Inspection on 21/05/08 for Blyth House

This inspection was carried out on 21st May 2008.

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 18/08/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Blyth House 16 Blyth Road Bromley Kent BR1 3RX Lead Inspector Wendy Owen Key Unannounced Inspection 10:00 21st May 2008 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.V361617.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.V361617.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 0208 466 1627 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.V361617.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 Date of last inspection 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. There is now one double room with the remainder single rooms to accommodate 16 residents. A garden is located to the rear of the building with hard parking to the front of the building. The rear garden is accessed by a side gate. 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 ranged from £590 for a shared room to £650 for single and £750 for single with en-suite. Additional charges are made for hairdressing, magazines, papers, toiletries and clothing. The home has developed a Statement of Purpose and Service Users Guide and this provides prospective residents and their representatives with information on the care provided. Inspection reports available from the home on request. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 5 Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. This unannounced inspection took place over one and a half days. It included a visit to the home; discussions with staff, residents, manager, area manager and Provider and comment cards received from three relatives. We toured the home and looked at records whilst we were there. We also looked at the Annual Assurance Quality Assessment (AQAA), a document that the service produces to tell us about the service provision. We also looked other information held by us in relation to the service. The number of residents able to be accommodated has reduced due to the reduction in the number of double rooms. There is now on one double and fifteen single rooms able to accommodate in total 17 residents. What the service does well: People living in the home are satisfied with the care they receive and believe their care needs to be met. The home is homely in style and residents all appear adequately cared for. One relative wrote on a feedback card, “I definitely feel confident that health care needs are met and that managers and staff have the right skills and experience to deal effectively with these.” They enjoy well-balanced meals provided in the surroundings they choose. Pre-admission assessments provide some information on the individuals’ needs to ensure that residents healthcare needs can be met and form the basis for care planning, taking into account some aspects of personal preferences and needs. Some staff have worked in the home for a number of years enabling stability and familiarity for residents. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 7 The manager has been running the home for many years and provides an open and inclusive approach to enable people to tell her about how their needs can be met. What has improved since the last inspection? What they could do better: Whilst generally the care needs of people living in the home are being met there were a number of areas that would improve the overall care, support and safety of individuals. This includes ensuring the care plans include individual preferences and routines and aspects of care, including emotional, communication, social, spiritual and financial to ensure care and support is provided where needed. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 8 Previous inspections have required more robust recruitment practices. Whilst there has been some improvement the lack of scrutiny of application forms and references provided may lead to unsuitable people being employed and vulnerable people not fully protected. The Commission may take further action if this requirement is not fully complied with. Improvement in communication, activities and stimulation must be made to ensure individuals have a voice and that they are stimulated throughout the day to ensure their emotional well-being. One relative wrote “ I think it would prove helpful is care staff were encouraged more to talk with residents than at them, although I should add that staff are generally friendly even when talking at residents.” Medication practices must be improved to ensure the healthcare needs of the people using the service at not placed at risk. Whilst there is evidence that staff have some information on how to safeguard people from abuse the need for training for all staff is required to ensure they have the knowledge and understanding of their role, particularly around “Whistle-blowing and the role of other agencies. Changes must be made to the way in which staff breaks are taken so that there is adequate monitoring throughout the day to ensure the safety of people living in the home. To determine the First Aid training required by staff the manager must risk assess the needs of the home and the individuals living there so that they receive appropriate medical treatment. Guidance must also be provided to staff to ensure they are aware of good practice in relation to infection control and the care of the individual. All residents should be given the home’s terms and conditions to provide them with full information on each person’s rights and obligations. Monitoring should take place on a number of areas, including the kitchen records and the way food is stored to minimise the risk of infection to people. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use this service have their healthcare needs assessed prior to admission to ensure that the home can meet them and there is information available to them to help them decide if the home will suit them. This home does not offer intermediate care; standard 6 is not applicable. EVIDENCE: The manager provides people with information on the service in the form of a Statement of Purpose and Service Users Guide, although we gather from Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 11 comments made that this information (Statement of Purpose) is not always provided prior to the admission. When viewing residents’ accommodation we noted that the “Guide” is available to view in peoples’ rooms. We were also made aware that the “Guide” is currently being updated. It is clear from the three residents’ files viewed that, before any person is admitted, the manager or one of the nursing staff undertake an assessment on the individual before making a decision to admit. The assessment is part of the “standex” care planning and assessment system used by many care homes. Where people have arrangements made by the Local Authority the manager endeavours to obtain a copy of the Care Manager’s assessment, although this may not always occur. We noted that not all the files contained a letter confirming, that upon assessment, they were able to meet the individuals’ needs giving the individual some confidence that they will be suitable placed. One file contained a letter, the second did not and the third was of a resident admitted in 2006. The area manager assured us that there is a system in place for these letters to be sent. We will look at this at the next inspection and if there is evidence that this is not taking place a requirement will be made. We also noted that there were gaps in the information required on the assessment form. This means that staff may not have the full information required to make a judgement or to provide the care or support required. This has been raised previously as a recommendation and remains as a very strong recommendation. People living in the home are provided with the Local Authority Placement agreement, when placed by them and they should also receive a copy of the home’s terms and conditions. Where people are privately funded they receive the home’s terms and conditions. We noted that the terms and conditions were missing for one of the people placed by the local authority and the placement agreement for another (although the authority does take time to produce these.) The manager and area manager were made aware of the need to provide all people living there with copies of their terms and conditions to ensure they have the information they need to continue living there and have agreed the conditions. We also noted that there were records of property brought into the home by individuals. This service does not provide intermediate care. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have most of the information they need to ensure individuals personal, health and social care needs are met. Medication policies and procedures are in place to protect people although practices do not ensure their health needs are fully met. People are generally treated with respect and dignity and in a way, which safeguards their privacy. EVIDENCE: Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 13 The “standex” system is used for assessing, care planning and recording information to provide staff with the information they need to make sure they meet individual needs. Three care plans were viewed and these had generally improved since the last inspection. However, whilst it covered core areas of physical need they provided very little information on social, emotional, spiritual, financial and communication needs. There is also a need to make sure they are more person centred and address specific individual needs. It is good practice that the individual’s preferences, as to how they would like to be dressed is recorded. However, it is clear from seeing care plans and the individuals themselves that there is a need to ensure there is information on how they prefer to spend their day. For example: where residents are cared for in bed or spend much of their day in bed or their rooms or the importance to the individual regarding their spiritual needs and their continued relationship with the previous church attended and its members. They should also show where residents refuse personal care regularly or have behavioural issues that present a risk to staff. There are also issues relating to the bathing/showering routines or preferences. The records viewed do not reflect what is in the care plan and this should be addressed, as it appears that residents are not receiving regular care in this area. If the care plan is amended to show any particular issues or needs in this area then this would reflect this. For example: if a person regularly refuses to bath or shower, or make clear that the person wishes to shower rather than bath. There was evidence of a resident or family member signing the care plan but very little other evidence of their involvement. Although reviews are due to take place that include the resident, keyworker and relative these have been limited. The manager was made aware that these should still take place even if family do not want to be involved. This will ensure they are meeting individual needs. It is evident that staff ”review” the care plans each month and any changes noted on the evaluation form. The original care plan is rarely amended to show the changes meaning the changes could be “lost” and staff not aware of the their current needs. Risk assessments were noted to be in place for falls, pressure sores and nutrition and, where necessary, addressed in the care plan, where required. We also recommend the detailing types of hoists and pressure relieving equipment used for individuals. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 14 We also noted that there were records in place to show that each person is registered with the GP and that there is access to other healthcare professionals, including optician, speech therapy, DN, GP and podiatry or chiropody. Those spoken to said that where they felt poorly, staff responded appropriately by contacting the relevant health professional. One relative wrote on a feedback card, “I definitely feel confident that health care needs are met and that managers and staff have the right skills and experience to deal effectively with these. It is difficult however to assess whether or not individuals’ social needs are given adequate attention to enhance residents’ quality of life. I just feel some residents would welcome a chat or listening ear.” People spoken to told us their health and other needs are being addressed, although they felt the quality of staff varied. One person spoken to was able to use the alarm and does use it. She told us that staff responded, although the time taken does vary on how busy they are. There was evidence of pressure relieving equipment in place for those requiring it and bedrails in place for a number of people. There was not always a corresponding risk assessment completed to ensure the risks of using the rails had been assessed against not using them. We saw good practice in that they reviewed the need for bedrails where one person previously had bedrails in place but then a decision to remove it was made after a further assessment. We also noted that people looked appropriately dressed and groomed for the time of year with some residents preferring to remain in nightwear. People also felt that their privacy and dignity was respected and staff always knock before entering the room and that doors are closed when personal care is undertaken. “I have always found that there is a great deal of respect given to individuals’ privacy and dignity by all members of staff” wrote one relative. Those spoken to were in their rooms and spent most of their time there. They were happy with this arrangement and could sit in the lounge if they wanted. We noted when speaking to residents in their rooms with the door open that a domestic and care staff member came into one of the rooms without knocking or asking. They did so before they realised we were in there talking to resident. We also noted when discussing infection control that some staff believe that isolating people with MRSA is good practice. This does not give them respect or dignity. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 15 An audit of the prescribed medication also took place. This is stored in the medication trolley for safety with other medication stored in the medical room. There is a list of signatures for staff authorised to administer medication along with signatures. However, we noted that the signature for one nurse did not correspond to that on the medication record. This was discussed and found this to be more related to lack of awareness or understanding as to the reason for putting their signatures with initials. Prescribed medication is recorded on individual pre-printed medication record. (MAR). These were completed with photographs of each resident; allergies generally recorded and other information required completed. Medication received into the home had been counted, signed and dated, except for two medications. This leaves a margin for error when administering medication and auditing. Handwritten records also showed there to be two signatures confirming the accuracy of the recording. We noted that a number of medications had not had the numbers carried forward each month and there were also a number of creams signed for that afternoon for that evening’s administration. This was investigated at the time of the inspection and dealt with by the manager and area manager. Other medication had been signed for appropriately with few gaps on the MAR. One medication, diazepam, to be administered as required did not have any details of the administration ie the circumstances as to when it should be administered so any new staff would not be aware when they should administer it or they rely on word of mouth where reasons could get distorted along the way leading to potential harm to the individual. There was also one medication found in the trolley that was not recorded on the MAR. Controlled drugs were found to be stored, recorded and administered, in line with good practice. There is also one person on oxygen and a risk assessment details this along with dates for reviewing. However, this is quite basic and would benefit from a wider risk assessment that includes staff training and understanding of administration etc. We were told that staff undertake accredited medication training although this does not include observation of competency. It is positive to note that the manager undertakes an audit of medication practices regularly to ensure any risks are reduced. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service enjoy flexible routines of daily living but activities and stimulation are limited affecting their overall well-being. Meals provided offer a generally healthy and varied diet for the people who live there and that they receive the support they require to ensure their nutritional needs are met. EVIDENCE: We observed the lunch-time routine. This has improved since the last inspection mainly due to reduced numbers of residents. Residents spoken to told us there are choices on the menu, although there is little indication as to whether they are asked what they would like to see on the menu. Some residents like to remain in their room rather than dine in the dining room. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 17 We noted that it would be rather crowded if all residents wished to eat their meals in the dining room at the same time and so a second sitting would have to be arranged. There was a choice of main course on that day, although no choice of dessert. This had also been changed by the cook but not entered onto the menu. Residents were supported, assisted or encouraged to eat their meals where required with staff seated when assistance to eat was needed. They appeared to be enjoying their meal, although we would expect individuals to be asked about whether they wished condiments or gravy etc rather than assuming they wanted this. It is courteous to check occasionally that their taste/choices remain the same. Some residents preferred a soft diet and likes and dislikes were recorded on their files. Drinks were in place in individual rooms and refreshments offered throughout the day. Residents spoken to said the food was “ok” and “alright” but one relative wrote “Supper-time is a bit hit and miss.” Residents are able to make basic choices, although comments have been made that staff do not sit down and talk with residents to determine their preferences and choices. One relative “ I think it would prove helpful is care staff were encouraged more to talk with residents than at them, although I should add that staff are generally friendly even when talking at residents.” This would “encourage residents to voice their preference.” This was also