Inspection on 18/08/06 for Blyth House

This inspection was carried out on 18th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Blyth House 16/04/09

Blyth House 21/05/08

Blyth House 29/10/05

Blyth House 18/05/05

Blyth House 21/12/04

Blyth House 24/08/04

Blyth House 16/12/03

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

CARE HOMES FOR OLDER PEOPLE Blyth House 16 Blyth Road Bromley Kent BR1 3RX Lead Inspector Wendy Owen Key Unannounced Inspection 10:00 18th August 2006 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 Blyth House DS0000037404.V296132.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. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blyth House Address 16 Blyth Road Bromley Kent BR1 3RX 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) 020 8460 3070 blythhouse@tiscali.co.uk Chislehurst Care Limited Ms Rhona Delores Robinson Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th October 2005 Brief Description of the Service: Blyth House is a twenty-two bedded facility, providing nursing care for service users in the category of Older Persons. The home has been registered to the current provider since September 2002. The home was previously registered under the Registered Homes Act 1984. The premises have been adapted and are purpose built. It has bedroom accommodation on the two floors. Communal areas are located on the ground floor with the laundry located in a separate building at the rear. The number of double rooms have reduced this year from eight to seven with an increase to eight single rooms. A garden is located to the rear of the building with hard parking to the front of the building. The home does not have full disabled access. The top floor of the building is used as staff accommodation and is therefore not part of the registered premises. The home operates with qualified nurses and care assistants throughout the twenty-four hour period. Residents are supported by GP services and specialist health provision, such as the Community Psychiatric Nurse. Fees range from £542-£690. Additional charges are made for hairdressing, magazines, papers, toiletries and clothing. The home has developed a Statement of Purpose and Service Users Guide which provides prospective residents and their representatives with information on the care provided. Inspection reports available from the home on request. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one and a half days. The site visit included a tour of the building; discussions with residents, relatives, staff and Manager, viewing of records and policies and procedures. The inspector spoke to three residents, two relatives and three staff members. Four written comment cards were received from relatives and two from residents. What the service does well: Relatives provided the following comments “I feel the standard of care my mother receives if first class.” “I am completely satisfied for the care that X receives.” “We have been extremely impressed with the level of care given to my mother……..Nearly all the staff greet us with welcoming smiles and are obviously very caring.” A resident said that staff are sensitive, kind and caring. The home provides comprehensive induction training for new staff with ongoing training. The food provided is healthy and nutritious with choices for residents on meals and dining arrangements. The assessment and care plans provided information on the individual support and although there were a few gaps these were generally satisfactory. The plans were well supported with good records on accessing health professional for advice and support and overall adequate medication practices and procedures. Blyth is clean and generally well decorated with a warm and welcoming environment with good practices in relation to infection control. The Manager is qualified and experienced, approachable and listens to concerns or issues raised. With the Provider ensuring that there is regular monitoring of the quality care in the home. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home must ensure that it admits residents within its category of registration and ensure that an application to vary its registration is made when any changes are made, including numbers. Whilst the home undertakes assessments of prospective residents before they make a decision to admit there is still no confirmation in writing that they are able to meet their needs. On the day of the inspection there was a lack of contracts in place and therefore residents and relatives are not always aware of the terms and conditions of residency or the placing authority agreement. There have been improvements made in respect of the care planning and risk assessment although gaps were still identified which may be significant to the care. Medication practices were generally safe and well recorded although some practices place residents potentially at risk and need to be improved. There is also the need to ensure the information available to residents and relatives is more freely available and in appropriate formats. Staff must also be provided with clearer guidance and information to ensure residents are safeguarded. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 7 The lack of documents and required checks of new staff employed by the home also place resident at risk and must be improved. The home generally provides a warm and comfortable environment for residents although there are some areas that require attention. The systems in pace for managing the care are satisfactory but need to be improved in the following areas; the Provider has developed a basic quality assurance system which does not fully meet the regulations. A fuller consultation and report on the outcome must be provided in order that appropriate action is taken to improve the care; the home must ensure that the Commission is notified of the incidents as required under regulation 37. Currently the home has generally informed the Commission of deaths and very little else. 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. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate system for admitting and assessing prospective residents. However, they admit outside the category of registration. This places residents potentially at risk of inappropriate care. EVIDENCE: All prospective residents are assessed prior to admission. Where residents are placed though the Local Authority or PCT appropriate assessment information is obtained by the home. An assessment is also made by a member of staff from the home to ensure they are able to meet the residents’ needs. The records of two recent admissions were viewed and found to contain the required information. However, there is some concern that the home admits residents outside of its category of registration ie individuals with dementia. The assessment of a client admitted in March 06 stated confusion, CVA and cognitive impairment and the care plan developed in May 06 recorded dementia. The pre- inspection questionnaire said 10 of the 20 residents have dementia. The staffing levels are determined by the nursing needs and do not Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 10 reflect the requirements of those with dementia. The Manager must ensure that the home is able to meet the residents’ needs and, where necessary, make an application to vary its registration to include the residents with dementia. (See requirement 1) Prior to admission it is, in general, the family that visit the home due to the resident’s dependency. Contracts were not available for new service users during this inspection neither for Local Authority, PCT or self-funding residents. (See Requirement 2 & recommendation 1) The home provides respite care at times but no intermediate care Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has made progress in ensuring care plans reflect the identified needs of residents ensuring staff have the information to provide residents with appropriate care and support. Medication practices are adequate and with some further improvements the home will ensure that residents health needs are being met. EVIDENCE: The standex care planning system is used to develop care plans and risk assessment. These have improved since the last inspection. Two files were viewed and these generally had care plans and risk assessments which reflect the identified needs from up to date assessments. There were some gaps noted, including detailed risk assessments for bed rails and use of catheters and risk of infection. Risk of falls had been identified, albeit in a very brief format. The Manager stated that a new falls risk assessment has been developed which will provide more comprehensive information and interventions. This is due to be implemented in the near future. Pressure care risk assessments were in place and had been included in other areas of the care plan. However, it is recommended that this be included as a separate care Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 12 plan detailing the combined action of other care plans as well as core intervention. Where residents use catheters there should also be a corresponding risk assessment detailing the risks eg risk of infection, blockage. Wound care is detailed in the plan with appropriate records in place. In one file the assessment detailed the use of pads but his information had not been transferred to the care plan. It also detailed that personal care included choice of shower or bath. However, the supporting information showed that the resident often refused a bath and a body wash was provided. This must be made clear in the care plan. It is recommended that the care plans detail the number of staff involved in mobility and personal care to ensure staff have the information to provide the care. (See recommendation 2, 3, & 4) Nutritional risk assessments and corresponding care plan records are also in place. Weights are recorded regularly and there is indication that, where there has been weight loss, there is some indication as to the reason why. The care plans also detail contact with dietician and the use of food supplements, where appropriate. There was evidence of care plans being regularly with the initial assessments and care plan being signed by the relative. It is recommended six-monthly reviews take place with resident/relative involvement. (See recommendation 5) Feedback from relatives and residents show that health care needs are met. Discussions with relatives and residents on the day also confirmed this. The home had good records of health professional input including tissue viability, CPN, infection control, podiatrist, chiropodist, GP, optical examination and dietician support. The records also showed where there are problems, such as with catheterisation there is CHLT involvement. A number of residents have bedrails in place. The recording of the justification and reasons for their use must be improved to ensure the decision making is clear. (See requirement 3) Medication procedures case tracked those care plans and assessments viewed. There was evidence of medication prescribed on admission on assessment and receipt of medication is also recorded. Medication administration records (MAR) were generally completed fully, although there were a few in relation to allergies and one or two gaps on the MAR, where medication had not been signed for and not given. There was no reason recorded. In most other cases the reasons for non-administration had been noted. In most cases hand transcriptions were recorded with two signatures in place. The records detailed administration required, although in some cases the “as required” need a little more information and guidance on when to administer. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 13 The system for recording PRN needs to be consistently applied and where there are a number of MARs in place for one resident, the records should show how many pages For example 1 of 4 etc. (See recommendation 6) All medication is stored securely in a locked trolley, located in a locked room when not in use. Controlled drugs are stored in a controlled drugs cupboard and recorded in a controlled drugs book with two signatures. Medication is also stored in a freezer, where appropriate, with the temperature recorded daily with a maximum and minimum thermometer. Calagen stored in the fridge did not have a date of opening and was prescribed in June with a timescale for use within fourteen days. All other medication had the date of opening detailed. (See requirement 4) The residents are treated with respect and dignity and their privacy assured. Privacy screens are available in double rooms and preferred names are used. Relatives spoken to said staff were considerate and sensitive to residents’ needs and whenever personal care is undertaken the doors are shut and staff knock to enter. Staff were observed interacting with residents and relatives. One relative stated that due to her very regular visits she would have “picked up” any concerns and would not hesitate in raising them. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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. The provision of activities in the home is improving therefore providing residents with a more stimulating environment. There is still some capacity for improvement. The quality of meals provided and the way in which they are served ensures residents’ individual needs can be met with a healthy and nutritious diet. EVIDENCE: The residents at Blyth House are quite dependent and the last inspection raised issues regarding the lack of activities and stimulation including the lack of records. This has now improved with evidence of activities including one to one taking place. There is also entertainment brought into the home once a month. Many residents do not wish to take part and are happy to spend their time in their room reading or watching TV. On the day of the visit bingo was taking place with a small number of residents choosing to take part. The activity schedule was posted on display on the lounge. Residents’ and relatives’ feedback showed that routines are fairly flexible with residents choosing to get up and go to bed when they wish. A number of residents choose to remain either in bed or their rooms during the day and take meals there. Rooms are furnished with TVs and radios etc. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 15 There is a key worker system in place with the staff member responsible for the individuals’ rooms, clothing etc and taking a particular responsibility for their care. Information is provided on how to complain both the Providers and social Services and there is information on advocacy services and how to contact them. Visitors are welcome throughout the day. One relative is actively involved in their relative’s care and visits twice and day. The home understands her need to be involved and will provide the support and help she wishes. There is a good communication system in place. Another relative said that they are always offered a drink and a “warm welcome.” The inspector observed good interaction between the Manager, staff and relatives. A relatives’ meeting took place September 05 and was well attended. However, the Provider is due to change the system and have a regular surgery to enable more confidential and personal communication between parties. Residents meetings also took place with the minutes of the last two viewed. The Manager must show how issues raised are actioned and addressed. (See recommendation 7) Residents are able to have their own possessions around them. One relative has decided to bring in the family members furniture, linen etc. This she said was is no way a reflection on the home but what she wishes to do. The home ensures the possessions present no risk to health and safety. Food is varied with the menu showing choices each day. The feedback about the quality of food was mixed with one resident saying there are too many casseroles and another saying more fresh fruit and salads are required. One resident enjoys marmite on toast and has their own supply of marmite at their choosing. The home provides for pureed, soft, vegetarian and diabetic diets and can cater for others if they are needed. Refreshments of hot or cold drinks and biscuits are served at various times throughout the day. Meals and refreshments can be taken in the dining room or individuals own rooms as they wish. A brief observation of the lunch showed staff to be assisting residents according to good practice with the meal appearing appetising and well presented. The recent residents’ meetings picked up some minor issues with food. Comments made earlier state that the Manager should record how these issues have been addressed and hopefully resolved. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel safe and listened to. However formal processes need to be further developed so that the home’s procedures are available, understood and consistently applied. EVIDENCE: A copy of the home’s complaint procedure is on display in the reception area. This states that it is available in larger print on request. Very few of the residents are mobile and therefore in reality this procedure is for visitors. The Statement of Purpose and Service Users Guide contain a copy of the procedures, although the Manager has yet to provide the residents with a copy of the Service Users Guide. This is to be implemented. Residents would also benefit from receiving this information in another format eg verbal communication rather than the written word. (See Requirement 5) Residents and relatives spoken to said they felt the staff listened to concerns and the Manager is “particularly kind and caring” and acts on any concerns raised. Relatives and residents written feedback also provided a similar response. There have been no concerns in the last twelve months, although there are appropriate procedures in place for recording and management of these. Neither the Commission or Bromley Social Services complaints department have received any complaints or concerns over the last twelve months. One relative said they would not hesitate in bringing concerns to the Manager but “there is no need.” Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 17 Adult protection procedures and Whistle-blowing procedures have also been developed. Staff receive adult protection training via videos and questionnaire. Some have undertaken external training via Social Services. Adult protection was discussed with three staff. Staff spoken to had a basic understanding of the action to be taken if an allegation was made but there were some gaps in their knowledge of this subject. Staff will therefore benefit from the planned training. There is a need to ensure it is clear for staff, from policy and procedures, the role of other agencies, in particular social services as lead agency. Staff also need to be aware of consequences of proven allegation and referral to the Protection of Vulnerable Adults Register. (POVA) Whilst the procedures refer to POVA they should make clear that it is the Providers responsibility for referring on. Blyth House has had no incidents or allegations requiring investigation. This is more to do with lack of incidents rather than not referring on. (See recommendation 8) Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Blyth House provides a generally comfortable, clean and satisfactorily decorated environment. However, there are some areas which require attention to ensure all areas are well maintained and comfortable. EVIDENCE: Blyth House is generally well maintained and reasonably decorated adapted house. It is furnished in a comfortable and homely fashion. However, the corridor carpets appear worn and tidy giving a negative impact. (See requirement 6) The last inspection identified burglaries of office equipment taking place. There have been no further incidents due to the action taken by the Provider. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 19 There is a dining room/lounge on the ground floor and at the rear of the house there is a secluded garden and patio area with garden furniture. The communal areas are not well used with many residents choosing to remain in their rooms. The bedrooms have all been redecorated over the last twelve months with new furniture purchased. Individual rooms are personalised with residents’ possessions and mementoes. Discussions with one relative showed that furniture and other possessions may be brought into the home. In this particular instant the relative wished to supply the bed, linen, furnishings and other belongings and this had been agreed by the home. Bedroom furniture is sited according to the needs of the residents with appropriate beds and equipment in place ensuring staff and residents are provided with appropriate access and space. Shared rooms are provided with screening and bedrails are in place where risks have been identified. Please note comments made in the health and personal care outcome group. There are bathrooms and WCS located on each floor. The equipment had been serviced and temperatures of the hot water were satisfactory. Appropriate hand washing facilities were in place. The wash hand basin pedestal in bathroom 1 was cracked and broken and the shower room on the first floor is used to store equipment, making it unusable. (See requirement 7 & 8) Since the last inspection last inspection the laundry equipment has been lowered for safer use and a laundry assistant employed to undertake the increase in the laundry tasks. The risk assessment identifying the access to the external area was viewed and whilst this detailed the risks and what staff should do to minimise the risk this had not been reviewed since 2004. A brief discussion with the laundry assistant showed them to believe there to be no health and safety issues. Hand-washing facilities are located throughout the appropriate areas including bathrooms, wcs and laundry. Gloves and aprons were noted placed around the home and in rooms where there was a need for infection control. The procedures in place for minimising the risk of infection were good and staff had a sound knowledge of this. All feedback was positive regarding the cleanliness of the home. Areas of the home viewed were found to be clean and fresh, with the exception of the carpets which looked worn and tired. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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. Staff receive adequate training and support and there is further capacity to improve in this area. However, the admission of residents outside of their category of registration must be addressed as it means that staff may not always have the training, knowledge and skills to provide the most appropriate care. The recruitment practices still require improvements to ensure that vulnerable residents are protected. EVIDENCE: The Department of Health staffing notice was amended a few years ago with the result that the home is being staffed morning and evening with one RGN and 5 care staff, including one senior. It was agreed at the time of the change that the level should be reviewed to ensure the needs of the residents continue too be met. With a number of residents with dementia and the home continuing to admit residents in this category the Commission has requested the Manager undertake an analysis of the residents needs. The outcome of w may require further variations if agreed, a review of the staffing levels and the training provided. The home is also supported with an activity co-ordinator catering, domestic and laundry staff. The staffing roster viewed showed that the management and activity coordinator hours were not always noted on the roster. (See requirement 9) Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 21 Since the last inspection last inspection the home has recruited a number of new staff. Three of the latest employees were viewed. These were of a mixed standard. One member of staff had transferred from another home in the group. However, the file contained no Criminal records Bureau check (CRB). The original check appeared to have been carried out in 2002. There is no firm evidence of this and it is also good practice to ensure that these are updated regularly. In the one other file there was a POVA check but no CRB and this individual was working unsupervised. In the third file there was a POVA and CRB check. On each file there was evidence of proof of identity but on two file only one reference was obtained. There is some evidence of qualifications with certificates maintained and PIN numbers checked for nurses. (See requirement 10) The provision of training was also discussed with three staff. This includes induction for new staff (home and Skills Sector training). During the first week new staff work with other care staff observing good practice. This period may be extended of the home or staff member requires it as in the case of one new staff member. Induction includes a tour of the home, emergency procedures, including fire and video regarding moving and handling. Staff spoken to had an understanding of accident reporting, fire procedures and COSHH. Staff must be provided with moving and handling training, by a competent trained person with a video used as supporting guidance and information. (See requirement 11) Training provided includes moving and handling, dementia, customer care, adult protection, wound care, venepuncture, first aid, applying dressings, nutritional screening, food hygiene and pressure care. Not all staff have received this training. Blyth has thirteen care staff, 5 staff have NVQ 2 or above, one member is undertaking a nursing care course and another access to nursing. This just meets the 50 required but action should be taken to ensure the remainder of staff have the NVQ 2 in care qualification. (See recommendation 9) Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. 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. The management of the home is good in a number of areas but gaps, including systems for improving the quality of care, means that residents may not always receive consistent care. EVIDENCE: The Manager has been in post for approximately two years and is a qualified nurse and has the Registered Managers’ Award. The inspector received good feedback regarding her attitude, approach and caring nature. One relative wrote we are “… particularly grateful to matron for contacting us if there have been any problems.” The Provider has improved their system for undertaking monthly visits as required under Regulation 26 with the Commission receiving the outcome in report format. These reflect the current situation in the home with an element of auditing also included. Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 23 As part of reviewing the quality of care the Provider sends out monthly questionnaires to two relatives, residents and staff. These are returned to the Provider and viewed. However, there is no formal system for analysing, reporting and taking appropriate action. The scale of the review is also limited and should include a larger consultation group undertaking at least annually. (See requirement 12) Neither the home nor organisation hold residents’ monies. All purchases are made out of petty cash and receipts sent to the Head Office for relatives or representatives to be invoiced. This can be audited. The pre-inspection completed before the visit detailed a number of health and safety servicing of equipment and services. A number of these were sampled and found to be appropriate and in date. Electrical portable appliances are in