Care Home: Blackmore House

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What the care home does well As this inspection concentrated upon previous shortfalls in the service and assessing progress with these we did not look at areas of the service where we have previously found that the service is providing a good service. The general manager stated that admissions and discharges now take place at weekends as well as during the week. The home had 16 people living at the home at the time of this visit. We were however informed that the planned seaside theme week which is mentioned within our previous report took place. The idea was to recreate the environment of a typical British sea side resort around the 1940`s - 50`s. We only looked at one of the five bungalows during this visit. However from our brief observation the home appears to continue to have a good standard of cleanliness and hygiene. What the care home could do better: As highlighted earlier within this report the service needs to make improvement in some areas. We made an immediate requirement in relation to our concerns about the management of medication. Following our inspection we wrote to confirm the actions which needed to be taken in order to safeguarding people and to ensure compliance with the associated regulation. The day after our inspection we received a written up date from the general manager regarding what she had done to address the issues. Risk assessments and management of the use of bed rails needs to be improved to ensure residents are safe. Records following action taken in the event of finding water delivery to be in excess of 43 degrees Centigrade need to be maintained. Random inspection report Care homes for older people Name: Address: Blackmore House School Drive Bromsgrove Worcestershire B60 1AY one star adequate service 25/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrew Spearing-Brown Date: 2 9 0 4 2 0 1 0 Information about the care home Name of care home: Address: Blackmore House School Drive Bromsgrove Worcestershire B60 1AY 01527575222 F/P01527575222 kay.workman@bcop.org.uk www.bcop.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Broadening Choices for Older People Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 28 Number of places (if applicable): Under 65 Over 65 0 28 dementia old age, not falling within any other category Conditions of registration: 28 0 The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 28 Dementia (DE) 28 Date of last inspection 2 5 0 9 2 0 0 9 Care Homes for Older People Page 2 of 9 Brief description of the care home Blackmore House was built in 1989 as a care home for older people. The home is single storey and incorporates an activity centre that helps to maintain links with the local community. The home provides single bedroom accommodation for a total of 28 people who are accommodated in 5 bungalows. Each bungalow represents a virtually self-contained living environment with a lounge/dining space, toilets and bathrooms, bedroom accommodation and a kitchenette. Three of the bungalows each accommodate 4 people, while two of the bungalows accommodate 8 people. The majority of places at Blackmore House are for providing respite (short stay) care. Emphasis is placed on creating a homely living environment. Blackmore House provides a care service for older people with or without a physical disability and for older people with dementia. Broadening Choices for Older People (BCOP) is the registered provider however, the building is owned by, and leased from Worcestershire County Council. As all beds are block purchased by Worcestershire County Council Adult Services there is a standard bed fee. For further information regarding fees the reader should contact the service directly. Additional charges apply for items such as private chiropody, toiletries, magazines, newspapers and hairdressing. Care Homes for Older People Page 3 of 9 What we found: This inspection visit was unannounced. Therefore nobody within the home knew we would be coming. This inspection was carried out by one inspector over a period of one day. The last key inspection at Blackmore House was carried out during September 2009. The outcome of that inspection was that we rated the service as Adequate. As this was a random inspection we wanted to gain an assessment of the progress made since our last inspection. We had a look at the areas where we either required improvement or highlighted scope for improvement within the previous report. During our visit we looked at some documents such as care records, risk assessments, medication records, staffing records and service records. During the inspection we had discussions with the general manager, the head of care and a senior carer. As part of this random inspection we viewed the care plans and daily records regarding some people living at Blackmore House. A care plan is a document designed to give staff guidance about the care needs of people in order that service delivery is consistent. Everybody had a care plan and we saw that reviews take place. The care plans contained a range of different headings such as personal care, mobility, oral care, diet and history of falls. Under each section information and guidance was provided such as the need to offer reassurance when using the hoist as the resident was frightened of it. Within another part staff were instructed to report any concerns in relation to skin condition and the need to use creams. We looked at the records regarding the application of creams and found a large number of gaps where staff had not signed to indicate that cream was used. Risk assessments were in place for some activities. However there