Care Home: Blackwells

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What the care home does well The manager and staff always meet people who may wish to move in to make sure the home could give them the support they need. They can then visit and stay at the home to check it would be suitable and if they want to live there. Everyone living at the home has a plan they are involved in making. Plans show their needs, possible risks and goals. They help staff know how best to keep them safe and support them to achieve their goals and develop life skills. People living at the home are enabled by staff to go out and mix in the local community and take part in activities they like. They can choose what they do every day, which helps them to have a more independent lifestyle. One care manager says that the home "Supports service users with complex needs to explore their abilities and capacity and to express themselves safely". Staff support everyone living at the home well with their personal care. They also ensure they stay healthy and have necessary health care checks. People are protected by the home`s policy & procedures for handling their medicines.Blackwells is in a good place near to shops, pubs, colleges and other facilities. This home is an ordinary house, which fits in well with the community. It offers the people living there a secure, well-kept and very comfortable home. Staff are receiving training and good support to help them meet the needs of people who live at the home and to keep them safe. The staff team work well together and give a good individualised service to people with complex needs. The manager has the right knowledge and skills and the home is well run. The way the service is managed is checked regularly and plans are made to keep making it better, as the people who live there want and/or for their benefit. What has improved since the last inspection? Information on the home is now available in a more suitable way. The service users guide has pictures and simple language to make it easier for people with learning disabilities who may want to move into the home to understand. Staff have enabled people living at the home to take part in more activities. They also encourage them to go out so they have full and interesting lifestyles. People living at the home now have a health action plan. They should better ensure all their health needs are met and they are involved in their health care Work has continued to improve the premises. People living there are making their bedrooms more personal and the garden is a nicer area to use and sit in. More regular audits of medicines in the home have been introduced to check they are being managed safely and so better protect the people living there. What the care home could do better: CARE HOME ADULTS 18-65 Blackwells Blackwells Residential Care Home Blackwells (Hereford) Ltd 210 Whitecross Road Whitecross Hereford HR4 0DY Lead Inspector Christina Lavelle Key Unannounced Inspection 7th November 2007 1.15–5.45pm Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 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 Blackwells DS0000061934.V351580.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 Adults 18-65. 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. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blackwells Address 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) Blackwells Residential Care Home Blackwells (Hereford) Ltd 210 Whitecross Road Whitecross Hereford HR4 0DY 01432 350853 F/P 01432 350853 carl3d@aol.com Blackwells (Hereford) Limited Mr Carl Douglas Gillson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may have a physical disability or a mental health disorder in addition to their learning disability. 16th November 2006 Date of last inspection Brief Description of the Service: Blackwells was first registered as a care home in 1986 and the current provider took over its management in September 2004. At the time of registration the provider proposed to change the purpose of the service. Existing service users then moved elsewhere and the home did not provide a service for some time whilst the premises were extensively upgraded and refurbished. In August 2006 the Commission agreed a variation to the home’s registration and it can now provide accommodation with personal care for seven adults. Service users must require care primarily due to learning disabilities but may also have a physical disability or a mental health disorder. People living at the home could also have autism and/or use behaviours that can challenge a care service. Blackwells is located half a mile from Hereford city centre in one of the older residential areas. There are local shops and other facilities close by and it is within reasonable walking distance of the city centre and on a main bus route. The house is a large detached property, with three floors and a cellar. There is a small and enclosed garden at the back of the house and car parking spaces. A sitting room and separate dining room are available for communal use. Six bedrooms are on the first and second floors of the house. The other bedroom is on the ground floor and so is more suitable for a person with limited mobility. Bedrooms are all en-suite; all but one also having shower facilities. Information about the home is provided in a Statement of Purpose and Service Users’ Guide, which are available from the home. The fee for the service is dependant on the needs of individuals, as agreed with their funding authorities. Each person has a contract including terms and conditions of residence and the amount and method of payment of their fee. This charge covers day services and activities and additional items not covered include such as personal clothes & toiletries, newspapers, hairdressing, dry-cleaning, private health treatment i.e. Dentist, Optician & Chiropodist and additional transport e.g. taxis. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided at Blackwells. This means all the Standards that can be most important to adults living in care homes were assessed. This visit was made without telling anyone at the home beforehand. Time was spent with the people living there and talking to some of the staff. The way the home is run and any changes made since the last inspection were discussed with the manager. A Commission pharmacist inspector carried out a specialist inspection of the arrangements for handling medicines, as part of this key inspection, that took place in a separate visit to the home over 3¾ hours. It is difficult to obtain the views of everyone living at Blackwells directly due to their disabilities, so their activities and interactions were observed during this visit. Surveys were left at the home for staff and some people who live there asking what they think of the service. Surveys were also sent to their families and to health and social care professionals involved with their care. Feedback from the fourteen surveys returned is mentioned in this report. The manager had also completed an annual self-assessment form before this visit. This asks managers to say what they think their home does well and could do better; what has improved and about their plans to improve the service. It includes information about the people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All information received by the Commission about Blackwells since the last inspection is also considered, such as events that affected people living there. What the service does well: The manager and staff always meet people who may wish to move in to make sure the home could give them the support they need. They can then visit and stay at the home to check it would be suitable and if they want to live there. Everyone living at the home has a plan they are involved in making. Plans show their needs, possible risks and goals. They help staff know how best to keep them safe and support them to achieve their goals and develop life skills. People living at the home are enabled by staff to go out and mix in the local community and take part in activities they like. They can choose what they do every day, which helps them to have a more independent lifestyle. One care manager says that the home “Supports service users with complex needs to explore their abilities and capacity and to express themselves safely”. Staff support everyone living at the home well with their personal care. They also ensure they stay healthy and have necessary health care checks. People are protected by the home’s policy & procedures for handling their medicines. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 6 Blackwells is in a good place near to shops, pubs, colleges and other facilities. This home is an ordinary house, which fits in well with the community. It offers the people living there a secure, well-kept and very comfortable home. Staff are receiving training and good support to help them meet the needs of people who live at the home and to keep them safe. The staff team work well together and give a good individualised service to people with complex needs. The manager has the right knowledge and skills and the home is well run. The way the service is managed is checked regularly and plans are made to keep making it better, as the people who live there want and/or for their benefit. What has improved since the last inspection? What they could do better: 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. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Thorough assessment and admission procedures are in place to help to ensure the home would suitably meet the needs and wishes of potential service users. EVIDENCE: Required information documents about the home are provided. They include a Service Users’ Guide, which is now in a suitable format with pictures, symbols and simple language so people with learning disabilities should be better able to understand it. It is confirmed potential service users are given a copy of the guide before moving in and the manager says he goes through it with them. The processes followed by the home when a referral for a placement is made and admissions were discussed with the manager. Care records of one person who recently moved into the home were also checked. The home appropriately receives a copy of a community care assessment completed by care managers from their funding authorities. The manager and company director then visit them at their current residence to make their own initial needs assessment and to check existing care plans and obtain other relevant information. One social worker says that the manager was very proactive in liaising with them and the assessment unit one prospective service user was living in at the time. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 9 Whenever feasible, due to the complex needs of most people who move into the home, introductory visits to the home are then arranged. A decision was made in consultation with relevant people that too many visits could be very stressful for one person and so he was offered a programme of daily visits and the staff from his previous home brought him there a short while. Prospective service users are also allocated a particular member of staff from Blackwells’s team (their keyworker) from the beginning so they can get to know them before they move in and can help to introduce them etc. New people are able to chose their bedrooms whilst there has been more than one available. They then move in on a three-month trial basis and during this time staff keep detailed reports of their progress and how they are settling in and start to develop a care plan. At the end of this period a review meeting is held, which all relevant people attend, when a decision is made about the suitability and so continuation of the placement. This takes into account the person’s views and if they wish to live there. The manager recognises the home should formalise the views of people already living at the home about possible new residents, as part of this process. He is clearly mindful anyway of the importance of their compatibility and staff do check and/or observe their reactions if necessary. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in these outcome areas is good. This judgement has been made using available evidence including this visit to the service. People living at the home have a care plan showing their needs, likes & dislikes and goals. Plans detail the support needed to achieve their goals and a more individual lifestyle. Risk assessments and management plans are in place to reduce safety risks and they can make choices in their daily lives and routines. EVIDENCE: A sample of care records kept for people living at the home was looked at. They include their photograph, relevant background information and contacts. Each person has a full needs assessment carried out including an assessment of their daily living skills in areas such as their personal care, environment, communication and behaviours. This has resulted in an individualised care plan setting out their needs, wishes and goals and the support needed to meet them. Detailed daily reports are also kept by staff showing individuals’ health, moods and activities so providing information about their lives and progress. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 11 The home has implemented an appropriately person centred (PC) approach to care planning. This means people living in the home are involved in drawing up their plans to the extent possible. Plans are written in the first person and include all important events and people in their lives; things they need to help them; their story and dreams, wishes and nightmares. They also specify their likes & dislikes regarding their routines, food, activities etc and their personal goals. Short and long-term goals are specified, with an action plan and the outcomes regularly reviewed. It is good the manager plans to review the home’s PC tools to produce the plans in a more user-friendly format, so that people living at the home should understand and “own” their plans easier. PC assessment meetings had been held to set up plans, involving the person him/her self, their family, staff and relevant others to assess and identify their needs and goals. Keyworkers take an active role in care planning and reviews. and go through the plans with each person monthly. Plans are also formally reviewed and updated at least six monthly and/or when any changes occur. Keyworkers are also able to give some individual time and one-to-one support to their allocated people so they get to know them and their needs well and can help them to express their views and advocate for them better. Comprehensive risk assessments are undertaken for each person in respect of general safety areas and to manage aggressive and/or self-harming behaviour. They include mobility, moving & handling and support needed within the home environment and when out in the community to minimise any risks. Specific care management plans are also in place, which include techniques to reduce agitation and to diffuse challenging situations as they arise. When necessary (and only in exceptional circumstances) this can involve physical interventions. Staff have received relevant training and there are detailed descriptions and pictures showing the interventions they must use, drawn up in consultation with a specialist trainer. When any interventions are needed, detailed incident records are completed with an accident record and body charts if there are injuries. The manager always reviews incidents and they are also sent to the company Operations Manager with an overview of actions taken and outcomes. Staff involved would also be debriefed following any incidents involving them. Regarding issues of equality and diversity the home’s philosophy and practice clearly focuses on the needs of individuals. This includes considering particular ethnic and physical needs; for example relevant specialist input was sought to advise the home about mobility aids and adaptations. The home’s policies and induction programme includes the values and principles that should underlie care and the manager also plans to include equality & diversity as part of the staff training programme. He has received training himself to cascade to staff and should ensure this includes the new Mental Capacity Act and the process of setting up best interests groups when a person is not able to make informed choices so that decisions are made by appropriate other people if necessary. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are supported to take part in activities they enjoy, to go out in the community and maintain links with their families. Staff respect their individuality and encourage and support them to develop their social and life skills. The home provides food people like, with healthy options promoted. EVIDENCE: Plans include the social and developmental needs of people living at the home, which are also reflected in their goals. They each have a varied weekly activity programme that includes leisure, education, daily living skills and community integration. Outings and holidays are also arranged to suit individual choices and needs, in consultation with their keyworkers. Activity programmes are now in a user-friendly pictorial format and displayed in each person’s bedroom. Staff have much effort to encourage people who live at the home to take part in activities and go out more in the community, which can be more difficult for Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 13 those with mental health and behavioural issues. Weekday activities include college courses to help them gain skills towards work and independence e.g. literacy & numeracy. Some people attend a farm project, day services and/or social clubs for people with learning disabilities. Staff encourage and enable everyone to go out every day if they wish and to have opportunities for one to one input and leisure and social activities such as shopping, visiting a snozelen and spa, going to local pubs etc. Local events are also sought that they can walk to and the home has a vehicle when transport is needed. Programmes include in-house activities such as