Inspection on 03/04/06 for Blyford Residential Home

This inspection was carried out on 3rd April 2006.

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

Blyford Residential Home 04/02/08

Blyford Residential Home 01/05/07

Blyford Residential Home 23/01/07

Blyford Residential Home 22/08/05

Blyford Residential Home 17/06/05

Blyford Residential Home 24/11/04

Blyford Residential Home 07/06/04

Blyford Residential Home 09/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Blyford Residential Home 61 Blyford Road Lowestoft Suffolk NR32 4PZ Lead Inspector Julie Small Unannounced Inspection 3rd April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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.V287864.R01.S.doc Version 5.1 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@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.V287864.R01.S.doc Version 5.1 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. 22nd August 2005 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. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days on Monday 3rd April 2006 for seven hours and 18th April 2006 for almost two hours. The inspection was undertaken by regulatory inspector, Julie Small, and was assisted in the process on 3rd April by the homes manager and 18th April by a senior staff member. Medication inspector Mark Andrews undertook an inspection of the medication procedure of the home on 3rd April, these findings are summarised in this report, a detailed additional visit record has been forwarded to the home. This was a key inspection which focused on the care standards relating to older people. The report has been written using cumulated evidence gathered prior to and during inspection. A tour of the building and observation of work practice was undertaken during the inspection. Several residents were met and three individual residents and a group of four residents were spoken with. Ten staff members were spoken with. Residents and staff welcomed the inspector to the home and provided all requested information promptly and openly. Records viewed during the inspection included staff recruitment, induction and training records, work rotas, menus, residents’ records, fire safety records, health and safety records, residents questionnaire and the service users guide. What the service does well: What has improved since the last inspection? Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 6 The service users guide has been amended and includes a summary of the complaints policy. The homes infection control policy in relation to soiled linen was being adhered to. There had been five staff employed since the last inspection, there have been clear efforts to improve the staffing of the home. The homes manager had completed her NVQ (National Vocational Qualification) level 4 in care in March 2006. The decision to use pressure mats in resident’s rooms were explained and recorded in their records. 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 DS0000037146.V287864.R01.S.doc Version 5.1 Page 7 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.V287864.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 Prospective service users can expect that they will receive adequate information from the service users guide, they have their needs assessed and that they, their friends and relatives have the opportunity to visit the home. The home does not provide intermediate care. EVIDENCE: The service users guide was viewed, it was an attractive document, with pictures and written in plain English. The service users guide includes a clear description of the service, costs and type of accommodation which would be provided, staffing information, such as their qualifications and numbers of staff on duty at times throughout the day and a summary of how service users or their representatives could make a complaint. The service users guide includes an explanation of CSCI inspection and how often these are undertaken. However, the contact details of the local CSCI office are not included. Seven service user records were viewed and evidenced that the homes manager undertakes a needs assessment of each service user prior to them moving into the home. Two of the service users records included care management assessments and care plans. A discussion with the homes Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 9 manager and a service user was observed regarding the assessment and visit to a hospital the manager had made to the service user, and how the service user became to be accommodated in the home. This evidenced that this was undertaken appropriately. Records viewed contained care plans showing how the assessed needs would be met by the home. The manager confirmed that service users are provided with the opportunity to visit the home if the move is planned, service users had been accommodated who had previously used the short term service provided by the home, so were aware of the service that would be provided to them at the home. The home does not provide intermediate care, a senior staff member spoken with confirmed that the home provides a respite service, where two beds are available. The booking chart was viewed for the respite service provided by the home, which provides a service for up to two people for on average two weeks throughout the year. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Service users can expect that their health, personal and social care needs are set out in an individual plan of care and that their health care needs are fully met. Service users can expect that they are treated with respect and their right to privacy is upheld. The home does not meet the required standard with regards to the storage and administration of medicines. EVIDENCE: Service users records viewed included detailed care plans, which show how the home would meet their assessed needs. The care plans were updated regularly and also contained a ‘spider chart’, which identified a summary of the care plan, including ‘likes one sugar in their coffee’, ‘prefers a bath’ and ‘wears dentures top and bottom’. One staff member was spoken with and said that the spider chart does not replace the care plan, but can be used for reference at times such as when assisting service users when they became confused. The care plans show when service users have received support from health care agencies and any treatment received. Care plans viewed included information regarding the prevention of pressure sores, nutritional information, Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 11 assistance required during personal care, continence management and weight charts. A group of four service users were spoken with and said that they have an optician, hairdresser