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Inspection on 01/05/07 for Blyford Residential Home

Also see our care home review for Blyford Residential Home for more information

This inspection was carried out on 1st May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken with reported that the staff were very good and were respectful. Interaction between staff and residents during the inspection was observed to be positive, professional and friendly. The home was clean, well maintained and attractively furnished. Residents were observed enjoying the communal areas of the home. Staff spoken with had a good knowledge of the resident`s needs whom they provided a service for. There was a nutritious and balanced menu, which was changed regularly. Residents were offered three choices, including a vegetarian option, for each meal and there were other choices available for those who wished to have an alternative to the set menu. The kitchen was clean and in good order and all necessary checks were routinely made, including fridge, freezer and food temperature checks.

What has improved since the last inspection?

There were no offensive odours detected during a tour of the building and there had been a new carpet and bed replaced in a bedroom in which an offensive odour was identified during the last inspection. There were care plans in place for each resident. The manager had received regular supervision and support and Regulation 26 visits were regularly undertaken and the reports were available in the home for inspection. There were improvements in the safe administration of medicines, which included regular audits and improved procedures, see the section below `what they could do better`.

What the care home could do better:

Staff recruitment records were incomplete. Six were viewed, two held only one written reference, one did not include an application form and identification of the staff member and one did not have a CRB (criminal records bureau) check, undertaken by the home. However, an application form and identification for one staff member was forwarded to the inspector following the inspection. The daily records held several abbreviations, which were not easily understood by the inspector. Two staff were asked what each abbreviation meant and they were unsure of all the abbreviations used and there was no written key which explained them. Although care plans were in place, they would benefit from being more detailed and clearly explain the support each resident required. Risk assessments including fire safety and manual handling were provided in residents records and were sufficiently detailed, however there were individualised risk assessments which would benefit from more detail, that would clearly identify how the risks could be minimised. There have been improvements in the management of medicines for people who use the service, however, the pharmacist inspector also identified some further record-keeping failures and matters relating to the administration of psychoactive medicines of a sedative nature at the discretion of members of care staff.

CARE HOMES FOR OLDER PEOPLE Blyford Residential Home 61 Blyford Road Lowestoft Suffolk NR32 4PZ Lead Inspector Julie Small Unannounced Inspection 1st May 2007 09:30 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 Blyford Residential Home DS0000037146.V338200.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. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blyford Residential Home Address 61 Blyford Road Lowestoft Suffolk NR32 4PZ 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) 01502 405420 01502 405429 sharon.hurren@socserv.suffolkcc.gov.uk Suffolk County Council Mrs Sharon Jane Hurren Care Home 36 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (12) Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 1. Rosedene House may accommodate persons of either sex, over 65 years who require care by reasons of old age (not to exceed 12 persons) 2 Foxfields House may accommodate persons of either sex, over 65 years who require care by reason of a diagnosis of dementia (not to exceed 12 persons). 3 Woodleigh House may accommodate persons of either sex, over 65 years who require care by reason of a diagnosis of dementia (not to exceed 11 persons). 4 1 named person, over 65 years of age, and with a mental disorder, as detailed in the variation application accepted by CSCI on 8th July 2005 may be accommodated on Woodleigh House. 5 The total number of service users accommodated in the home must not exceed 36 persons. 23rd January 2007 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Blyford is a residential home, which was purpose built and is owned by Suffolk County Council. It is situated in a quiet area of Lowestoft, to the north of the town. Although it is some distance from the town centre there are some shops and facilities nearby. The building is single storey and divided into three houses, Rosedene, Woodleigh and Foxfields. Each house offers accommodation for twelve residents in single rooms with en suite facilities. Rosedene is registered to provide for twelve older people who need care, not nursing care, and Woodleigh and Foxfields each offer care to twelve older people with dementia. The houses all have their own front doors, lounges, dining areas and indoor conservatory space. The gardens are attractive, secure and accessible to the residents. There is a day care service within the same building, which the residents can attend if they choose. During the inspection the manager informed the inspector that fees for the home were £386 per week. