CARE HOMES FOR OLDER PEOPLE
Princess Alexandra Home For The Blind Bosworth Place Squires Gate Blackpool Lancashire FY4 1SH Lead Inspector
Mr Kevan Royston Unannounced Inspection 19th September 2007 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 Princess Alexandra Home For The Blind DS0000009733.V343143.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. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Princess Alexandra Home For The Blind Address Bosworth Place Squires Gate Blackpool Lancashire FY4 1SH 01253 403091 01253 407010 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) Blackpool, Fylde & Wyre Society For The Blind Miss Elaine Wright Care Home 40 Category(ies) of Sensory impairment (2), Sensory Impairment registration, with number over 65 years of age (38) of places Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered numbers to include two (2) named person between 50 and 65 years of age. 17/08/07. Date of last inspection Brief Description of the Service: The Princess Alexandra home for the Blind is registered for 40 people aged 60 and over who are visually impaired. The home is situated in its own grounds close to the sea front and south shore shopping centre. Local bus and tram routes are near by. All the rooms are single occupancy and provide en-suite facilities. Communal lounges are located on both floors. There is a large dining area on the ground floor. Communal bathrooms and toilets provide aids and adaptations. The outside of the building provides seating for residents, and has well kept garden areas available. Ramp access is provided at the front of the building. There is a Statement of Purpose/Service User Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. The fees for the home are £330.00. Extra charges at the home are for Hairdressing and chiropody, which vary. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place over two days the 19/09/07 & 20/09/07. We spoke to the manager in charge, two members of the management team, seven residents, five staff, one person visiting and a group of residents sitting in the lounge to get their views of the home. As part of the inspection process we talked to people using the service and asked staff about those peoples needs. We also looked at their rooms, care plans, medical records and daily notes this is called case tracking. Other residents are invited to pass their opinions to us if they wish. The response from surveys sent to residents, GP surgeries and relatives for their views on how the home cares for people was good. Eight completed questionnaires were received from residents, five from relatives and four from Doctors. Most comments were positive about the standard of care and support provided by the staff and management and how the home is run. We looked at records of two staff members. We walked around the building and watched people living and working to see how everyone supported and talked to each other. Looking at documentation, policies and procedures formed the basis of the inspection process. What the service does well:
Continuing from the previous inspection a General Practitioner (GP) visits the home every three weeks and holds a surgery for any residents who are suffering health problems ensuring residents receive medical attention on a regular basis and any issues can be identified early and appropriate treatment given. The manager spoken to said, “The system is working well”. One resident said, “It is handy having a doctor come into the home every month”. The premises is set out purposely and decorated to consider partially sighted and blind people. And this ensures the residents are familiar with the surroundings and provide a safe environment. Comments from residents included, “The bright colours help me around the place”. Another said, “ Its purpose built for us with sight problems”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 6 We looked at training records and talked with staff, the management team and found there are excellent training opportunities for all staff to attend and access courses in relation to their job role. This ensures the development of all personnel and provides the skills and competencies required to support and provide good care for the residents. Training in visual awareness is compulsory for all staff and helps to support residents with sight problems, ensuring staff have the knowledge of how to care for this particular resident group. Staff spoken to said, “The induction training was very good and the sight awareness course was very helpful”. And, “Very good training is available to enable me to work with partially sighted and blind people”. The Princess Alexandra Home for the Blind has achieved the “Investors In People Award” which demonstrates the owners commitment to training and develoment of staff. This in turn ensures that good quality care is provided to the residents to ensure they are well looked after and supported. We saw staff helping and talking to residents with respect and staff members joining in with conversations and helping with personal care needs in a sensitive manner. Comments from residents included, “They are all very caring ”. And, “They treat me with respect”. A comment from a relative in a survey returned said, “I visit my aunt every fortnight and the staff are always kind”. What has improved since the last inspection? What they could do better:
To enhance the current use of a suggestion box and comment book to gather visitors views about the home the management team should consider introducing a system of using surveys for relatives and friends. This would provide another way of seeking the views of families and friends to monitor how the home is achieving its stated aims and objectives. Recruitment procedures must be improved further with thorough reference checks obtained for staff applying to work at the home, to ensure they are suitable and so safeguard the residents living at the home.
Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 7 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. Princess Alexandra Home For The Blind DS0000009733.V343143.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 Princess Alexandra Home For The Blind DS0000009733.V343143.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear and precise to ensure the needs of the residents are met. EVIDENCE: We looked at three residents care records and found they had full assessment information recorded in detail. One resident funded by social services had been assessed by social workers with information on file for the management team to carry out their own assessment to develop a care plan and ensure all health, welfare and social needs are identified and recorded. One staff member spoken to said, “We have a comprehensive initial assessment process for new residents”. A relative/friend visiting the home spoken to said, “They provided us with good information and were thorough with the assessment before my friend came in”. Standard 6 was not assessed, as the home does not provide intermediate care.
Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs are identified and met. EVIDENCE: Records of resident’s looked at, were accurate and had good information about their health, welfare and social care needs. This information supported the staff to maintain and promote each individuals daily needs. Records examined confirmed risk assessments have been completed and are constantly reviewed and updated reflecting any changes that have occurred individually and especially in the environment due to the sight problems of residents ensuring their needs are being met. Care plans were up to date and regular reviews taking place with involvement of the residents and relatives where possible with good information of care provided, ensuring the welfare and general wellbeing of residents is continuously monitored. When asked about her care plan a resident said, “Yes every month they look at my care and we go through any problems or changes”. One member of staff spoken to said, “We have a
Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 11 list of our monthly reviews for key workers to go through”. A survey returned from a Doctor, when asked about the care received by residents said, “Yes they provide good care”. Medication practices looked at with senior staff for the resident’s case tracked were safe and good records had been kept ensuring residents health is maintained. The manager said, “We make sure senior trained staff only administer medication”. This was confirmed through talking to members of staff. We saw resident’s respect and privacy being observed by staff knocking on bedroom doors and supporting residents who needed help to lounges “They give freedom of choice and respect” said one visitor spoken to. A survey returned by a relative commented, “Always treats residents with respect”. A member of staff spoken to said, “Respect and dignity is an important part of our role”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 12 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 and15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Lunchtime meals were seen being prepared, and were wholesome, home baked with fresh produce used providing a nutritious meal. We spoke to the cook who has recently started work at the home and he said, “We try and use fresh and good produce as much as possible and provide a choice”. There was a concern raised at the residents meeting about some of the meals provided, however this has been addressed and was due to the chef getting used to the new kitchen and working at the home. We spoke to residents about the quality and quantity of food and every comment was positive they included, “ Great food”. And, “Always a choice and you can have as much as you like”. Also, “Very much improved, at first the vegetables were a bit hard”. Meal times are set although flexible enough to accommodate preferences. One resident spoken to said, “ I like my breakfast in my room and that’s ok”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 13 Activities are centred on each individuals preferences ensuring flexibility. Residents can enjoy their own personal interests, which are recorded on their care plan. One resident spoken to said, “ I enjoy the quiz”. And another said, “There is always lots going on”. A member of staff spoken to said, “The weather has been poor but we try and get out as much as we can”. There is a visitor’s policy, which allows friends and relatives to come and go any time of the day. One friend visiting the home said, “They are always nice to me and offer me a drink, I come and go as I please”. A resident spoken to said, “Generally visitors come to see anytime there are no restrictions”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have a good knowledge and understanding of adult protection issues, which safeguards residents from abuse. EVIDENCE: There is a detailed complaints procedure, which is made available to all residents on admission and written in the Statement of Purpose and Service User Guide to ensure they feel protected. Residents and relatives in surveys returned confirmed are aware of the complaints procedure and who to complain to. Comments included, “I would speak to the care service manager Elaine Wright”. And, “I have never had to, but would know what to do”. There have been no complaints since the previous inspection. We examined records and found there is a procedure and policy for dealing with allegations of abuse and safeguarding adults in order to protect people living at the home. One member of staff spoken to said, “I have requested to update abuse training at my supervision and will be put on a course”. . Another said, “Yes National Vocational Qualification (NVQ) training tells us of abuse issues”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: We had a walk around the building and found