and chiropodist who visit the home. They said that there is a local dentist whom they use and they can have a doctor visit the home or they can go out to a surgery. A recommendation from the last inspection report was made, to record in service users records why decisions to use pressure mats have been made. This recommendation has been met, with the reasons why pressure mats were used. One staff member spoken with said that some service users are unable to use the call bell, due to their confusion, but they were still reminded to use these. The care plans viewed include a ‘life story’, which provides a history of the service users life. One staff member spoken with said that this helps with when the service users have talked about their past, such as when working in the police force or in the navy, and this has helped with their responses to the service users. One service users history had not been obtained, and the manager confirmed that the home have attempted, and continue to, locate some aspects of the service users life. The manager said that information for the life story has been gained from family, friends, previous carers and service users. The manager said that family; friends and previous carers are requested to provide some historical information when the service user is admitted to the home. Care plans viewed included directions for what names service users preferred to be called. One service user was spoken with and said that they preferred to be called by their middle name rather than their first name. They confirmed that staff always respected this. A group of four service users spoken with said that they could use the homes pay telephone to make calls if they wanted to and that they can receive telephone calls on the home telephone. They said that their mail is not opened by anyone other than themselves. One service user spoken with said that they help to sew their peers name tags into their clothing. The laundry was viewed, clothing was labelled with service users names and when clothing has been laundered they are returned to the owner. Staff induction records were viewed and evidenced that staff were instructed on the homes philosophy and how service users should be treated with respect. Service users spoken with confirmed that staff are respectful and always knock their bedroom doors and the bathrooms if they are using them, before entering, this was confirmed through observation of interaction and work practice of staff during the inspection. The home had a pet budgie, which was on one of the homes units. When asked about the pet, service users and staff said that the budgie has a care plan, Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 12 which was viewed. This was found to be helpful to the service users in their understanding of care plans and how they were used. A group of four service users spoken with explained about the recent death of one of the service users living on their unit. The medication inspector inspected the arrangements for medication at the home, a summary of their findings can be found in this report, a detailed letter has been forwarded to the home. The medicine round was observed, procedures followed for the selection, administration and record keeping of medicines were noted to be satisfactory. Medicines were mostly administered from a 28 day monitored dosage system (MDS). The administration of citalopram 40 mg oral drops was discussed as during the inspection four drops scheduled for administration were seen to be given via a plastic vessel. It is of concern that the administration of a small dose of liquid in this way, a significant proportion of the dose is likely not to be ingested. A staff member spoken with agreed to consider alternative means of administration of the medicine such as administration via a 5ml spoon. Timings of medication was of concern, which identified administration times as ‘breakfast’, ‘lunchtime’ etc. Breakfast medication was observed to be administered between 10.45 and 11.10 hours on one unit in the home, it is recommended that timings of medication be included on the medicine administration record (MAR) charts. The MDS and MAR colour coding was highlighted differently by the home, there were some inconsistencies between the location of some MDS blister packs and their scheduled time of administration, for example haloperidol 0.5 mg capsules scheduled for evening administration were found in the tea time section of the MDS rack. It is recommended that there should be regular reviews of medication administration to ensure that medicines are safely administered as scheduled. For service users prescribed psychoactive medicines on a PRN (as required) basis for management of psychological agitation there was insufficient written information to enable their appropriate use at all times. In view of this it is recommended that clear care planned guidance is formulated relating to the circumstances in which these medicines should be considered for administration. The MAR charts were viewed, it was found that there were a significant number of omissions, where it could not be determined if the medicines had been administered, the exact doses given were not recorded for prescribed medicines with variable doses and prescribed external medicines were not recorded appropriately. It was identified that ‘O’ is recorded when medication has not been administered, the precise reason for non-administration is not recorded, which include the non availability of the medication at the pharmacy. It is recommended that a detailed written procedure be developed for Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 13 obtaining medicines and action to be taken when the pharmacist is unable to supply a prescribed medication. It was identified that one service user who prescribed an antidepressant, administration was omitted in the evening as the service user was asleep. One service user’s MAR chart stated that the medication was prescribed for twice daily, administration was taking place once a day. The home has a dedicated central area for the storage of medicines including a cabinet for the storage of controlled drugs and a medicine refrigerator. Medicines for external application are stored separately to those for oral administration. Arrangements described for the safe custody of keys to the storage of medicines were noted to be satisfactory. It was noted that on ten occasions during the most recent four week period the temperature of the refrigerator had fallen below the accepted minimum temperature of 2°C. The manager confirmed that eleven staff were authorised to access, handle and administer medicines at the home. Eight had recently received external training provided by the pharmacist December 2005, the remaining three had received in house training and further training by the pharmacist was being planned. It is recommended that following training there is, via supervision, a regular assessment of the competences of authorised members of staff to safely administer medicines. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users can expect that their life in the home matches their experiences and preferences, that they maintain contact with family and friends, exercise choice and control over their lives and receive a wholesome appealing balanced diet. EVIDENCE: A group of four service users were spoken with and said that the home has religious services each Sunday, which they could attend if they wished. The service users said that there were various activities provided, such as bingo and singsongs, which they could also attend if they chose to. The group of service users said that they could exercise their right to choose what they do in their daily lives. There were several newspapers observed in two of the homes units, one service user spoken with who was reading a newspaper, confirmed that they have their daily newspaper delivered and that they had read this newspaper for many years. Staff were observed to ask the service user about the days news, which provided positive interaction and stimulating the service users interests and understanding. One service user was observed to be looking at a ‘past times’ book, which had pictures of items which had been used in the past, such as soap flakes and Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 15 food. There were several books, music CD’s and videos in the home. One unit were watching a ‘flog it’ type television programme and one unit were listening to Daniel O’Donnell and Jim Reeves music. Two service users sang a song to the inspector, and said that they enjoyed sing songs. Service users spoken with said that they maintain contact with family and friends by telephone, letter and visits. It was confirmed by the service users that they felt that their family and friends could visit them at any time during the day, but not when they ‘were in bed’. During a tour of the building there were several seating areas which visitors could use, which were comfortable and provided privacy away from the communal day rooms. A staff member was observed supporting a service user who had asked for information about their solicitor, who managed their financial affairs. This was provided promptly and sensitively, as the service user had become confused several times during the interaction. Service users spoken with said that they had some of their own furniture in their bedrooms. The manager was spoken with and said that the home should be informed of any personal furnishings that come into the home, to ensure that they meet health and safety requirements. Minutes were viewed of a recent service user meeting, where they were asked their opinions of the service they receive. The homes menus were viewed, which were displayed on paper on a notice board and written daily on large ‘white boards’ in units. The menu provided a nutritious, varied and well balanced diet. Each meal provided three choices, one of which was a vegetarian choice. Two catering staff members were spoken with; one said that service users are provided with a tick box, which they make their choices the day before they are served, they confirmed that they could change their mind, if they wanted another option on the day. One catering staff spoken with said that there are some service users who have specific dietary requirements, which they are notified of. The service users with dietary requirements needs were met, and these were also provided a choice of dishes, which met their needs. There were large bowls of fresh fruit in each of the homes three units. One staff member spoken with said that the fruit is ordered weekly and service users can help themselves to the fruit and are reminded it is there regularly. Service users were provided with hot and cold drinks and snacks such as biscuits throughout the day of the inspection. Service users were also provided with drinks as they requested them. During the inspection lunch time was observed, meals looked and smelled appetising. Two units had some food, which was those who require liquefied meals, these were provided separately, such as meat, vegetables and potatoes. Food was served in the units dining areas, which were attractively Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 16 furnished and provided sufficient seating. Main meals were served on plates at the table, with vegetables, potatoes and gravy served separately on the tables, which enabled service users to help themselves. One staff member was observed assisting a service user to eat their meal, the staff member sat by their side during the meal, and was observed to be asking the service user what they wanted next, and continually checked that they were enjoying their meal. Meal time was observed to be a social occasion, which service users were observed to be enjoying. Service users spoken with said that the food at the home was good. One service user said that the ‘food is good, and I should know good quality as my family were butchers’. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Service users can expect that their complaints will be listened to. Staff should receive further protection of vulnerable adults training to ensure that service users are protected from abuse. EVIDENCE: A requirement from the last inspection report was that a summery of the complaints policy be included in the service users guide. The service users guide was viewed and contained details of how service users or their representatives may make a complaint. Service users and staff spoken with clearly understood actions they could take if they were unhappy about something in the home. Staff spoken to explained what they would do if they were concerned about the safety of service users. A requirement in the previous inspection report was that staff are provided with updated POVA training. The manager was spoken with and confirmed that there were plans to deliver this training in house to all staff; however, this had not yet been actioned. Preparations had been made including a room, which would be used for the training with television and video equipment. Training materials, including videos, were viewed, which would be used on the training. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Service users can expect that they live in a safe, well maintained environment, which is clean, pleasant and hygienic. EVIDENCE: During a tour of the building the home was attractively decorated, homely and well maintained. Furnishings were found to be well maintained and comfortable. The grounds were observed to be attractively maintained, which were accessible to service users. It was a cold day at the time of the inspection and service users spoken with said that they only go outside when the weather is good. There were lots of seating areas around the home, where service users could relax and enjoy the views of the grounds. The home was clean and there were no offensive odours at the time of the inspection. One domestic staff member, who had been employed at the home recently, was spoken with. They had a good knowledge of the expectations of their role, and showed the inspector the sluice room, which held the COSHH (Control of Substances Hazardous to Health) cupboard, where items were Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 19 locked away. COSHH information was present for staff in the sluice area. A schedule was viewed which identified work which domestic staff were to complete on a daily basis, weekly basis, monthly basis etc. which were signed and dated when the tasks had been undertaken by the staff. Staff were observed wearing different colour tabards, two staff members were spoken with and clearly explained the needs and use of protective clothing. They wore white tabards for when they worked in the kitchen area and disposable aprons and gloves when assisting with personal care. There was hand wash gel situated around the home, which all those in the home could use. The laundry was viewed; this had appropriate washing facilities for service users. There was shelving and named boxes, where clean clothing would be placed for each service user. There were hygiene and health and safety notices displayed in the laundry. One laundry staff member was spoken with and explained the methods of undertaking their role. They confirmed that all clothing is named and clothing is returned to the owner, and unit on a clothing rail. The previous inspection report had a requirement that the infection control policy in relation to soiled linen must be adhered to. The manager was spoken with and confirmed that staff had been informed of this and notices had been placed in the home advising staff not to over fill soiled laundry bags and mix soiled laundry with unsoiled laundry in bags. The laundry staff confirmed that staff are adhering to the policy and explained how the bags and soiled laundry. Disposed bags were observed in the laundry. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Service users can expect that their needs are met by the numbers and skill mix of staff who are trained and competent to do their jobs and that they are supported and protected by the home’s recruitment policy and practices. EVIDENCE: Since the last inspection there have been four care staff and two domestic staff recruited. Two staff have left the home, so the manager confirmed that there would be further recruitment to meet these losses. The homes staffing rota was viewed and was found to provide sufficient staffing, one staff member spoken with produced a number of hours required to meet the needs of the service users at the home, this was viewed by the inspector. Five recruitment records were viewed and were well kept and met with requirements. Staff were appropriately inducted, receiving both in house and Suffolk County Council induction. One staff member was undertaking their first day of induction at the home, they were observed being advised on various duties by staff members throughout the day. Staff records viewed showed that staff receive sufficient TOPSS (now Skills for Care) induction and foundation training. The manager was spoken with and had an awareness of changes in the induction and foundation training requirements. The home has met the target of at least 50 of staff to achieve NVQ level 2 by 2005. One staff member spoken with, who is also an NVQ assessor at the home, confirmed that there are several staff who do not have the qualification, Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 21 on a waiting list to be registered to complete their award. One staff member was spoken with regarding the prospect of them completing their NVQ award; they had knowledge of requirements of the qualification. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38 Service users can expect that they live in a home which is managed appropriately and that their rights and best interests are safeguarded by the homes record keeping. Service users can expect that the home is run in their best interests, their financial interests are safeguarded and that their health, safety and welfare is promoted and protected. EVIDENCE: The homes manager completed their NVQ level 4 care in March 2006; they had previously achieved a management qualification. The manager had appropriate qualifications and experience and produced a training certificate where they had updated their practice. The manager confirmed that they work as a ‘dementia mapper’, where they visit other establishments to undertake dementia mapping. They had received training to undertake this role. The manager said that there has been individuals from other establishments undertake dementia mapping in their home. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 23 Discussions with the manager identified that they have a clear understanding of their role and explained methods of performance management, which is practiced in the home. Information provided to the inspector was provided in an open manner. Records viewed were well maintained, accurate and up to date. All records were stored securely in the home. Completed service user questionnaires were viewed, one staff member spoken with said that they had been completed in the past twelve months. The staff member said that where service users have difficulties completing the questionnaires they are assisted by family members, a return of approximately one third were received. The questionnaires format was a choice of tick boxes ‘always’, ‘sometimes’ and ‘never’, questions included were regarding the helpfulness of staff, the way the home is run, routines, food, activities and the environment. Minutes to group meetings were viewed from one of the homes dementia units, where service users had discussed their thoughts about the care they receive. A service user said that they have regular chats about what they think about the service and care they receive. The monthly managers (regulation 26) report was viewed which had taken place 11th April 2006, a copy was provided to the inspector. The report included the numbers of service users at the home, staffing, training, care plans, medication, activities, finances, environment and accommodation, records and discussions with service users. One staff