need of the yearly test. This is in hand. Core training includes First aid and moving and handling. Infection control training is being planned this week as is adult protection training. Staff had a basic understanding of this and appropriate practices were observed throughout the day. The last inspection recommended that domestic had infection control training. This has yet to be implemented. Any training must take into consideration the Department of Health guidelines recently produced. Kitchen staff have received food hygiene training. Bedrails are in place for those where the need had been identified. However, previous comments identified the need for more in depth risk assessments including the decision-making process regarding the use. The inspector sent guidance which will assist in the process. Viewing of the accident records and the number of notification received by the Commission has identified that not all incidents are being notified, as required. Further information and guidance was provided on this matter. (See requirement 13) Appropriate insurances were in place together with the Registration certificate. However, the home should seek an application to vary its registration due to the change in numbers. At present the certificate does not reflect the current numbers. (See requirement 1) Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 2 2 3 2 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/a X X 2 Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 25 Yes 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 Standard OP3 Regulation Requirement Timescale for action 01/10/06 2 OP2 3 OP7 4 OP9 5 OP16 CSA 2000 The Registered Person must only Regulation admit service users within its 15 category of registration. Variations to the registration certificate must be applied for. 5 (b) The Registered Person must ensure all residents are provided with contracts and the placing authority agreement, where applicable. 13 (4) The Registered Person must ensure that, where bedrails are in place, a comprehensive risk assessment is developed which includes the decision making process. 13 (2) The Registered Person must ensure that there are safe systems for ordering, receipt, recording, administration and disposal of medication. Specifically, medication with timescales for use must record the need date of opening and be used within the timescale; “as required” medication must have full directions for administration. 22 & 5(2) The Registered Person must DS0000037404.V296132.R01.S.doc 01/10/06 01/10/06 01/10/06 01/10/06 Page 26 Blyth House Version 5.2 6 OP19 23 7 8 OP21 OP21 23 23 (l) 9 OP27 17(2) 10 OP29 19 ensure that residents have full information on how they can make a complaint. The Registered Person must replace the worn carpet in the corridors. Please supply an action plan for their replacement. The Registered Person must repair or replace the wash- basin pedestal in bathroom 1. The Registered Person must ensure that the shower room is made fit for use. Storage items must be removed. The Registered Person must ensure the staff roster records all staff hours of work including the management and activity hours. The Registered Person must ensure that recruitment procedures are more robust in order that residents are adequately protected. This is a repeated requirement. The Registered Person must ensure that staff receive training from a competent person. Specifically moving and handling training must be provided to staff prior to their commencing shifts within the home unless training is up to date. The Registered Person must ensure that quality of service is reviewed regularly, consulting with residents and a report on the outcome of the review provided to the Commission. The Registered Person must ensure that the Commission is notified of all incidents as required under Regulation 37. 01/11/06 01/11/06 01/11/06 01/11/06 01/11/06 11 OP30 18 01/11/06 12 OP33 24 01/01/07 13 OP38 37 01/09/07 Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The Registered Provider should amend the notice period for non-payment of fees, in the homes contract, to ensure this is fair and reasonable to residents. The Registered Person should ensure a full risk assessment is undertaken where catheters are in situ. The Registered Person should ensure separate care plans are developed identifying pressure sore and interventions. The Registered Person should ensure care plans are more reflective of the care required. Specifically issues with personal care and number of staff required to provide support. The Registered Person should ensure full reviews are undertaken regularly. The review should include the resident/relative/representative involved. The Registered Person should ensure medication administration records are numbered; allergies are recorded or if none known; hand transcriptions have two signatures; one procedure is used for the administration of “as required” medication. The Registered Person should ensure meetings record the action taken by the home to address the issues raised. The Registered Person should ensure all staff are aware of the procedures for safeguarding residents. The Registered Person should provide the Commission with an action plan as to how they intend to increase the number of staff with NVQ 2 or above. 2 3 4 OP3 OP8 OP7 5 6 OP7 OP9 7 8 9 OP14 OP18 OP28 Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Blyth House DS0000037404.V296132.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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