it to be very clean and tidy and maintained to a good standard ensuring residents live in a pleasant, clean home. Comments from residents included, “Spotless”. And “The girls work hard to keep everything clean”. A member of the domestic staff spoken to said, “We have sections which we are responsible for it works well and we have enough staff to cope”. The layout of the home is purpose built and decorated to support partially sighted and blind people, which help them feel safe in the environment. A relative said in a survey returned, “The care home does everything to a high standard”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 16 There is a programme of maintenance and records kept were looked at. The manager spoken to said, “Repairs are reported and the men check the book and do the work”. We saw on the day of the visit minor repairs being carried out by the maintenance staff ensuring the home is kept in good order. The laundry area is situated in an area away from the dining room so that soiled items and clothing are not carried through where food is prepared, cooked or eaten. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 17 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): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are good ensuring the safety and protection of the residents. Training for staff is very good ensuring they have the skills and competencies for their roles. EVIDENCE: We examined rotas for working, and discussion with the manager and staff confirmed there were sufficient numbers on duty to ensure the resident’s needs are being met. One member of staff spoken to said, “ We have problems sometimes with staff sickness, however we always have enough to cover”. Residents confirmed this and one spoken to said, “Yes there is plenty of the girls around to help”. We looked at two staff files and confirmed the recruitment procedures of the home have improved ensuring residents are more protected. The application form now asks for a full employment history with any gaps explained and staff photographs are on file for identification purposes. Staff records include, application forms, Criminal Records Bureau (CRB), Protection of Vulnerable Adults (POVA) disclosures, medical checks and references. However one file looked at only had one reference, They must request two references to make sure potential staff are suitable to work at the home.
Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 18 Records show training is ongoing and there is over 70 of care staff that has completed National Vocational Qualification (NVQ) level 2 in care. Discussion with staff confirmed training is accessible and the management team encourage staff to attend courses to develop their skills. Individual training records are kept of staff and the manager said, “We are putting forward staff to do NVQ level 3 and 4”. Members of staff confirmed the good access to training by their comments, which included, “Good training opportunities”. And, “Good support to access courses” A relative said in a survey. “Staff are competent”. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 19 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): 31,33,35,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well, with systems and policies in place for the protection and safety of staff and residents. EVIDENCE: The manager has the necessary skills, qualifications and experience required to support the staff and residents and enable the home to meet its stated aims, purpose and objectives. Staff spoken to said the management team are supportive and helpful, comments included, “Good to work for”. And, “Yes if you had a problem you can speak to Elaine anytime”. Also, “Always has time to listen”. Surveys returned from residents and relatives commented on how well the home is run, comments included, “Competent skilled staff”. And, “My aunt always has a good word for them”.
Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 20 We examined records of residents and found they are comprehensive, well written and up to date ensuring the correct information is available and health and welfare needs are continuously monitored. To enhance the current use of a suggestion box and comment book to gather visitors views about the home the management team should consider introducing a system of using surveys for relatives and friends. This would provide another way of seeking the views of families and friends to monitor how the home is achieving its stated aims and objectives.Staff and resident meetings are held regularly and recorded. The latest resident meeting highlighted some issues with the food, which was addressed by the manager and staff. The manager said, “The residents enjoy the meetings and get a lot out of them”. A resident said, “I attended the meeting and food was discussed, the problem has been sorted out”. Resident surveys are completed annually for their views and opinions on how everything is run and to ensure they feel the home operates smoothly. We looked at records and found regular tests to emergency lighting, fire procedures, electrical appliances, the lift and fire extinguishers had been carried out ensuring the safety of residents and staff is maintained. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No. 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 4 schedule (1) Requirement Recruitment procedures must be robust and two references must be obtained before staff are employed in order to ensure that only suitable staff are employed to work at the home. Timescale for action 31/10/07 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 OP33 Good Practice Recommendations The views of families and friends should be sought to monitor how the home is achieving its goals for the residents. Princess Alexandra Home For The Blind DS0000009733.V343143.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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