confirmed by us during the inspection where there was very little interaction or discussion with residents. It was also evident that individuals had their preferred routines. These should be part of their care plan, especially as so many spend time in rooms either in their beds or armchairs. There was little interaction/stimulation over the day and half of the inspection. Residents were not chatted to except when involved in a task. We recognise that there are “residents” meetings that take place to determine choices but these should support the everyday discussions about decisions and choices. With the activity co-ordinator only working one day per week it is important that staff accept that part of their role is social interaction/stimulation which can be part of everyday tasks. We noted that a handyman was working in and around the home and at one point he had a little chat/ a laugh with a resident. This cheered them up and brought a smile to their face showing what a Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 18 positive effect a small amount of contact can have on the individuals overall well-being. This interaction was brief but invaluable. Outside entertainment is provided including weekly movement to music; monthly entertainment programme and some activities by the activity coordinator. Otherwise it is mainly TV and radio with some people having newspapers or magazines. This is an area that needs to be reviewed to give people real choices and involve them everyday interactions that would stimulate them. Family and relatives visit residents and are made welcome by staff. They are included in meetings, although few attend. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home feel that their views are listened to and acted upon. Policies and procedures are in place to safeguard residents. However, more needs to be done to ensure staff understand how they are protected and supported in bringing forward issues. Recruitment practices are not robust enough to ensure vulnerable people are protected. EVIDENCE: We noted that the complaints procedure is on display in the hallway as well as in the Service Users Guide. Complaints are discussed during meetings either one to one or in group meetings and residents spoken to said they felt able to complain and knew who to complain to. It is important to note the comments made in the previous outcome group where improvements could be made in staff interactions with residents not only to elicit choices and preferences but also enable them to open up and speak freely to staff about any concerns or issues. We note from the complaints register and AQAA that there have been no complaints made over recent months nor have we received any concerns or Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 20 complaints. There are, if a complaint is made, adequate recording systems in place for recording and investigating the issues. One relative wrote “Matron and staff always listen to any concerns I have raised and discussed solutions with me should a particular course of action be necessary to resolve whatever gave rise to my concerns.” Adult protection procedures are also in place. These were discussed with three staff. Staff understood their role in ensuring people are protected and kept safe. Although they were not very aware (apart form stating the CSCI) where else they could report the incident. For example: Social Services Department. They felt able to tell the area manager if they could not approach the manager or if the allegation concerned the manager. The manager was aware of her role in ensuring such allegations were investigated by referring to her line manager and involving the adult protection co-ordinator. The main concern is that the three staff were not aware of the meaning of whistle-blowing and its impact on staff. ie how it protects them in raising concerns. The manager and area manager have acted accordingly in previous allegations or concerns raised. However, this is an area of concern because it is important that staff on the floor understand how they are protected as it enables them to report issues freely without fear of dismissal or other unfair action. Adult protection guidance and training is generally in the form of a DVD. The manager may wish to revise this method in light of some of the responses received. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a clean, comfortable and safe environment which is continually improving. EVIDENCE: Whilst looking round the home we found there to be a number of improvements since the last inspection, including the relocation of the office, reduction in the number of double rooms and refurbishment of a ground floor bathroom. The reduction of double rooms into single has certainly made the rooms look much larger. It is also positive that they have addressed the storage issue and made the first floor shower room ready for use. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 22 Currently work is going on to make some of the rooms en-suite and once this work has been completed the Provider has “promised” to change the stained hallway carpet. “The home is bright and clean and well-maintained and staff do endeavour to make residents comfortable and content” wrote one relative. Residents spoken to were happy with their rooms with many making them comfortable and homely meeting their individual requirements. The size of the communal areas still limit the number of residents able to be accommodated especially the dining area. However, at present is adequate as a number of residents prefer to remain in their rooms during the day, including mealtimes. The manager would also look to arranging a second sitting if people preferred to eat in the dining room. The kitchen had been inspected by environmental health officers in recent months and achieved a commendable 4 star rating. We noted throughout the home a plentiful supply of gloves and aprons and hand washing facilities were well located. Staff’s knowledge of infection control was adequate, although there are some elements of practice that need to be addressed, such as isolating people with MRSA and ensuring all staff are aware of clostridium difficile, good practice and understanding its resistance to alcohol rubs. Staff must be updated with current practice, especially where there are high risks. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,239,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from a well-established staff team who understand their needs. Training is not consistently provided to all staff roles to ensure they are safe, knowledgeable and competent which means people are not always fully protected. Recruitment procedures and practices should be more robust to ensure residents are protected from people who should not be working with them. EVIDENCE: Staffing in the home has reduced in line with the reduced number of residents. Staff were mixed in their views of how this has affected the workload with one staff member saying they were very busy and felt they were short staffed at times. Residents appear to be satisfied with support they are receiving although mixed in their view about the quality of staff. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 24 “some not as good as others” and “staff vary” “Some have bad moods on them; some will do things for you others won’t.” One relative stated that many members of staff not English and, although some have good command of English language, they speak it with a very strong accent. “I believe this sometimes results in residents not always being able to understand what is being said to them and therefore they do not reply/respond and opportunities missed to voice their needs.” One relative wrote-“there is a warm and friendly and generally caring atmosphere at Blyth House and the Nurse on duty was very kind, caring and considerate with a pleasant disposition. However, observations of practice showed that during the one and a half days spent in the home there was very little interaction between staff and residents. We also noted on the second day that the staff on duty were all doing “long days”. The three care staff all had their lunch break together in the dining room, whilst the nurse on duty wrote the daily records in the dining room. Some residents were in lounge, although a number of residents were in their rooms (ground and first floor). There was little monitoring or supervision during this time. Breaks should be staggered so that monitoring takes place to ensure the safety of people living there. The AQAA showed contradictory information regarding the number of staff with NVQ 2 or above. An e-mail clarifying this was sent and of ten carers two are undertaking their nursing; three carers with NVQ2 and two with NVQ3. Two night carers were waiting to start the qualification. This shows that there has been an improvement in the number of people qualified and competent. Training for staff is provided through Bromley Social Services training consortium, although the administrative arrangements have meant this has not worked effectively over recent months with gaps in a number areas. We found there to be a mixed provision of training for qualified staff to enable them to keep up with clinical practice. It is evident that some nurses attend training more than others. We also found from discussions with three staff and looking at records that there is a mixed standard of training, particularly attending statutory core training. This must be addressed so that individuals living in the home are in “safe hands”. Three files were viewed to make a judgement on the quality of the recruitment practices. At the last inspection these practices required improvement. We viewed three files; a domestic, careworker and adaptation nurse. In all cases they were found to have a Criminal Records Bureau, application forms and interview proformas. However, the application forms and references should be subject to more scrutiny. In both cases the references were from former employers that had not been detailed on the application form and, in one case, not from the last employer. There was no evidence of the previous Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 25 employments being verified and in one case gaps in employment had not been explored. This means that people are at risk from unsuitable staff being employed. The Commission will take further action if the required checks have not been completed by the next inspection. Photographs and proof of identity had been obtained in all cases. The adaptation nurse file contained the PIN number and statement of entry into the Royal College of Nursing. (RCN). For the care worker there was evidence of orientation into the home and TOPSS induction. In all three files there was little evidence of formal supervision although staff spoken to all stated that they had regular supervision with their line manager. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the valid experience and qualifications to run the home. However, improvements are needed in a number of areas to ensure their health, safety and well-being. There are systems in place to ensure the service is run in their best interests and that their views will be taken into account. EVIDENCE: Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 27 The Manager has been in place for a number of years and is an experienced and qualified nurse. Feedback from staff interviewed was positive about the management of the home stating that she was approachable. Residents appeared to know who she was when we toured the home together and were quite communicative. The area manager was also in attendance for part of the inspection. She undertakes monthly monitoring visits, including visits during unsocial hours. Reports are written that highlight areas that need to be addressed and monitors the compliance at the next visit. An annual survey also takes place and a report on the outcome produced. This is in the form of a chart and shows the differences year on year. There is, however, no action plan detailing how they are gong to make improvements in the areas where they are possibly falling short. This needs to be produced to ensure they are taking action to continuously improve the service. The area manager agreed to produce this in the near future. Staff spoken to stated that they had regular supervision although individual files were not viewed on this occasion and will be monitored at the next inspection. During the course of the inspection we noted areas requiring regular monitoring. Systems should be put