was no risk assessment in place regarding the use of bed rails by one individual. We viewed the bed concerned and found that the bumpers although in place were not fitted correctly. The incorrect use of bed rails and bumpers can be potentially hazardous. We brought our observation to the attention of the general manager who took immediate action. At the time of the last key inspection we noted that the majority of the MAR (Medication Administration Record) sheets were completed satisfactorily. We noted that the service was using a code S for asleep which did not appear as a code. In addition during the previous inspection we saw some eye drops which were prescribed for 5 days however they were administered on the morning of our inspection which made it the 8th day. In addition we noted that some boxed medication did not have the date of opening recorded upon it. As a result of the above, on this occasion, we asked whether anybody was currently prescribed eye drops. We looked at the eye drops in use and found that they had the date of opening recorded upon them. We check the MAR sheet and found that the medication prescribed for that morning was not signed as given. We checked the blister packs or boxed medication for some of these which indicated that the medicines were Care Homes for Older People Page 4 of 9 given but that staff had not signed. As a result of the above we viewed the MAR sheets of other residents and discovered that this was not an isolated incident. We found other similar MAR sheets, one sheet had a gap from the evening beforehand. It was of some concern that medicines were not signed as administered as this could potentially lead to somebody receiving a further dose of the same medication. We saw on one MAR sheet that staff had used a code demonstrating that the home had run out of medication for an individual. We discussed with people on duty the procedure for administering medication and discovered that the person signing the MAR sheet was not necessarily the person who administered the medicine. This is potentially unsafe practice. Due to the concerns we had at the time of our visit we left an immediate requirement. We wrote a letter to the service to confirm the action they needed to take. The general manager responded appropriately to our correspondence detailing what she had done. The general manager informed us that the service has not received any complaints since our last inspection. We were also informed that no further training in relation to the safeguarding of vulnerable adults has happened since our last inspection. Since the previous key inspection we have received notification that the registered manager has resigned from her post. The assistant manager took over responsibility for the day to day management of the home. We are aware that the provider has appointed the former assistant manager as general manager and that she now intends to apply to the commission regarding registration as the manager. The service has, in addition to the appointment of the general manager, created a new post entitled head of care. Blackmore House continues to have a team of senior carers who manage shifts in the absence of the head of care. Within previous reports we have highlighted that the introduction of BCOPs Quality Assurance system had not commenced. We were told, during this visit, that the implementation of the system is due to commence the following week. As part of this inspection we saw the most recent Regulation 26 report written by a representative of the organisation. These visits take place on a monthly basis. We asked for the most up to date documentation regarding the servicing of hoisting equipment. It appeared while we were at the home that the last service took place during May 2009. Under the LLORA (Lifting Operations and Lifting Equipment Regulations) 1988 all equipment that lifts people needs to be serviced / checked by a competent person every 6 months. Following our inspection the general manager informed us that she had found documentary evidence that the portable hoist was serviced during November 2009. We were informed that the overhead hoists in the bathrooms are not used as staff believe them to be undignified. As no other equipment is available to assist people to use the baths the majority of residents are likely to need to use the showers. We previously reported that although hot water taps over the baths have a device fitted to control temperature that these are not fail safe and therefore water temperatures should routinely be checked. Records existed however these showed temperatures in excess of 43 degrees Centigrade. We were informed that a contractor is called to deal Care Homes for Older People Page 5 of 9 with these matters however the records did not indicate this. Prior to our visit we received a copy of a letter sent to the service from Hereford and Worcester Combined Fire Service regarding improvements needed to the fire risk assessment. The general manager informed us that she plans to bring the need to up date the document to the attention of the local authority who are the leaseholders. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 Risk assessments must identify strategies to eliminate or minimise potential risks. To properly safeguard people living at the home from identifiable harm 30/01/2009 Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 A full and detailed risk 04/06/2010 assessment must be in place regarding the use of bedrails to ensure that risks are identified and eliminated. This is to ensure that people are safe from injury. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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