Care Home: Blackwater Mill Residential Home.

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What the care home does well There is a good pre-admission process in place that staff followed to ensure that the home is able to meet people`s needs prior to admission. The service is warm and homely and people said that they loved the views from their rooms. There is an ongoing programme to refurbish and upgrade the home. The furnishing was of high standard and appropriate to the service users` needs. Equipment was available to support and maintain the service users` independence.. The service users told us that the meals at the home were very good to excellent and choices were available to them. The service has a well maintained garden that is accessible to the service users and people we spoke to said that they enjoyed walking and sitting in their favourite spot in the garden. What the care home could do better: Further development of care plans and risk assessments is needed to ensure that care is always provided in a consistent manner and people needs are met as appropriate. Arrangement must be in place to ensure that people receive their prescribed medicines at all times as this is inadequate at present time. The service remains without a registered manager with responsibility for the day to day management of the home. Random inspection report Care homes for older people Name: Address: Blackwater Mill Residential Home. Blackwater Mill Country Retirement Home Blackwater Newport Isle Of Wight PO30 3BJ one star adequate service 06/03/2009 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: Anita Tengnah Date: 2 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: Blackwater Mill Residential Home. Blackwater Mill Country Retirement Home Blackwater Newport Isle Of Wight PO30 3BJ 01983520539 01983520539 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Buckland Care Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 50 0 old age, not falling within any other category physical disability Conditions of registration: 0 50 The maximum number of service users to be accommodated is 50. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: either, whose primary care needs on admission to the home are within the following categories: Physical disability (PD), Old age, not falling within any other category (OP) Date of last inspection 0 6 0 3 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Blackwater Mill Country Retirement Home is a registered care home that provides personal care for up to 50 older people. Buckland Care Ltd owns the service. The home is a substantial detached three-storey property set in extensive landscaped grounds, that includes a lake. It is located in rural Blackwater approximately two miles south of Newport town centre with its shops and amenities. There is a wide range of sitting rooms, separate dining room and all bedrooms have en-suite facilities. The building is accessible and there is ample parking space. Details of fees and any other charges are available from the home. Care Homes for Older People Page 3 of 11 What we found: An unannounced inspection visit was undertaken over one day on 21 June 2010 as part of our monitoring process and lasted four and a half hours. We sent out the Annual Quality Assurance Assessment (AQAA ) to the registered person at the time of the key inspection visit. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have also looked at any other information that we have received since the last inspection. During the visit we spoke to a number of the service users and the staff. We looked at the environment, the service users records and care plans and some staff records as maintained at the service and we observed care practices. The pre-admission assessment process showed that the staff carried out an assessment of the service users needs prior to admission. The assessment for a newly admitted service user included their current medical needs, history of falls, a brief personal history, mobility and skin integrity. The manager discussed that this information is used in the development of the initial care plans. Although the service users did not visit the service prior to admission due to their poor state of health/ frailty, the manager said that their family are always offered the chance to look round the home and that they often did visit, where information about the service is shared with them. The care plans for four service users were looked at and had been developed following needs assessments since the admission to the service. The care plans contained varying degrees of information regarding the assessed needs of the service users and some action plans were in place to show how these would be met. The last report required that where it has been identified that the use of bed rails is required for the safety of a resident; a clear plan of care must be in place that follows current good practice guidance, and provides information for staff on how the risks are to be managed, and regularly reviewed. The care plan for one service user who has been identified as a high risk of fall showed that a pressure mat was in place to alert the staff when this person is up and about at night so that they can be monitored. The care plans contained some details about the service users needs and an action plan to meet those needs. However these were inadequate and required further development to ensure that care is provided in a consistent manner. The care plans showed that a service user was requiring one to one support with their meals and assessed as high risk of malnutrition and the last recorded review was dated January 2010. This may put people at risk of having their needs met as required. Another service user was identified as high risk and had lost weight. The care plans and records did not contain detail of action that had been taken including if they were receiving any supplement. The manager stated that they were on a supplement but the Care Homes for Older People Page 4 of 11 care plans did not contain this information. The service user who required support with their personal care did not have clear care plans in place to show how these were being met. The manager confirmed that this would be looked into and addressed. The care plans had been developed for people who were receiving support with the management of their diabetes. The manager reported that there was good support from the primary healthcare team to monitor these service users. Regular blood sugar monitoring was undertaken by the healthcare team. The care plans for these service users contained conflicting information and should be reviewed to ensure that information is accurate and people receive their care/ support in a consistent manner. The staff were monitoring the food and fluid intakes to ensure that people have an adequate diet and meet their dietary needs. The records of food and fluids seen as maintained at the home were poor and contained gaps of days where the records had not been completed. This is of concern as the staff were failing to record and monitor the food and fluid intakes appropriately and this puts people at high risk of malnutrition and dehydration. The weight records for people who were identified as having lost weights were inadequate as these service users had not been weighed for the last two months according to the records seen. The service maintained