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 5 Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on Tuesday 1st May 2007 from 9.30 to 16.35. The inspection was a key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. Pharmacist inspector Mr M Andrews inspected the medication standard. In December 2006 a legal notice was issued regarding breaches of the Care Homes Regulations 2001 in relation to unsafe medication management practices. A formal caution was subsequently offered to the Local Authority as an alternative to prosecution in recognition of the fact that they admitted the breaches. The Local Authority accepted the caution on 5th April 2007. The findings of this inspection were discussed with Ms S Hurren (Registered Manager) and Ms L Nottage (Senior Team Leader) during inspection. The report has been written using accumulated evidence gained prior to and during the inspection. The home’s manager was present during the inspection and provided the inspector with all requested information promptly and in an open manner. Mrs Hurren said that service users were referred to as residents and this term will be used throughout this report. During the inspection four residents and six staff members were spoken with. A tour of the building and observation of work practice was undertaken. The pharmacy inspector viewed the administration and recording procedures and records of medication in the home. Records viewed included seven residents care plans, six staff records, health and safety records and menus. Further records viewed during the inspection are identified in the main body of this report. What the service does well: Residents spoken with reported that the staff were very good and were respectful. Interaction between staff and residents during the inspection was observed to be positive, professional and friendly. The home was clean, well maintained and attractively furnished. Residents were observed enjoying the communal areas of the home. Staff spoken with had a good knowledge of the resident’s needs whom they provided a service for. There was a nutritious and balanced menu, which was changed regularly. Residents were offered three choices, including a vegetarian option, for each meal and there were other choices available for those who wished to have an Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 7 alternative to the set menu. The kitchen was clean and in good order and all necessary checks were routinely made, including fridge, freezer and food temperature checks. What has improved since the last inspection? What they could do better: Staff recruitment records were incomplete. Six were viewed, two held only one written reference, one did not include an application form and identification of the staff member and one did not have a CRB (criminal records bureau) check, undertaken by the home. However, an application form and identification for one staff member was forwarded to the inspector following the inspection. The daily records held several abbreviations, which were not easily understood by the inspector. Two staff were asked what each abbreviation meant and they were unsure of all the abbreviations used and there was no written key which explained them. Although care plans were in place, they would benefit from being more detailed and clearly explain the support each resident required. Risk assessments including fire safety and manual handling were provided in residents records and were sufficiently detailed, however there were individualised risk assessments which would benefit from more detail, that would clearly identify how the risks could be minimised. There have been improvements in the management of medicines for people who use the service, however, the pharmacist inspector also identified some further record-keeping failures and matters relating to the administration of psychoactive medicines of a sedative nature at the discretion of members of care staff. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 8 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. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 9 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 Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 10 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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their needs assessed prior to them moving into the home. EVIDENCE: The home does not provide intermediate care. Previous inspection reports identified that residents records viewed included detailed needs assessments completed by the placing authority. There were assessments in place completed by the homes manager, which identified that the home could meet their needs. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 11 The manager was spoken with and said that they undertook all assessments of prospective service users before they moved into the home and identified if the home was appropriate to meet their needs. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that their needs are set out in an individual plan of care, that they are treated with respect and their right to privacy is upheld. Whilst most people who use the service have their medicines administered to them safely some current medication practices place people at risk of not receiving external medicines as prescribed and not safely giving oral medicines of a sedative nature when prescribed for use at the discretion of care staff. EVIDENCE: Seven residents records were viewed and each contained an individual plan of care. However, the care plans would benefit from further detail, which clearly explains the types of support they require. For example, one care plan stated ‘hair, nail and oral hygiene to be regularly maintained twice a day’, there were no specific details of how this support should be provided. There were Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 13 references to ensure that bathroom and bedroom doors were closed when residents were provided with personal care ‘to ensure their privacy and dignity’. Records identified each resident’s preferred form of address. There were two service users who had received treatment for psychiatric issues, these were not clearly identified in their care plan which would assist with the staff observations and completion of daily records. There were signed documents which evidenced that care plans were