member spoken with said that these are carried out on a monthly basis. The previous months reports were not received at the CSCI office by the inspector. Two service users records were viewed, which clearly identified their financial arrangements, with the use of a solicitor to manage their affairs. Service users and family wishes were recorded. Records were viewed of service users financial transactions, including their spending and receipts. One staff member spoken with explained that the service users monies are banked by the local authority and provided to the service user when required. All service users bedrooms have safe and secure drawers for the storage of their valuables and the home has central secure facilities for the safe keeping of service users valuables if required. A tour of the building was undertaken and a staff member provided explanations of fire safety of the home. Fire records were viewed, which evidence that regular checks are made of equipment and fire alarms and that all staff members are provided with fire safety training during their induction. During the first day of the inspection a newly appointed staff member was receiving fire safety training from the maintenance operative, who completes fire safety checks. All doors have fire closures which were installed last year. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 24 Water temperature checks records were viewed and water was of a consistent 40 – 43°C. Water checks were made across the home and in various outlets, including sinks and showers. The maintenance operative produced evidence where they clean shower heads on a quarterly basis. Records were viewed where contracted services have made repairs in the home, staff spoken with confirmed that they use two regular services. A hoist and stand aid were viewed in their usual storage location, which was safe and secure. There was a record of maintenance and cleaning of the equipment, which was viewed. There were seven first aid boxes in the home, three were viewed and were found to be accessible and well stocked, they included regular checks of the contents by staff. A central notice board was viewed which included information regarding the health and safety law, safety representatives, suitable and safe dress for work, reporting an incident and accidents, six staff responsible for First Aid names, who is the fire marshall and other staffs roles in the event of a fire and taking care of yourself and others. Three staff members spoken with explained protective clothing they wear at work and at different times including in kitchen areas and when providing personal care. Staff were confident in their knowledge of infection control. There were many hand washing facilities in the home, which staff were observed using. One domestic staff member was spoken with and showed the inspector the secure location where COSHH (control of substances hazardous to health) items are kept and guidance, which is available in each sluice area for staff’s information. One laundry staff member was spoken with and explained methods of infection control while undertaking their role, the staff member demonstrated a good knowledge of the expectations of their role regarding health and safety. Staff records viewed evidence that all newly appointed staff receive TOPSS (now skills for care) induction and foundation training, and in house induction where staff are informed of the homes health and safety procedures. Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 3 Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 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 OP9 Regulation Requirement Timescale for action 17/04/06 2. OP9 3. OP9 4. OP1 5. OP9 6. OP18 13.2, 13.4 The registered person must undertake a review of medicine administration ensuring medicines are safely administered at prescribed and scheduled times 13.2,13.4, The registered person must take 17.1(sch steps to ensure full and accurate 3) records for the administration of medicines are completed at all times. This must include medicines prescribed with variable doses and medicines for external use. 13.2, 13.4 The registered person must take steps to ensure medicines requiring refrigeration are stored within the accepted temperature range at all times 5(1)(f) The address and telephone number of CSCI must be included in the service users guide 26(5)(a) The registered provider should supply a copy of each regulation 26 report to CSCI when completed 13(6) Updated POVA training for all staff must be undertaken. Thus DS0000037146.V287864.R01.S.doc 17/04/06 17/04/06 30/05/06 30/05/06 30/05/06 Blyford Residential Home Version 5.1 Page 27 is a repeat requirement. 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. Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that the scheduled times for each medicine are expressed on MAR charts in terms of the precise times they are scheduled to be administered It is recommended that clear care planned guidance is formulated relating to the circumstances in which medicines prescribed for PRN (as required) use should be considered for administration It is recommended for purposes of safety of medicine administration that all MAR medicine entries include the medicine dose directions in full It is recommended that full records of the nonadministration of medicines are recorded on the reverse of the actual MAR charts and green duplicate forms are routinely removed prior to the use of the MAR charts each month It is recommended that a detailed written procedure is developed and implemented for obtaining medicines and action to be taken when the pharmacist is unable to supply a prescribed medicine It is recommended that audits of records are conducted by a senior member of staff at the home in order to promptly identify both record keeping and medicine administration inadequacies arising It is recommended that medicines not supplied in MDS containers are regularly stock checked and audit trailed on a monthly basis by annotating medicine stock figures carried forward at the start of each 28 day period It is recommended that members of staff become familiar with action to be taken at times when the temperature of the refrigerator moves outside the accepted range It is recommended that following training there is, via supervision, regular assessment of the competence of authorised members of staff to safely administer medicines 3. 4. OP9 OP9 5. OP9 6. OP9 7. OP9 8. 9. OP9 OP9 Blyford Residential Home DS0000037146.V287864.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent 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 DS0000037146.V287864.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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