Care Home: Balliol Lodge

What the care home does well The home provides information in a variety of different ways for new people who are interested in moving in. This includes providing information in picture format and information in large print. This means that people who experience confusion with reading written language or have sight difficulties are still included in making choices, which is good practice. The staff at the home demonstrated that they have a good understanding of how to support people with dementia. In particular staff understand that diverting someone who is distressed can help them to become distracted and calm and settled again. The home employs a long-standing team of staff, which has minimal turnover. This means that people are more likely to receive care and support from someone that they know. Although discussions were limited with people who live in the home they were able to tell us that they liked the staff. Comments were made that staff were "kind and caring" and one person told us that they" trust the staff- this is my home". The manager and staff are diligent in ensuring peoples health care needs are met and this includes arranging for people to receive specialised care and assessments when their health deteriorates. This shows that staff promote peoples quality of life as much as possible. The home employs an activities coordinator who supports groups of people to undertake a wide variety of activities. This includes trips to places of interest in the local community. People have been divided into groups so that they can get the most of the activities offered. This shows that staff understand that the people who live in the home are individuals with individual needs. The home is kept clean and appears comfortable and smells pleasant. Staff understand how to reduce the risk of infection spreading and equipment is available to promote this. The chef provides a variety of home cooked food which people enjoy. People told us " we get plenty" and " it`s always something tasty". The manager and staff team have a very good understanding of how to protect vulnerable people from abuse. For example one situation had occurred were another person who lived in the home intimidated someone else who lived there. The manager took action by consulting social services and us and ensuring that the risk of this person feeling afraid was reduced. This included supporting this person to have a key to their bedroom so that they no longer felt afraid whilst ensuring that staff could still access their bedroom to ensure they were safe. This is good practise. What has improved since the last inspection? We found that a number of requirements, which had been made following our previous visist, had been addressed. This included ensuring staff were provided with training to enable them to care for people properly and ensuring that new staff employed were suitable to work with vulnerable people. This means that the people`s health and welfare is being promoted. The home has also employed the services of a health ands safety consultant who visits the home monthly and makes a full assessment. This helps to ensure that the home is a safe place to live and this also addresses a number of concerns that we had about how health and safety was managed within the home. The provision of activities has improved greatly since we last visited so that stimulating activities are offered according to people`s needs and abilities. Efforts have been made to ensure that each person has a care plan which fully reflects their needs, wishes and support required. This means that staff have up to date instructions about everyone`s care, which reduces the risk of someone receiving the wrong care or receiving it in a way that they wouldn`t like. This is good practise. A new manager has been employed who has now been in post for six months. Staff spoke very positively of her ability to manage by making comments such as " she has very high standards" and " she fights for these residents- she`s great". Redecoration and refurbishment of the building has continued which helps to produce a more homely and comfortable home to live in. CARE HOMES FOR OLDER PEOPLE Balliol Lodge Balliol Lodge 58-60 Balliol Road Bootle Liverpool Merseyside L20 7EJ Lead Inspector Mrs Joanne Revie Unannounced Inspection 09:00 9th July 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 Balliol Lodge DS0000065370.V362765.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. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Balliol Lodge Address Balliol Lodge 58-60 Balliol Road Bootle Liverpool Merseyside L20 7EJ 0151 9336202 0151 9336070 balliol_lodge@yahoo.com 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) Mr Bharat Modhvadia Mrs Jaya Bharat Modhvadia ** Post Vacant *** Care Home 32 Category(ies) of Dementia (32) registration, with number of places Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 32 Date of last inspection 25th July 2007 Brief Description of the Service: Balliol Lodge is a care home that provides nursing and personal care for up to 32 people. The care provided is for people with a diagnosed condition of dementia. Balliol Lodge is situated on a busy main road near a college. The local train station is accessible at the bottom of the road and there are a number of shops within walking distance and a main shopping centre a little further. The main shopping areas of Liverpool can be accessed via public transport. Balliol Lodge is 2 converted buildings over 3 floors. There is a passenger lift to some of the bedrooms and a stair lift to others. There are various single rooms, and a number of double bedrooms none with en-suite facilities There are 3 lounge areas and 2 dining rooms on the ground floor. There is also a smoking area available for people who live at the home. The cost per week to stay at the home is £400.00 to £519.17. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The visit was unannounced and lasted over two days for a total of ten hours. Before the visit took place we (the commission) looked at all the information that we held about the service. We asked the registered manager to complete a form called an AQAA (Annual quality assurance assessment). This gave us information about the service and showed us that quality was still being developed and that people were happy living at the home. During our visit we met with staff who work at the home and the owner. The manager was taking annual leave so was not available. We sent surveys out for people to complete and had four surveys returned which had been completed by staff who work at the home. We had brief discussions with four people who live in the home. Due to peoples needs in depth discussion were not possible. Some quotes have been included in the summary section of this report but these are limited for this reason. We also had discussions with eight members of staff who work at the home. During our visit we spent time observing how well staff interact with the people who live at the home. This is known as a SOFI (short observational framework for inspection) observation. We looked at peoples care records, staff personal files and off duties. We looked at the building and whether it was a suitable, comfortable place to live. We also looked at other records, which showed us how the service makes sure that people’s health and safety is promoted and whether staff have the skills to make sure people are cared for and supported correctly. . Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 6 What the service does well: The home provides information in a variety of different ways for new people who are interested in moving in. This includes providing information in picture format and information in large print. This means that people who experience confusion with reading written language or have sight difficulties are still included in making choices, which is good practice. The staff at the home demonstrated that they have a good understanding of how to support people with dementia. In particular staff understand that diverting someone who is distressed can help them to become distracted and calm and settled again. The home employs a long-standing team of staff, which has minimal turnover. This means that people are more likely to receive care and support from someone that they know. Although discussions were limited with people who live in the home they were able to tell us that they liked the staff. Comments were made that staff were “kind and caring” and one person told us that they” trust the staff- this is my home”. The manager and staff are diligent in ensuring peoples health care needs are met and this includes arranging for people to receive specialised care and assessments when their health deteriorates. This shows that staff promote peoples quality of life as much as possible. The home employs an activities coordinator who supports groups of people to undertake a wide variety of activities. This includes trips to places of interest in the local community. People have been divided into groups so that they can get the most of the activities offered. This shows that staff understand that the people who live in the home are individuals with individual needs. The home is kept clean and appears comfortable and smells pleasant. Staff understand how to reduce the risk of infection spreading and equipment is available to promote this. The chef provides a variety of home cooked food which people enjoy. People told us “ we get plenty” and “ it’s always something tasty”. The manager and staff team have a very good understanding of how to protect vulnerable people from abuse. For example one situation had occurred were another person who lived in the home intimidated someone else who lived Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 7 there. The manager took action by consulting social services and us and ensuring that the risk of this person feeling afraid was reduced. This included supporting this person to have a key to their bedroom so that they no longer felt afraid whilst ensuring that staff could still access their bedroom to ensure they were safe. This is good practise. What has improved since the last inspection? What they could do better: Some records within peoples care plans (risk assessments) need to be updated o that staff can demonstrate what action they have taken if people’ needs change. Medication audits should be implemented without further delay so that shortfalls in staffs practice can be quickly identified and addressed. This will help to ensure people’s medications are managed safely. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 8 Although some staff have had training in basic food hygiene this must be extended to all staff that handle food. Not providing this training could mean that staff mishandle food, which could be detrimental to, people’s health and welfare. Staff should have training in the recent changes, which have occurred in the mental health capacity act and how to promote people’s equality and diversity. This would help staff to support people’s individuality and protect their rights. Records must be kept of any pin number checks of nurses who work in the home. Not providing this evidence could suggest that checks are not being carried out regularly. This could mean that the risk of a nurse providing care who should no longer be practising is increased. This could impact on people’s health and welfare. The redecoration of the home should continue and the provision of orientation aids for people should also be considered. Some efforts have been made in this area however this work could be built on to ensure that the home is a suitable environment for people to live that have dementia. The manager has been employed for six months and is not yet registered with us. This must be addressed as employing someone who is not registered to manage breaches the Care Standards Act 2000. This is the law which governs Care Homes. The owner should ensure that the work being undertaken to reorganise all filing systems is continued. This means that important documents can be found quickly and would be available for inspection by interested parties. 