updated on a monthly basis. There was written documents of care plan reviews, which included the resident, their family and their key worker, which identified that they resident and their family were consulted regarding their care plan. There were spider charts which identified each resident’s preferences, likes and dislikes with items such as food and drink and allergies. There were details of when each resident had received health care treatment, such as visits from the district nurse, chiropodist and doctor. One care plan identified that the resident wore spectacles and would need assistance with cleaning them. One resident’s records identified that they had wished to change their doctor and had been supported to do so. During the inspection a doctor visited a resident in the home, they were supported in using the residents bedroom to ensure their privacy. Residents records contained a record of falls, summary of their personal history, future aspirations, dietary requirements, record of family visits, activities which they had participated in, continence management, behaviour incidents which were different form their usual behaviour, weight and nutritional screening. Risk assessments were in residents records regarding issues such as fire evacuation and manual handling, which were detailed and identified the risks and methods of minimising the risks. One resident’s record held a clear risk assessment of their seizures. Further individual risk assessments viewed did not contain sufficient details of methods of minimising the risks, for example one record stated the risk was ‘to keep (the resident) safe in a warm clean environment’ and the actions were ‘to monitor (the resident) daily’. Daily records were viewed, which were maintained for each resident and identified their actions throughout each day. During the inspection a staff member was observed updating the records in one of the homes units prior to the end of their duty. The daily records included several abbreviations such as D/N, B/O, B/M, C/O and P/U, and there was no recorded key to explain what the abbreviations meant. Two staff members were asked what each abbreviation meant and they could not identify all of them. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 14 Staff spoken with demonstrated a clear understanding of residents individual care needs. During the inspection residents were observed to be clean and tidy and evidenced that staff supported them in maintaining a positive appearance. Residents daily records and records of activities they had participated in identified that residents could use a visiting chiropodist and hairdresser and that an activity was hand massage and nail painting. All bedrooms in the home were of single occupancy. During the inspection staff were observed knocking on bedroom and bathrooms doors before entering them. A staff member spoken with explained how they supported a resident who had seizures and had said that they did not want staff to enter the bathroom when they were bathing. The staff member said that the resident was hard of hearing and how they had agreed with the resident methods of ensuring their safety and privacy. The laundry was seen and the laundry staff was spoken with, they explained methods of ensuring that each resident was provided with their own clothing after being laundered. Each item of clothing was labelled with the residents name, which they said care staff did, and if a newly admitted resident had not yet had their clothing labelled they ask the resident and the key worker to confirm if the clothing belongs to them and checked that it is on the list of the residents belongings. Interaction between staff and residents was observed to be positive, friendly and respectful. Residents spoken with confirmed that the staff were respectful and ensure that their privacy was maintained. The medication standard was inspected simultaneously by pharmacist inspector Mr M Andrews. This inspection follows the issue of a legal notice on breaches of the Care Homes Regulations 2001 in relation to unsafe medication management practices and a total of seven previous pharmacy inspection. Subsequently, a Formal Caution was offered to the local authority on 5th April 2007 as an alternative to prosecution in recognition of the fact that the breaches were admitted by them. The findings of this inspection were discussed with Ms S Hurren (Registered Manager) and Ms L Nottage (Senior Team Leader) during inspection. The inspector found that the home has improved its medicine administration and record-keeping practices by putting in place closer supervision and audits of medicines prescribed for people using the service. Generally there was found to be improvement in the quality of record-keeping practices in relation to the administration of medicines. The inspector found two discrepancies where medicines could not be accounted for in full. The home’s own internal Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 15 audit has recently identified some discrepancies but overall there is improvement in this area. The inspector found, however, that for medicines prescribed for external application, records frequently did not indicate how often the medicines were to be used. In addition, records indicated that these medicines were applied intermittently and not as prescribed –see requirements. The inspector also looked at how the home manages medicines of a psychoactive (and potentially sedative nature) prescribed for PRN (as required) use and given on the decision of senior care staff for the management of psychological agitation. On conducting audits of the use of such medicines against both medication and care note records, there was sometimes insufficient recorded information to determine that the medicines were being administered when clinically justified. In addition, for several people there was no written care plan guidance to assist staff when considering the use of such medicines (and variable higher doses) –see requirements and recommendations. Medication for a resident who is prescribed a relatively high dose of antipsychotic risperidone was considered. Whilst it was established that this resident is under the care of a consultant psychiatrist, the inspector was concerned that the home did not have records relating the resident’s psychiatric history which would justify the current high dose of this medicine. As an out-patient appointment had been arranged during the week following the date of inspection, it was agreed with the manager that, where relevant, further information relating to the resident’s history would be obtained and a copy provided to the Commission. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they are provided with opportunities to participate in their chosen recreational activities, maintain contacts, exercise choice and control over their lives and are provided with a wholesome and balanced diet. EVIDENCE: Residents spoken with said that there were sufficient activities available in the home and that they could also attend activities provided by the day centre which was located in the premises. They said that they played bingo, arts and craft, had visiting musicians and got their hair and nails done. A staff member said that residents also danced to music. There were activities available such as ‘musical bingo’ and a ‘musical quiz’, which a resident explained and evidenced that there were activities available which residents of all abilities could participate in. There was a record of what activities each resident had participated in, in their individual records and included watching a video, completing a life story, doing Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 17 crosswords, listening to music and religious services. Records identified what residents enjoyed doing and their previous hobbies. There were religious services held in the home from various denominations in the area, such as Christian and Catholic. One resident’s record stated they had enjoyed the Salvation Army visit. During the inspection a group of residents were observed watching television, residents were chatting to staff, a resident was returning the menus to the kitchen and a resident was making a bird bath. They were spoken with and said that they had bought a container from the local shops, which they were going to use as a bird bath, they said that they had previously used a different container but the birds could not use it. A staff member explained that the resident enjoyed going out to the shops independently. There was a risk assessment in place in their records relating to their going out in the community. Resident’s records viewed included records of contacts with family members and friends. Residents spoken with said that their visitors could visit when they wished and were always made welcome at the home. They said they could entertain their guests in their bedroom or in the communal areas of the home. During the inspection a family member visited a resident and staff were observed welcoming them into the home. Residents said that staff in the home listened them to and that they felt that their choices were respected. Residents spoken with said that they were provided with a good diet and there was sufficient food. Staff were observed to provide residents with hot and cold drinks throughout the day and they were offered a choice of biscuits with their drinks. The menus were viewed and provided a healthy, varied and balanced diet. There were three choices for each meal, including a vegetarian option. The cook explained that there was a supplementary menu, including salads, jacket potatoes and sandwiches which residents could choose if they did not want what was offered on the main menu. The cook showed the inspector the summer menu and explained that the menus were changed with the seasons and the summer menu would be introduced the end of May 2007. The cook explained methods of presenting liquefied foods for those who required it, which included providing each food item separately such as meat, vegetables and potatoes to ensure that residents were provided with the opportunity of choice and experiencing different tastes. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 18 The cook reported that they and their assistant had received food hygiene training and that the cook had attended training to enable them to provide food hygiene training. The kitchen was viewed and was clean and well ordered, there was a good stock of fresh vegetables, fruit and branded items such as squash, beans, soups and sauces. All items which had been opened were labelled by their use by dates. The cook explained and provided documentary evidence of fridge, freezer and food temperature checks, ‘safer food better business and risk assessments. A recent environmental health inspection report was viewed and stated ‘very clean and well organised’ and ‘food safety management system in place and working well’. Lunch was observed briefly and the meals looked and smelled appetising and residents were observed to be enjoying their meals. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that their complaints will be listened to and acted upon and that they are protected from abuse. EVIDENCE: Previous inspection reports stated that the home had a detailed complaints procedure which provided contact details of CSCI (Commission for Social Care Inspection). Residents and staff spoken with said had a clear understanding of how they could make a complaint or raise concerns. Evidence was forwarded to the inspector, following a previous inspection, that staff had received updated POVA (protection of vulnerable adults) training. The training included video, work sheets and discussions in team meetings of Abuse in the Care Home and No Secrets. Two staff records viewed evidenced that they had received abuse training within the TOPSS foundation training. Records of five staff, who had been recently employed at the home were viewed and showed that they had commenced their Skills for Care induction, which included POVA sessions. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 20 Staff spoken with were aware of their responsibilities in the protection of residents at the home. A senior staff member spoken with said that the senior team had received a training session regarding how the police and social care work together with issues relating to POVA. The home had the local authority guidance for POVA. There were notices posted in the home explaining No Secrets. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that they live in a safe, well maintained environment which is clean and hygienic. EVIDENCE: The home was clean and well maintained. Records of repairs of the home were viewed, the homes handy person completed minor repairs. There were clean and attractively furnished communal areas which the residents could use. The grounds were attractive and well kept and could be used by residents if they chose to. One resident was observed making a bird bath out of a container they had bought from the local shops. They said that they enjoyed being outside in the gardens. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 22 The laundry was viewed and the laundry staff member was spoken with. There were two industrial and one domestic washing machine, and there were drying facilities such as two drying machines and outside washing lines. There was hand washing facilities in the laundry. The laundry staff member had a clear understanding of their role with regards to infection control and ensuring that residents had their own laundry returned to them. The laundry had a fire notice displayed on the wall, and the laundry staff told the inspector where the nearest first aid box was, which was in the staff room, which was in the neighbouring room to the laundry. A staff member showed the inspector Skills for Care knowledge sets, which were being worked on by the staff team and included infection control. The knowledge sets included work books and the staff member said that they were discussed in their supervisions. There were no offensive odours in the home. Since the last inspection a bedroom, where a previous odour was detected, had been provided with a new carpet and bed. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that their needs are met by the numbers and skill mix of staff who are trained and competent to do their jobs. They cannot expect to be protected by the homes recruitment practices. EVIDENCE: Five staff recruitment records were viewed. One staff member whose started work at the home February 2007 did not have a CRB check which was undertaken by the home. There was a CRB application form and a letter from January 2007, which stated that the form had been returned as it was incorrectly completed. The manager was spoken with and said that the form had been re-sent and the staff member had a ‘current’ CRB check from the agency they had previously worked for, the manager said that they were instructed to start the staff member as they were short staffed. A staff member telephoned the human resources department and they said that they were told that the CRB had not yet been received as there was a ‘backlog’. There had been no POVA check made on the individual prior to them working at the home. Four staff recruitment records viewed held CRB checks. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 24 One staff member’s records, who started work at the home February 2007 did not include the job application form, identification and had only one reference. There was a signed record completed by a senior staff member stating that the documents had been requested from the human resources department. A staff member telephoned the human resource department on the morning of the inspection and asked if they could fax the information to the home, it had not been faxed to the home by the end of the inspection. A fax was sent to the inspector 8th May 2007 with the staff members application form and identification attached, and a staff member informed the inspector that human resources had forwarded these documents to the home following the inspection. One staff member’s records, who started work at the home in 2002, contained only one reference. There was a signed document from a senior staff member which stated that a replacement reference had recently been sought from the referee. Three staff recruitment records viewed held the required information such as two written references, identification and CRB checks. Newly appointed staff records viewed held the probationary procedure and probation reports had been completed. There had been four staff employed at the home since the last inspection and the manager stated that, at the time of the inspection there were no vacancies at the home. Observation of staffing levels during the inspection and staff rotas evidenced that there were staff available in the home to meet the needs of the residents. Residents spoken with said that there were sufficient staff working at the home and they were available when needed. Staff spoken to said that there were sufficient staffing at the home and there were improvements in staffing following the recruitment of the new staff. Staff records viewed evidenced that newly appointed staff were undertaking their Skills for Care induction and existing staff had completed their TOPSS (now Skills for Care) induction and foundation training. A document entitled ‘workforce planning data’ was viewed and identified the qualification levels in the home. There were 56 staff working at the home and 28 had achieved a minimum of NVQ (National Vocational Qualification) level 2 in care. There were 11 planned for completion of their awards in the 2007 – 2008 period. At the time of the inspection the home had met the target of a minimum of 50 of staff to have achieved at least the NVQ level 3 by 2005. A senior staff member showed the inspector Skills for care work sets which