in place to ensure day-to-day practice is monitored. The training matrix provided shows there to be significant gaps in the provision of core training. One of these, moving and handling has been required at the previous two inspections. Whilst there is evidence that some staff have had a recent update, this is not the case for a number of others. Prior to writing the report the manager provided me with details of training arranged in the near future. However residents and staff remain at risk until such updates have been provided. This requirement remains until fully complied with. The lack of administration has clearly affected the organisation and administration in the home and meant that training has not been addressed, as it should have been. This is currently being addressed. However, there are also other records such as medication, supervision, assessment and care planning records that need to be fully completed to ensure there is accurate and up to date information held on individuals behalf. We informed the manager and area manager of the need to ensure they risk assess the first aid training requirements for staff to determine the need for one day or four day training. The risk assessment should detail the decisions for providing the training requirement. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 28 A sample of service contracts were viewed against the AQAA information received. These were satisfactory, except for the lift being serviced annually rather than six monthly. Fire procedures and practices were also audited to ensure the safety of the residents, staff and visitors to the home. Fire drills are taking place for day and night staff with induction for new staff; fire training is provided via DVD and testing of the fire alarm weekly. There were records in place to show the fire alarm system and equipment had been serviced by an approved contractor. When we spoke to staff we noted that they had a sound knowledge of what to do in an accident so that appropriate treatment is provided. The Environmental Health Officer gave the kitchen four stars as a result of it’s visit during October 2007. This is a very good standard. However, regulation 26 reports record a number of gaps over the last few visits. We also noted the storage of foodstuffs on the storeroom floor. We suggested the manager monitor this more closely. The organisation continues to ensure there is adequate insurance that is in date and that the Certificate of Registration is also on display to assure people of their registration and who they can admit to the home. Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 29 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 3 3 2 3 x 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 2 Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement The Registered Person must ensure that recruitment procedures are more robust in order that residents are adequately protected. This is a repeated requirement. Timescales 01/11/06, 14/6/07 and 01/12/07 have expired. Timescale for action 01/08/08 2. OP7 15 01/09/08 Care plans must detail how the home is to meet the health, social and personal care needs of the residents. These must be reviewed in consultation with individuals and/or their relatives or representatives. This is a repeated requirement. The Timescale of 01/03/07 and 01/01/08 has expired. There must be accurate records of all prescribed medication in the home including medication received in the home and medication carried forward from one month to the next. DS0000037404.V361617.R01.S.doc 3. OP9 13 01/07/08 Blyth House Version 5.2 Page 31 Records must not be signed for before medication is administered to the individual. Failure to maintain accurate records of prescribed medication may result in an individual’s health being adversely affected. 4 OP14 12 Interaction and communication 01/09/08 between staff and residents must be improved so that residents enjoy positive well-being and stimulation during the day. This will also encourage them to discuss their choices and wishes. Staff must be provided training 01/08/08 in Safeguarding and whistleblowing so that they are aware of the role in protecting individuals and what other agencies are involved in protecting the vulnerable people they care for. Moving and handling training 01/08/08 must be carried out by a competent person, unless a risk assessment determines otherwise. Where moving and handling training is provided, there must be a record of the training provided and by whom. There has been some progress in meeting this requirement. Staff must be provided with guidance on good practice on caring for people with infections so that they do not isolate them unnecessarily. A risk assessment must be developed to determine the home’s first aid requirements so that people receive appropriate care and treatment Staff “breaks” must be reviewed to ensure there is adequate DS0000037404.V361617.R01.S.doc 5 OP18 13 6. OP38 13 7 OP10 12 01/09/08 8 OP38 13 01/09/08 9 OP38 12 01/07/08 Page 32 Blyth House Version 5.2 monitoring and supervision of residents. 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 OP3 Good Practice Recommendations The Registered Person should ensure that the preadmission assessment is completed in full by that the information is signed and dated by the individual completing the assessment. The range of activities should be improved to provide people living in the home with stimulation. Staff should be provided with updated contracts where contract details have been changed. Where staff are employed from other homes in the organisation, it is good practice to obtain a reference from the current manager as to the individuals suitability. Infection control training should include information on clostridium difficile and how staff can prevent the spread of the infection. The food supplied at supper-time should be reviewed to ensure it is of a satisfactory quality. The monitoring of day to day activities should be improved to ensure a consistent standard of care is achieved and people remain protected. 2 3. 4. OP12 OP36 OP36 5. OP38 6 7 OP15 OP33 Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blyth House DS0000037404.V361617.R01.S.doc Version 5.2 Page 34 - 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!