manager had been trained to do this. The director spoke of plans to use an external trainer for this. But in the short term new staff were working in pairs and had been given guidance by the training officer. However, not all new staff involved in moving and handling could be evidenced as having received the appropriate training by a trained trainer. and they should not be involved in moving and handling as discussed with the manager and the training officer at the inspection. Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 10 11 2 x x x x x x 2 STAFFING Standard No Score 27 28 29 30 3 3 x 2 2 3 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 26 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 OP12 Regulation Requirement Timescale for action 10/09/07 Regulation People living in the home must 16 be consulted about and have their social interests and recreational preferences recorded, and provided for, having regards for the differing needs of the service user with mental frailty to that of the service users with physical disability. This requirement remains outstanding from the last two inspection reports of 30/5/06 and 18/1/07. Regulation Incidents affecting the well being 37 of the residents and allegations of abuse must be reported to the commission. 18 There must be sufficient evidence to demonstrate that all staff are trained in areas including adult protection, induction, infection control and moving and handling in order to meet the needs of residents. This amended requirement remains outstanding from the last two inspection reports of 2 OP18 30/08/07 3. OP30 10/09/07 Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 27 4. OP33 5. OP36 30/5/06 and 18/1/07. Regulation Quality assurance systems must 24 be in place to ensure that systems in the home such as for training, supervision, the management of risks, and reporting incidents are used effectively to ensure that residents’ needs are met consistently. Regulation The manager must formulate a 18 system for undertaking and recording staff supervision 10/09/07 10/09/07 6. OP38 This requirement remains outstanding from the inspection reports of 30/5/06 and 18/1/07. Regulation The risk assessment for the 30/08/07 13 home must be reviewed and updated to reflect the current environmental changes to the home whilst refurbishment works are in progress. This requirement remains outstanding from the inspection reports of 30/5/06 and 18/1/07. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bluebell Nursing Home DS0000062757.V345338.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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