were workbooks which were completed by staff and discussed in their Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 25 supervisions. The work sets used by the home at the time of the inspection were infection control, medication and dementia, they said that when they were completed there were also work sets on issues such as health and safety, POVA and palliative care. A staff member showed the inspector the work set they were working on at the time of the inspection. Staff spoken with confirmed that they had received sufficient training at the home to support them in their work role which included POVA, manual handling, dementia and fire safety. One staff member said that they had received a good training programme in their previous work place and that they felt that there was minimum training available at Blyford Road. Staff records viewed evidenced that staff had been provided with training such as POVA, food hygiene, health and safety, manual handling, medication, dementia, communication and Unisafe. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that the home is managed by a person who is fit to be in charge, is run in their best interests and that their financial interests are safeguarded. However, there were issues such as medication and recruitment checks, identified in the health and personal care and staffing sections, which may affect the safety of residents. EVIDENCE: The homes registered manager had achieved a diploma in management and an NVQ level 4 in care. During the last inspection it was identified that the manager was not receiving regular supervisions and that Regulation 26 visit reports were not available in the home for inspection. A plan had been Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 27 forwarded to the inspector identifying that the manager had been provided with a management system which provided them with regular supervisions and copies of Regulation 26 visit reports were forwarded. During this inspection monthly Regulation 26 visit reports were stored in the home and were viewed. The manager explained that they had been provided with a senior manager who was responsible for the home and provided the manager with positive and regular support and supervisions. The inspector had been sent comprehensive details of audits and quality assurance of the running of the home. Medication procedures had been improved and there was regular monitoring of the medication procedures and the procedures for resident’s individual care plans. Previous inspection reports identified that the safeguarding of residents financial interests was positive. There were clear records of the balance of monies which were stored in the homes safe and records of ingoing and outgoing monies. There were some issues regarding the well being and safety of residents which was discussed in the Health and Personal Care section of this report. Health and safety records were viewed and evidenced that regular checks were routinely made, such as water temperature, legionella, fridge and freezer temperature, food temperatures, and electrical appliance. Fire safety records were viewed and evidenced that regular checks were undertaken. The home had a fire risk assessment and each residents records viewed held a fire risk assessment, which identified methods of supporting the resident if there was need of evacuation of the home. There were fire safety notices posted around the home, which provided information to staff, visitors and residents. There were good, detailed environmental risk assessments which were viewed and there were risk assessments specific to kitchen staff and the maintenance staff member which were viewed. The first aid box was viewed in the kitchen and the cook explained that they had responsibility for ensuring that it was well stocked. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling and infection control. There was a sign posted on a notice board which identified the staff who were designated first aid individuals. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 28 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 29 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 OP29 Regulation 19(1)(b) Schedule 2 Requirement The registered persons must ensure that documents set out in Schedule 2 must be kept in the home. This is a repeat requirement from the last inspection 23rd January 2007 The registered persons must ensure that staff members receive a satisfactory criminal records bureau check has been received prior to them starting work. People who use the service must have medicines prescribed for external application by staff who have clear records in line with prescribed instructions to protect people’s health and welfare. People who use the service must have medicines prescribed on a PRN (as required) basis for the management of their psychological agitation administered only when clinically justified. This is to protect people’s health and welfare. Timescale for action 31/05/07 2. OP29 19(1)(b) Schedule 2 31/05/07 3. OP8 OP9 OP38 13(2) 31/05/07 4. OP9 OP38 OP7 13(2) 31/05/07 Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 30 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 OP7 OP7 OP9 Good Practice Recommendations It is recommended that care plans provided increased details of the specific care provision required by residents It is recommended that residents individual risk assessments provide increased detail of specific methods of minimising the risks It is recommended that recording on statutory records is legible and can be understood by those who may have access to them It is recommended that clear written guidance is prepared and made available for staff for all people who are prescribed medicines of a psychoactive nature on a PRN (as required) basis. Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Blyford Residential Home DS0000037146.V338200.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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