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Inspection on 17/06/05 for Blyford Residential Home

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

This inspection was carried out on 17th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

The home provides a very good standard of daily life for Service Users. There is a pleasant, open atmosphere, independence is promoted, and Service Users are supported where it is needed. The home provides a good range of activities, including contact with the local community, and there is good social interaction with staff at all times.

What has improved since the last inspection?

Health and safety practices have improved in the home.

What the care home could do better:

Full and timely recording of care plans is required, including risk assessments for pressure areas for all Service Users. The home must be able to deal with incontinence without odours lingering in Service Users rooms, and in a discrete way. Medication practices had been reviewed since the last inspection, but their remained a number of gaps and inconsistencies in recording, and shortfalls in practice.

CARE HOMES FOR OLDER PEOPLE Blyford Residential Home 61 Blyford Road Lowestoft Suffolk NR32 4PZ Lead Inspector Mary Jeffries Unannounced 17th June 2005 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 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 I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blyford Residential Home Address 61 Blyford Road Lowestoft Suffolk NR32 4PZ 01502 405420 01502 405429 None Suffolk County Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sharon Hurren Care Home 36 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (12) of places Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. Woodleigh House and Foxfields House may accommodate persons of either sex, over 65 years who require care by reasons of a diagnosis of dementia (not to exceed 24 persons) 3. The total number of service users accommodated art the home must not exceed 36 persons. Date of last inspection 24/11/04 Brief Description of the Service: Blyford Residential Home is a purpose built home owned by Suffolk County Council. It is situated in a residential area in the North of Lowestoft, Suffolk, some distance from the town centre, though there are some shops and facilities nearby. Blyford is registered to provide care for twenty-four persons, over 65, with a diagnosis of dementia , twelve in Woodleigh House and twelve in Foxfields House. Another twelve older persons who require care by reasons of old age on within Rosedene House. The building is single storey and is divided into three houses, Rosedene House, Woodleigh House and Foxfields House, each with its own front door, lounges and dining areas. There is a separate day centre attached, which service users may attend if they so wish. There is a common entrance to the day service and the home. A Social Care Services Admission Prevention Team is located off the common entance area. There is car parking space for visitors at the front of the building and attractive gardens accessible to service users. The garden for Foxfields House is enclosed, but is accessible from the Day Centre and users of the Day Centre share this facility. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on one late afternoon and early evening in June l 2005. The homes manager was not present, and a senior carer s took part in the inspection. The home was full, although one of the Service Users was in hospital. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 4 The Service Users’ Guide does not give prospective Service Users the opportunity to know what current residents think of the Home. EVIDENCE: A Service User Guide had been forwarded to the CSCI following the last announced inspection. It does not include some information that is required. For example the home uses Suffolk Social Care Complaints procedure, but this is not made clear in the Service User’s Guide, and is a separate document. The Document did not include Service User’s Views of the home. An application had been received by the CSCI in respect of one Service User who had been admitted out side of the homes categories of registration in November 2004. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service Users can expect to be treated with dignity and respect on a personal level, however this is not fully supported within all practices. Personal files were not securely stored at the time of the inspection, and this has been an issue at previous inspections. Improvement is required in the recording and administration of medicines, to safeguard Service Users. Service Users cannot be confident that their care plan will be completed in a timely way. EVIDENCE: Five Service Users spoken with confirmed that they were treated with respect and dignity. One said that staff “talk to me in a very nice way”, and that they could always find someone to talk to. One added that if it is anything personal, they will speak to you in your room. The Service Users spoken with confirmed that they had keys to their own rooms. Public phones and seating areas were located to provide privacy. Incontinence pads were not discretely stored in one Service User’s room; they were apparent in a bag on a chair of a Service User confined to bed. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 9 The cupboards containing care records on Rosedean and on Woodleigh were found to be unlocked. Care notes were completed daily about each Service User. The entries read by the inspector were appropriate. Care plans contained positive and detailed person centred assessments. These contained a range of information about social involvement, mobility, religion, interests and orientation. They were well completed. Night care plans were also in evidence. Files also contained Life stories. Some had been completed but not all. Two Service Users who had been in the home for at least 4 weeks, however, on special needs units did not have person centred assessments, night care plans or nutritional screening completed. 