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. Balliol Lodge DS0000065370.V362765.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 Balliol Lodge DS0000065370.V362765.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): 3, standard 6 was not assessed, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given enough information to decide whether they would like to move into the home or not. EVIDENCE: We looked at people’s care records and information that the home has available for anyone who is interested in moving in. We saw that people meet with a senior nurse to discuss their needs before they move in and that staff write this information down. These records are then used to plan the person’s care. We saw that the home have produced a picture format service users guide. This is a booklet, which tells people what they can expect if they move into the Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 11 home. Picture format records help people understand information if they struggle to understand written language. This is good practice. When we read the homes AQAA we saw that this information has also been produced in large print to help anyone who has sight difficulties. This is also good practice. Balliol Lodge DS0000065370.V362765.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 good. This judgement has been made using available evidence including a visit to this service. People receive the care and support that they need. Staff ensure that seeking as much advice as possible about people’s needs reduces the risk of their health deteriorating. EVIDENCE: We looked at the homes AQAA, which told us that people’s care records, had improved since we last visited the home. We looked at some records during our visit and agree with this statement. We found that staff had clear, written instructions to follow about the care and support that each person needed. We also found that these records were reviewed every month to make sure that they were up to date. This is important as some people who live at the home are not able to express their wishes therefore staff need written instructions so that they can give people the correct care and support. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 13 We did find that other records were included in the plans, which identified whether people’s health was at risk of deteriorating. Some of these records were out of date and this should be addressed. We looked at how people’s health care needs were met and found that staff were diligent in ensuring that people received the right care and support. For example one person had been identified at being at risk of falls and appropriate equipment had been provided to reduce the risk of this occurring. Staff had also recognised that this person walked with an unsteady gait, which could contribute to, falls occurring. Following consultation with this persons G.P. an appointment had been obtained for this person to be assessed by a specialist who dealt with gait and movement problems. This is good practise as this could also reduce the risk of this person experiencing falls. We found that the home is equipped to meet people needs. For example some people were using bedrails and others had pressure mats so that staff could be alerted if they got out of bed during the night. We found that one person was at risk of developing pressure ulcers and a specialised mattress had been provided to reduce the risk of ulcers occurring. We found that a variety of health care professionals visit the home such as dentists, opticians, specialist nurses, G.P.s and consultants. We found that staff were quick to seek advice from these professionals if peoples health needs changed. We watched staff when they were supporting people with their care needs. We saw that staff were respectful and had a good understanding of how to support people with dementia. We noticed that people who live in the home were dressed nicely and appeared well cared for. People who live at the home told us that they liked the staff and that they trusted them to care for them properly. We saw staff knocking on doors before entering and heard them calling people by their chosen names. We looked at how the home manages people medications. Generally we found these to be managed well and safely but we did identify some recommendations. We found that staff were recording the temperature of the fridge, which is used to store medications on a daily basis, however staff were not taking action if the temperature exceeded the recommended highest levels. This should be addressed as storing medicines at the wrong temperature can impact on how they work. We found that the room that medications were being stored in felt warm and no recordings were being made of the temperature. Medications, which require storage at room temperature, should be stored no higher than 25 degrees Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 14 Celsius. Storing medications at a temperature higher than this could also impact on how medications work. We discussed these issues with the nurse in charge during our visit. When we visited again the following day we found that actions had already been taken to rectify these problems. We looked at the records that staff keep when medication is disposed of. We found that only one nurse signs these records to show what has been disposed of and how. Two signatures must be obtained when medications are being disposed. This will reduce the risk of medications being mishandled. We looked at a checklist for a medication audit. We saw on the homes AQAA that the manager intends to implement audits in all areas in the near future. The nurse in charge told us that medication audits were going to be introduced soon so that senior staff could monitor whether medications were being managed safely. This is good practise and should be implemented as soon as possible. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in meaningful activities. Staff recognise that eating meals is part of this. EVIDENCE: We saw that people are encouraged to take part in a number of activities through out the day. People have been divided into groups according to their needs so those who are less independent can take part in something more stimulating and those who are more dependant get more support. This is good practise. Activities available included reminiscence, baking, and quizzes, boards games, Bingo, crafts and card making and listening to music. Short trips to places in the local community also occur such as trips to the local shopping centre or the park. Some people had recently visited Liverpool museum. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 16 The activities organiser explained that she was in the process of ensuring each person had a current bus pass so that they could access public transport. This is good practice as it helps to promote people’s independence. We saw that people have a care plan, which says how they enjoy spending their time. The activities organiser explained that these were in the process of being up dated. When we looked at the homes AQAA we saw that the home are hopeful that they can organise a holiday for some of the people who live in the home. This is good practise and should be followed through, as it would help to improve people’s equality of life further. We saw that the home has an “open visiting” policy which means that they can visit when they choose within reason. We also saw that people who live in the home are supported to have visitors for refreshments if they wish. Local clergy (Roman Catholic and Church of England) visit the home weekly. Staff explained that they could take people to church if they wanted to go but that at the moment people preferred to receive visits at home. Staff told us before we visited the home that they believed that the standard of food served in the home has improved. We watched the lunchtime meal and saw that people were supported to eat their meal in an unhurried way. Staff were available to support and interacted well with everyone who was eating. Staff had provided a second quiet table for those who became distressed when sitting with others, which is good practice. A blackboard was available in the dining room which had the choices of the meal written down for people to see. The meal looked attractive was colourful, hot and smelt appetising. We met with the chef who told us that he believed he was provided with good quality produce to cook with and that he had accounts with various suppliers. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s rights are protected and their concerns and complaints are listened to and acted on. EVIDENCE: We looked at information we had about the home and records at the home, which told us how peoples concerns and complaints were addressed. The AQAA stated that the home believed that they could make improvements by displaying more complaints procedures and we would agree with this statement. However we found that the home investigates all concerns and complaints and keeps records to show how this has happened. When we looked at our information we found that one person had spoken to us anonymously about concerns that they had about the home since we last visited. We looked into these concerns and discussed them with the manager at the time they were raised. We found that the concerns were unfounded and that the manager had been acting in the best interests of the person involved. During our visit we looked at records in the home, which related to this. We found that an adult protection investigation had taken place and the manager Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 18 had instigated this. This helps to show that the manager understands how to protect people from abuse. We also found that staff have had training in this topic so that they have the knowledge to recognise abuse and staff told us that they know what to do if they should suspect that abuse has occurred. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 19 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home presents, as a clean, comfortable place to live however further work needs to take place to ensure that the environment meets the needs of the people who live there. EVIDENCE: We walked around the home and visited all communal lounges/areas, bathrooms toilets and looked at most bedrooms. The AQAA told us that the owner has started making improvements to all areas of the home. Communal lounges and the dining room have been redecorated since we last visited. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 20 We saw that all bedrooms that we looked at were clean, nicely decorated and had furniture, which matched. Many of theses rooms had been decorated with the owners personal effects which shows that people are supported to be” at home”. One person was very proud to show us their bedroom and confirmed that Balliol lodge is their home and that they are happy living there. We saw that bathrooms had been redecorated in a way, which made them appear similar to those in a domestic home. However we noticed the ceilings to some bathrooms were stained. The owner explained that this was due to accidents, which had caused water leaks. We saw that corridors within the home required attention also. The home is a converted building, which has narrow corridors, and in some cases these have several bends and turns. Keeping these areas nicely decorated would improve their appearance and providing orientation aids could help people who live in the home find their way around. When we looked at the homes AQAA we found that the need to redecorate the corridors had been identified and this intention should be followed through. We saw that a large faced clock had been provided in the dining room and that a large board displayed the day, date