Inspection on 29/10/05 for Blyth House

This inspection was carried out on 29th October 2005.

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

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

Other inspections for this house

Blyth House 16/04/09

Blyth House 21/05/08

Blyth House 18/08/06

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 Unannounced Inspection 29th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 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.V262688.R02.S.doc Version 5.0 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 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.V262688.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: Blyth House is a twenty-three 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 is 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.. There are eight double bedrooms and seven single. There is a garden to the rear of the building and 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. The home is supported by GP services and specialist health provision, such as the Community Psychiatric Nurse. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of a Saturday morning with two inspectors involved. The inspection included a tour of the home; discussions with service users and staff and an inspection of the medication procedures. The inspectors were unable to monitor all of the requirements raised at the last inspection. These will be monitored at the next inspection. Seven further requirements were raised during the course of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Improvement is still required in the medication practices with safe storage and record-keeping highlighted as a concern during this visit. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 6 This visit also highlighted concerns regarding the location of the laundry area and the safety of staff in carrying out the laundry tasks. Whilst the home provides adequate staffing to care for residents the inspectors were concerned about the amount of non-care tasks needing to be completed by care staff on duty at the weekend. This included domestic and laundry tasks and could therefore impact on the lack of activities and stimulation provided to residents. One resident stated “I’m bored” whilst another agreed that there was very little else to do except watch TV. The home also needs to ensure more robust procedures are in place when using agency staff. The home had not made the required checks for the agency staff used in the home on the day of the inspection and no request was made to check the individual’s identity. This raises serious concerns about the safety of residents. 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.V262688.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 9 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): 9 & 10 Lack of good care practices do not actively promote and protect service users’ privacy and dignity. Whilst progress has been made in implementing good medication practices shortfalls still place service users at risk. EVIDENCE: A brief audit of the medication procedures took place. This showed that there are still some requirements raised at the last inspection still awaiting implementation. The oxygen kept in the medication room was not labelled with details of the service users for whom the medication was prescribed or with administration details. The sink in the medication room is still not working and medication had not been carried forward from previous medication records. However, the fridge temperatures were recorded daily and were in order and there were no identifiable errors or gaps on the medication records. Limited-life medication was noted with the date of opening to ensure disposal within their required timeframe. The remaining requirements will be monitored at the next inspection. The inspector noted that the Controlled Drugs were stored securely with appropriate records of administration. The Nurse on duty was not aware of the recent changes in the disposal of medication for nursing homes. All staff should Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 10 be made aware of changes affecting the administration and disposal of medication. The inspectors observed medication left in service users’ rooms after the medication round. These were not stored securely. (See requirement 8) In one ground floor bedroom, a care assistant was providing personal care in a shared room. One resident was sat in a chair in the room, the carer was attending to the other resident. The divider curtain was open, and clearly visible was the partially naked resident. This was immediately referred to the nurse in charge. (See requirement 9) Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 11 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, 14 & 15 Current organised activities do not provide service users with a stimulating and interesting environment for residents to live. Meals provided are healthy and nutritious providing residents with a balance diet. EVIDENCE: Service users spoken to were unable to provide much information regarding how they are helped to exercise choice and control over their lives. Staff appeared set in routines and tasks. Two residents spoken to stated, that they were “bored” and when this was discussed with staff the inspectors were informed that activities take place for one hour in the afternoon. The remaining time for many is spent watching TV in the lounge. However, two residents do venture to a club once a week and most residents had visitors. Newspapers were also available. There was no attempt during our visit to ask residents what they wished to do ie play board games or listen to some music. From the observations some residents have control on how they wish to spend their day ie in their room or in bed but these are basic choices and decisions only. The lack of activities on offer, were repeated by several residents, with one resident stating that, weather permitting, she would like to spend more time outside. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 12 Two residents who were in their own rooms, spoke with the inspector. Both stated that they preferred to stay in their own room rather than the communal areas. One resident had the TV on, although there was a lot of interference and it was difficult to see or hear the commentary. (See requirement 10) Residents spoke positively about the food provided and the inspectors noted that fluids were to hand in all areas of the home including residents’ rooms. Menus were not inspected on this occasion. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 13 Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 14 Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 15 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): 17 The home encourages residents to use their legal write to vote and ensures this process is made as easy as possible. EVIDENCE: One lady was very able to converse with the inspector. In relation to her ability to vote, she stated that she would be taken down to the polling station by car and staff would assist those residents who needed it, alternatively “in mass by postal voting. She was positive about her stay and any concerns would be raised with her son or with the staff, if necessary. Another resident spoken to told the inspector that they could vote via the postal procedures. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 16 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): 19,24 & 25 The home provides warm, comfortable and reasonably decorated private and communal environment for residents to live. The location of the laundry area presents a potential hazard for staff undertaking the laundry tasks. EVIDENCE: The home was in a reasonable state of repair with new carpet recently fitted in the lounge. The décor is satisfactory throughout and the standard of cleanliness is also satisfactory, despite the lack of domestic staff at the weekend. There were no offensive odours noted. The laundry area is located outside the home to the rear. During the weekends there are no laundry assistants and therefore staff must completed these tasks along with the domestic chores and caring for residents. To reach this area staff have to carry laundry baskets down some steps. This may be potentially dangerous during fair weather but is a much higher risk in the dark winter evenings and mornings and when the weather is wet, icy and windy. There is a light for this external area but this needs staff to ensure it is turned on prior to leaving the main building. The laundry is located in a wooden structure Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 17 which houses two washing machines and one dryer. This is a small area which provides little space for the separation of clean and dirty laundry. Staff also have to step on to a crate to enable them to lift the clean laundry out of the top loading washing machine. The inspector is concerned with the location of the facility; lack of domestic staff at the weekend to carry out tasks; the hazards for staff and the limited room for carrying out laundry tasks. This is particularly, where the external laundry service for laundering the linen is due to cease very shortly and therefore all laundry will be completed within the home. (See requirement 11) Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 18 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): 27,29 & 30 The staff mix during the weekend requires reviewing, to ensure staff are deployed appropriately and the full needs of the residents are being met. The procedures for use of agency staff place service users at risk from abuse and poor practice. EVIDENCE: At the time of the inspection there was one qualified staff on duty with 5 care assistants. The RGN in charge had worked for twenty years in the home and currently worked two mornings a week. She related to the inspector some of the training which she had received in the last year which was manual handling, one day on first aid, and half a day dementia training. When the inspector enquired about her PREPP requirements to- re register with the NMC, she was unsure that she would re –register as she was considering retirement. The previous standard has highlighted concerns regarding the staff mix during the weekend. Care staff are expected to undertake domestic and laundry tasks as well as their normal care duties. It also appears from service user and staff discussions that staff are more task related than providing opportunities for stimulation for residents. The staffing mix and job roles must be reviewed to ensure outcomes for service users are being met. (See requirement 12) Discussions with an agency staff member showed that this was their first morning of work at the home and with the agency; they had not been provided Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 19 with induction and nor had anyone asked for any documentation or proof of identity. The member of staff in question also stated that her current Criminal Records Bureau Check was that of her previous employer and the agency had relied on this. (See requirement 13) Two care staff members were also spoken to. They explained to the inspector the training they had received either within this provision or previous employment. This was generally satisfactory although a lack of dementia training was noted for one member of staff and considering that some residents’ mental health deteriorates after admission this should be addressed to ensure appropriate care it provided. Another member of staff also stated that they had not received infection control training or food hygiene training and felt that this would be beneficial. (See requirement 14 & recommendation 4). Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 20 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): 35 & 38 Service users’ health, safety and welfare is adequately protected. However, improvement could be made through training of all staff in core areas to ensure service users and staff are fully protected from risks. EVIDENCE: No monies are currently kept by the home on service users’ behalf. Previous comments have highlighted any issues raised in respect of the health and safety of staff and service users and include the location of the laundry and the improvement required in the medication practices. Staff spoken to had received some core training including moving and handling. However gaps have been noted in infection control and for one member of staff spoken to, fire training. (See requirement 14) Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 2 X X X X 3 3 X STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X N/A X X 2 Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 22 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 14 Requirement The registered person must assess fully the needs of residents, before admission into the home and appropriate recordings maintained. This requirement was not inspected at this inspection. The registered person must ensure that care plans reflect the needs of residents. This requirement was not inspected at this inspection. The registered person must ensure, where risks have been identified, there is a record of the actions the home is taking to minimise the risks. This requirement was not inspected at this inspection. Please see attached pharmacy requirements regarding requirements. The registered person must ensure that recruitment procedures are more robust in order that residents are adequately protected. The registered person must ensure individual risk DS0000037404.V262688.R02.S.doc Timescale for action 01/07/05 2. OP7 15 01/07/05 3. OP8 13 01/07/05 4. 5. OP9 OP29 13 17 & 19 18/05/05 01/07/05 6. OP38 13 & 23 01/07/05 Blyth House Version 5.0 Page 23 7. OP33 26 8 OP9 13 9 OP10 12 10 11 OP12 OP19 16 23 assessments are in place to ensure residents are protected in the event of a fire. Timescale expired 1/02/05. This requirement was not inspected at this inspection. The registered person must ensure that monitoring of the homes procedures takes place regularly. This must include the undertaking of the required regulation 26 visits and a system for the internal auditing of practices. This requirement was not inspected at this inspection. The Registered Person must ensure that all medication is stored securely and a record made of all medication; who it is prescribed for and details of the administration. Staff must be updated in any changes affecting the medication procedures. The Registered Person must ensure that service users privacy and dignity are respected at all times. Specifically where service users share bedrooms appropriate screens are used to provide a private area for staff to undertake personal care. The Registered Person must provide adequate physical and mental stimulation to residents. The Registered Person must review the current laundry facilities provided. Specifically, the home must review the safety aspects of the location of the laundry area and location of equipment within the laundry. This review must take into consideration the proposal for the home to cancel its external contractor used for laundering of the linen and the burden that is to be placed upon the current DS0000037404.V262688.R02.S.doc 01/07/05 01/12/05 01/12/05 01/12/05 01/12/05 Blyth House Version 5.0 Page 24 12 OP27 18 13 OP29 17 & 18 14 OP38OP30 13,23 & 18 resources. The Registered Person must 01/01/06 review the current staffing level and mix. Specifically, the review must include amount of domestic and laundry tasks undertaken by staff at the weekend. The Registered Person must 01/11/05 ensure that robust checks are made on the agency staff used in the home. The Registered Person must 01/01/06 ensure that staff received core training. Specifically, staff must receive fire training and training in infection control procedures. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4 Refer to Standard OP2 OP12 OP15 OP30 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 individuals need are discussed, such as the provision of a TV or radio in room. The registered person should ensure that those residents with poor nutrition are provided with adequate food supplements and food fortification. The registered person should ensure all staff are provided with dementia training. Blyth House DS0000037404.V262688.R02.S.doc Version 5.0 Page 25 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. 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