6 weekly and main reviews were evidenced on file, and updates to various parts of the care plan were apparent. On two files inspected the last main reviews that were documented were 8 months previously. It was not clear whether monthly reviews were done to consider all parts of the care plan. There was no pressure area risk assessment on file for a Service User who had a pressure mattress and chair. A carer advised that the home does not do a risk assessment on pressure areas for each resident, as all Service Users are susceptible, but that Service Users are referred immediately to the District Nurse if they have a pressure area, and that they risk assess. They did not know where the home’s policy on pressure area care was. There was evidence of District Nurse visits recorded on file. Service Users spoken with were aware of their care plans. One advised that “ my weight is the main thing we are working on. They make me sugar free jellies”. 11 Service Users medication administration was observed and records were checked for 11 Service Users on one unit, and practices and recording were discussed with the senior carer. A very nice manner was observed, with quietly made enquiries to Service Users was evident buy the carer administering the medicine. Medicines were, however, signed for before they were seen to have been taken by the Service User in most cases, and the senior confirmed that they do not routinely observe medications being taken. A number of gaps were found in the medication administration records (Mars sheets). There were two inconsistencies in recording of medicines returned and a book detailing changes of medication, which included changes in doses and discontinued tablets. The majority of medicine bottles seen had not been dated when opened. The senior carer advised that they had not been told to do this. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 , 14 Service Users can expect to enjoy a good standard of daily life at the home, with access to a full range of activities, and ongoing social support from staff, provided in a pleasant homely atmosphere. They can expect to have choice over their daily routines, and support and encouragement when this is needed. They can be confident that their visitors will be made to feel welcome and will be able to see them in private. EVIDENCE: Service Users were seen making use of the garden, including a raised flowers garden, and were appropriately clothed for the hot weather, including one with a sun hat. A number of Service Users were in the homes day centre, taking part in, and seeming to be enjoying a memory quiz. A notice of available activities and events was on display in the units. A forthcoming fete at the home was advertised. One Service User said, “They look after you very well here. You can always go and talk to someone if you are a bit upset. I enjoy doing things, playing games, playing bingo. Whenever there is entertainment I always go... (and) I go to church on Sundays” Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 11 Service Users on the mainstream unit confirmed they could see guests and relatives when they wanted to, and that they were able to make them a cup of tea. They said that whilst they could always make a cup of tea, they would be asked by staff if they wanted a cup of tea as soon as their cup was empty. Service Users said that their relatives could arrange to have a meal with them. They confirmed they could get up when they liked, and have a bath when they liked, but would be encouraged if they needed to be. The home had recently had some problems with petty vandalism. This was discussed, and seen to be handled with confidence and in such a way as not to escalate difficulties. The covered veranda on one unit had been temporarily closed, due to damage from stones. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service Users can expect to feel comfortable raising any concerns in the home, but at present cannot be sure that all complaints are fully logged. EVIDENCE: Suffolk Social Care Services complaints leaflets were on display in the foyer. The contents were not summarised in the Service User’s Guide. When asked if the felt able to raise any complaint, one Service User said that “we can say what we want, no worries.” Another described the manager as very approachable. A file containing records of complaints recorded outcomes and processes. No log of complaints was maintained, so it was not possible to ascertain whether all complaints received had been dealt with. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 23, 24, 26 The home provides a good environment, which is well maintained. Service Users can expect to be able to personalise their own rooms, and to have all appropriate specialist equipment to maximise their independence. Service Users with incontinence problems cannot be confident that they will have their rooms kept odour free. EVIDENCE: A tour of the premises was made, and it was seen that the entrance to the day service was a shared common entrance with the home. Each of the units had separate front doors, and all were a different colour, making recognition easier in building that might otherwise be confusing for some Service Users, as the 3 units are all of a similar design. Some of the individual service rooms however, had two sets of room numbers on them, one of which no longer applied, and is potentially confusing. The home was seen to be in a good state of repair, well decorated and comfortable. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 14 A bar of soap and a towel were seen in one shared bathroom, however liquid soap and paper towels were available. Specialist equipment, including hoists and pressure mattresses were available. Hoists were appropriately stored. Individual rooms were attractive and personalised. Service Users spoken with said that they home was always nice and clean and up to the standard it should be. One said that they had been in another home for several years previously, and that this home was “brighter, had a better atmosphere, had nicer decorations and was kept nice and clean.” One Service User, adding to the discussion on the homes atmosphere being important, noted that they had “never heard any quarrel between any of The ladies, staff or Service Users as long as I have been here” Two Service User’s rooms had a vinyl type of floor covering. A carer advised that it was easier top clean than carpet, and that the Service User “thinks its’ fantastic”. The room however had a strong odour of urine. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 Service Users can expect the homes manager to have background information on staff, including those who have transferred from another Social Care Services home. The home was well staffed during the afternoon and evening of the inspection. Staff were able to interact well with service users and out carry out care tasks in a calm manner. EVIDENCE: Files of two members of staff who had been transferred from another County Council home were inspected, and were found to contain all required information relating to their recruitment. The staffing rota, observation and discussion with the senior carer established that there were to carers on each unit on the afternoon of the inspection. One of these as an agency worker. Additionally, Woodleigh and Foxfields shared a floating worker after between 5pm. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33,37,38 Service Users can expect to live in an environment which is safe from physical hazards and which has an open atmosphere. Service Users interests are not consistently protected through safe storage of information. EVIDENCE: There was a good atmosphere across the home, and staff were seen to be actively involved interacting with Service Users when not doing direct care tasks. A Residents Satisfaction Questionnaire had been forwarded to the CSCI following the last announced inspection, but no evidence of this having been carried out, and used as part of the homes development plan was available at the inspection. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 17 Care plans for Service Users were kept on the individual houses in cupboards in the kitchen / dining areas that had been fitted with locks, however, two of these cupboards was found to be not locked at the time of inspection. Clear notices were displayed throughout the home reinforcing health and safety policies and practices. A warning bollard was seen to be in use where a carpet had been cleaned. Hazardous Chemicals were stored in the laundry that was found to be locked. Staff confirmed that this room was locked at any time no one was in it. Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 x x 3 x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 3 2 x x x 2 3 Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? 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. 2. Standard 7 8 Regulation 15(1) 13(4) Requirement Service Users must current and complete care plans without delay, following admission. The registered persons must undertake and regularly reveiw risk assessments in relation to each service users’ susceptibility to developing pressure ulcers. Unexplained gaps must not occurr in mediaction record Medicines must be seen to have been taken before they are signed for. The medications returns book and the changes in Mediaction folder must be checked to establish consistency, and where this is not found an explanation established. Medicine bottles should be dated when opened. Continence pads must be stored discretely in service users rooms Two bedrooms had vinyl fllooring rather than carpeting. Private accommodation should be both homely and domestic in nature. The Registered Persons must demonstate how this flooring meets the assessed needs of service isers in these rooms. Timescale for action Immediate and ongoing. 31/08/05 3. 4. 5. 9 9 9 13(3) 13(2) 13(2) Immediate Immediate Immediate 6. 7. 8. 9 10 24 13(2 & 4) 12(4)(a) 16(1) 16(2)(c) 23(1)(a) Immediate Immediate 31/08/05 Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 20 9. 10. 11. 26 26 33 13(4)(b) 16(2)(k) 24 Bars of soap and handtowels must not be kept in shared bathrooms. The home must be kept free from unpleasant odours. Immediate Immediate and on going 31/08/05 12. 37 17(1)(b) The registered persons must establish a formalised system for reviewing and improving the quality of care provided at the home. This system must take account of the views of service users and their representatives. Service user plans must be kept Immediate securely within the home. This and requirement is repeated from the ongoing last three inspections. 13. 14. 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. Refer to Standard 1 7 7 Good Practice Recommendations The Service user Guide should include all matters referred to under Standard 1.2 of the National Minimun Standards. A log of any changes made to care plan bewteen main reveiws should provide evidence of monthly reveiws taking place. Life stories should be completed for all service users at the home to inform staff of important information relating to significant events and the life achievements of the service users. A complaints log should be maintained. Service User rooms should have only one number on them to avoid confusion. Any bedroom flooring which is not consistent with the care standrads should be detailed in the Statement of Purpose and relevant individual contracts. Service users should be consulted on their views about sharing the homes main entrance with other facilities. I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 21 4. 5. 6. 7. 16 19 24 33 Blyford Residential Home Commission for Social Care Inspection CSCI, 5TH Floor, St Vincents House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blyford Residential Home I54-I04 S37146 Blyford V224223 050617 Stage 4.doc Version 1.30 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!