and weather. These items help people with memory problems to orientate themselves to every day life. Providing bathroom/toilet doors of a different colour from other doors in the home could build on this work further. This could help some people easily recognise were toilets were which may promote their independence. We spoke with the owner about this who showed us a book that had been purchased which advises how the environment can be improved to support people who have dementia. He was able to explain that tablecloths for the dining tables have been provided in a plain colour so that people can focus on their meal rather than becoming distracted by patterns, which surrounds their food. This is good practise. We looked at records, which showed us the maintenance that occurs in the building. We saw that the maintenance officer works full time and carries out general repairs as well as redecoration. The owner explained that they did have a refurbishment plan to show which areas were going to be developed and when, however this had not been reviewed for some time. We would suggest that a new plan is developed which would help to show a commitment to improve the environment and to make it more suitable for people who live in the home. We looked at how the home reduces the risk of infection spreading. We saw that the home has a fully equipped laundry, which is staffed by people who are employed for this purpose. We saw that the home has products and equipment in place to reduce the risk of infection spreading and that staff have had training in this subject. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 21 When we walked around the building we saw that it was clean and smelt pleasant and that although some areas needed redecoration, in general it presented as a homely comfortable place to live. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care and support from sufficient numbers of staff who have had training to meet their needs. Robust recruitment of staff occurs so that vulnerable people are protected. EVIDENCE: We looked at records which showed us which staff were on duty and when. The records showed that the home is consistently staffed and that staff have a variety of skills. A senior carer (staff who have had more experience and training) is available each shift as well as a qualified nurse. The nurse in charge stated that the senior carers were “ a great support” as they enable the nursing staff to focus on nursing tasks whilst ensuring everyone had their basic cares needs are met. This is good practise. We looked at records, which showed us that over 50 of the staff at the home have achieved an National Vocational Qualification (NVQ) in care. Several staff have also completed a level 3 NVQ as well as NVQ 2, and some staff are training to work towards achieving their registered managers award. This is equivalent to an NVQ level 4 and shows a commitment by the home to develop the staff’s skills. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 23 On the day we visited some staff were being supported to take exams in numeracy and literacy for their personal development. One member of staff told us that they believed that this would make them more confident with their record keeping. This is good practice. We looked at a selection of staff files to see whether staff had been recruited correctly. The home has employed an administrator who is re organising the main office to ensure that information is available and that it can be found quickly. Some staff files had been re organised and we looked at five of these. Each file contained the information that we would expect to show that staff have been recruited correctly. This is important as it shows that the home are ensuring that staff have suitable skills and experience to work with vulnerable people. We spoke with the owner who explained that he regularly carried out pin number checks on the registered nurses who work in the home. This ensures that they are still registered to nurse. However some records we looked at were outdated and the owner explained that although he carried the checks out regularly he did not always write this down. This must be addressed to show that action is being taken to ensure that staff are still suitable to work in the home. We looked at the homes AQAA which told us that staff had received basic mandatory training in all topics and that the intention now was to build on this by providing training in more specialist areas. We found this to be true to a certain extent however we did find that only a handful of staff have received training in basic food hygiene. This must be addressed, as although staff do not prepare food they are responsible for serving it. We did see some practise, which we discussed with the owner and the nurse in charge, which would suggest that staff do not fully understand basic food hygiene. Providing training in this subject could prevent these poor practices from being repeated. In recent months changes have occurred in the Mental Health Capacity act. When we looked at the training plans for the forthcoming year we could not see that this topic had been included.. This training should be provided, as this legislation will apply to many people who live in the home and would help staff to promote their rights further. We also found that although people are treated, as individuals’ staff have not had training on how to promote their equality and diversity. The homes AQAA told us that they intend to make care planning more person centred and providing training on Equality and Diversity could help staff understand how to do this. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 24 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 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 well managed and is a safe place to live. EVIDENCE: We know that a manager who is not yet registered with us manages the home. This needs to be addressed as allowing someone to manage a care home that is not registered is a breach in the law that governs care homes. However we were able to look at information, which showed us that the manager is qualified as a general nurse and a mental health nurse and that Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 25 they have extensive experience in the management of care homes. The manager has been working at the home for six months. Our records show that she has informed us of any significant events that have happened at the home and that she takes appropriate action to protect people’s health and welfare if needed. Staff spoke very positively of her ability to manage by making statements such as “ She has high standards”, “ she fights for the residents here” and “ She’s really good- she’s made a big difference”. We saw that the owner of the home had recruited her correctly which means that he had checked that she is suitable to work with vulnerable people and to manage a care home. We saw that the home employs an outside agency who visits once a year to gain the opinion of the people who use the service (including staff and relatives). This information is then gathered to make a judgement about the quality of the service provided. This year the home was awarded four stars by this agency which is an improvement on last years score and shows that the information gathered suggests that this is very good service. The owner explained that the home intends to survey people as well however the survey forms that were used in the past were rather cumbersome and the intention is to redesign these. This should be addressed and implemented, as it would reflect good practise and help to show that the home is committed to being run in the best interests of the people who live there. We looked at records, which showed us that people are supported to manage their money safely and that they can access this whenever they need. This is good practise and helps to demonstrate that the home understands how to protect peoples’ rights. We looked at a variety of records, which showed us how the health and safety of people who live in the home and the staff who work there is promoted. Staff have had training to enable them to keep people safe and a variety of checks are undertaken to make sure that equipment in the home is suitable for use. When we looked at the homes AQAA we saw that the home has employed a health and safety consultant who visits once a month. This is a significant improvement as we raised concerns about how Health and safety was managed at our last visit. The purpose of the Health and Safety Officers visit is to identify any areas, which could pose a risk to someone’s health and safety. If a risk is identified a plan is produced stating what requires doing and how. This is good practice and helps to demonstrate a commitment by the owner to keep people safe. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 26 We had a discussion with the maintenance officer who explained that he regularly checks whether the bedrails that are used by some people are safe. However this information is not being written down. This must be addressed to ensure that people are kept safe from possible serious injury. We did checks two sets of bedrails and found them to be suitable for the persons needs however assessments need to be carried out to show that consideration has been given to whether people are at risk of entrapment and whether bedrails are suitable to meet their needs. Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 27 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 2 X 3 X 3 X X 3 Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13.2 Timescale for action Two signatures must be obtained 31/08/08 when disposing of any medication. Not providing two signatures increases the risk of medications being mishandled. Records must be kept of any 31/08/08 checks that are made to ensure that nursing staff are still registered to nurse. This will reduce the risk of people receiving care from someone who is not suitable to practice. Staff must receive training in 30/09/08 food hygiene. Providing staff with this training will reduce the risk of food being mishandled, which could impact on people’s health and welfare. The manager must apply to the 31/10/08 commission to be the registered manager of the home. Allowing someone to manage a service who is not registered with us breaches the Care Standards Act 2000. Records must be developed to 31/08/08 show that the bedrails that are used within in the home are suitable for the persons needs. DS0000065370.V362765.R01.S.doc Version 5.2 Page 29 Requirement 2 OP29 18.3 3 OP30 18.1 4 OP31 9.1,2 5 OP38 12.1a Balliol Lodge Assessments must take place to ensure people are not at risk of entrapment, which could be detrimental to their health. 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 OP7 Good Practice Recommendations Risk assessments, which identify a possible decline in someones care, should be regularly reviewed when their care plan is reviewed. Up to date information should be included to reduce the risk of staff not identifying a change in someone’s needs. A refurbishment plan should be developed with timescales of when work will be completed. This should include providing orientation aids, which are suitable for people who have dementia. This would help to show that the owner is committed to improving the environment and ensuring that it is suitable for the needs of the people who live in the home. Staff should have training on the recent changes in the Mental health capacity act. This would means that staff would have the knowledge to able to support people rights who live in the home. Staff should have training on equality and diversity. This would help staff understand why and how people should be supported to live their lives as individuals. 2 OP19 3 OP30 4 OP30 Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Balliol Lodge DS0000065370.V362765.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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