a record of accidents/ falls as required. The care record lacked details in their care plans for the treatment of skin tear. Although the record contained a body map , this was not completed as required to guide staff practices. The manager stated that all the service users are currently being reassessed by the continence team and training in continence management is planned for the staff by the end of July. Care plans will be developed following assessments with details of the action needed to meet those assessed needs. We looked at the process for the ordering, receiving and general management of service users medication. Medication was stored in a locked and secure medicine trolley, in a locked room, where a medical refrigerator was also housed. Controlled medicines were stored safely and recorded from the random sample that we looked at. The manager stated that the community pharmacist had undertaken an audit of medication at the service and advice was given. The staff have also completed training in the management of medications. The medication administration record(MAR) charts that we looked at showed that the staff were maintaining some record of the medicines administered. This was not consistent with a number of gaps on the MAR records that put people at risk of not receiving their medicines as prescribed. A random sample of medication that were in stock showed that this did not correlate with the amount given as the remaining balance contained extra tablets that staff could not account for. This indicated that although the MAR records showed that the medicines had been administered, the service user may not have received them. The MAR records were unclear as staff were not defining the code used for when medication was not administered. The manager reported that the staff have been instructed to record the reason when medicines were not given and staff were not writing Care Homes for Older People Page 5 of 11 this down as required and this will be addressed. One service user was noted not to have received one of their medication for six days as the staff had recorded this was out of stock. This was brought to the attention of the manager as immediate action was required. The manager took action and confirmed that the medication would be available later on that day. We took the decision not to issue an immediate requirement notice on this occasion. However the registered person must develop clear procedures for checking and ordering medicines to ensure that people receive their prescribed medicines at all times and they are not put at risk of harm. We spoke to a number of the service users and the staff throughout the day of the visit. People were positive about the care that they were receiving and were complimentary about the food and the care. Some of the comments included: The staff are all very kind and attentive. I do have the choice when I get up and go to bed. The food is very nice and always plentiful. Food is very good- excellent Comments by four people. The service users said that they did not usually have to wait long when they asked for help. The meals at the home were well managed and people we spoke to were complimentary about the food provided. They told us that they were supported to choose from the daily menu and they were able to opt for something different from the menu and this would be provided. The lunchtime meal was seen and this looked well presented, balanced and nutritious. Hot and cold drinks were available to the service users throughout the day. The chef as usual was observed serving dessert from the sweet trolley and this offered the service users variety and choices. Staff were available to offer support with meals as required and meals were not rushed. The service users spoken with said that they would like cold meat salads, jacket potatoes at lunchtime and this was shared with the manager at the time of the visit. The home has a planned activity programme in place that included music from external entertainers. The service users commented that the activity programme was excellent and they always looked forward to the varying programme on offer. The activity coordinator was away on ln the day of the visit. A monthly church service was also available from the local Parish Church. The service users said that they at times preferred not to join in activities and this was not a problem. The home has a procedure in place for dealing with concerns and complaints. We observed that the service has received a number of compliments and thank you cards/ letters from the service users. The complaint log as maintained at the service showed that staff maintained a record of concerns/complaints , details of investigation as carried out and their outcomes as required. Three people we spoke to said that they were very satosfied with the care and they would be happy to raise any concerns with the staff or go to the office. The staff we Care Homes for Older People Page 6 of 11 spoke to were aware of the procedures regarding allegations of abuse. Allegations of abuse had been reported to the local safeguarding team as required and investigations undertaken as per protocol. Records of all allegations reported and outcomes following investigations the safeguarding team should be recorded and including any action taken. The last report in January 2010 identified a need for the staff to receive training appropriate for the work they do. In the interests of meeting the care needs of people with dementia, staff must have suitable knowledge and training in dementia care. At the time of this visit, ten staff have completed training in dementia care and further training is panned for July 2010. The service has an ongoing training programme and other recent staff training included deprivation of liberty and equality and diversity. The service does not have a registered manager. The current manager has confirmed that she has started the process and will be submitting an application and waiting for her Criminal Record Bureau checks to be completed. 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 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 8 of 11 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 7 15 The registered provider must 15/08/2010 ensure that care plans and assessments are developed to show how the service users needs in respect of his health and welfare are to be met. So that staff have up to date information about peoples needs and they can meet them safely. 2 8 14 The registered person must 15/08/2010 ensure that the service users nutritional needs are monitored and appropriate action is taken as required So that people are not put at risk of dehydration and malnutrition. Staff maintain accurate records and monitor their dietary needs. 3 9 13 The registered person must 15/08/2010 ensure that arrangements are in place for recording, handling, safe administration Page 9 of 11 Care Homes for Older People 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 and disposal of medicines received into the care home. So that you can be sure that people receive their medicines as prescribed safely at all times. 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 10 of 11 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. Care Homes for Older People Page 11 of 11 - 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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