music & massage sessions, cooking, arts & crafts, films and painting. One support worker reflects the staff view that “The home gives service users access to the community on a regular basis and has set up many beneficial activities”, which is confirmed in this key inspection. People living at the home are assisted by their keyworkers to maintain contact with their families and significant others such as advocates through telephone calls and facilitating visits. Their relatives are also involved in care reviews and sign their agreement to their plans, when they are not able to. Staff also try to provide opportunities for people to socialise with others outside of the home. Each person’s daily routines are flexible and their rights and responsibilities are emphasised and risk assessed, including managing their own keys, money and medication. They are all encouraged to do as much for him/herself and around the house as they can and so develop their daily living and personal care skills. Service user meetings are held monthly facilitated by staff, which are recorded and have action plans arising. Matters such as holidays, activities, food and daily routines are discussed and they are all encouraged to raise their concerns and participate in decisions about the day-to day running of the home. Regarding food provided at the home 4 weekly menus are drawn up with the input of people living there and taking into account their likes & dislikes. Each person’s nutritional needs are assessed and there is guidance from a Dietician in their plans when anyone needs a special diet needs and/or assistance such as their food cut up. Staff aim to improve meals and promote healthier eating through wholesome food and home made meals. Fresh fruit and juice, low fat jams, wholemeal bread, high fibre cereals and skimmed milk was seen. Fresh food stuff products are bought daily and people living at the home go shopping with staff and help with cooking and meal preparation to the extent they can. Mealtimes are flexible and staff encourage them to be a social occasion when everyone can eat together. Attention is paid to good food hygiene with staff expected to undertake regular audits and check food temperatures etc. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People living at the home are being supported to meet all their personal and health care needs. They are protected by the home’s policy and procedures for handling medicines. EVIDENCE: Care plans of people living at the home show their personal and health needs and any support they need. Clear guidance and information is also available to staff relating to relevant aspects of their emotional and physical health. Plans appropriately reflect individual preferences for personal care daily routines and how they receive this e.g. gender of their carers. People were observed to be well presented and suitably clothed, in accordance with their age and lifestyle. Records are kept of health checks and the specialist input they all receive with reasons for visits, advice and treatment given. Records of necessary physical checks made by staff are also kept e.g. weight, fluid and food intake records. Each person now has a Health Action Plan (HAP), as is recommended by the Department of Health for people with learning disabilities. HAPs help to show they have regular, routine; specialist and preventative heath care checks ups Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 15 and should also enable people to be more involved in managing their own health care, to the extent they are able to. Everyone living at the home is registered with the local GP practice and most have regular input from health care specialists, including a psychologist and psychiatrist. One health care professional says the home always communicates clearly and works in partnership with them and takes up their specialist advice. They confirm they can see their patients in private and there is always a senior to confer with and staff understand the needs of people living there. One care manager says there is “Close monitoring of health and social needs. I have always felt that a service user with complex needs has been safely supported”. The pharmacist inspector looked at some stocks and storage arrangements for medicines and some medication records and procedures. The way medicines were given to one person in the home was seen. There were discussions with the manager and one other member of staff was met. Two people living in the home were spoken to and both appeared content and well cared for. Nobody was able to talk about his or her medicines. Staff who administer medicines undertake a formal training process about care of medicines. A medication policy is available so that staff also have written direction as to how the home expects them to handle medicines safely. Staff carry out a regular monitoring test for one person. They must however have proper training about this and ensure the clinical team have delegated this task to them and that the person consents to this. There are records about current medication for each person living in the home together with records of medicines received, administered and disposed of. Staff make regular daily and monthly checks of medicines and records. This helps ensure people living in the home have the right medicines and these are properly accounted for. Records for one person need to show clearly if 5ml or 10ml are taken each time a dose of one particular medicine are administered. Detailed protocols describing how to use most medicines that are only needed on an ‘as required’ basis were seen. Protocols like this are needed for each medicine prescribed in this way (including creams or other treatments applied externally) as this helps to ensure that staff understand the correct use of the medication for each person. A few prescription directions need updating by the surgery as the way the medicines are administered has changed. This will mean that the up to date information will be printed on the medicine label and chart and will be clearer for the staff. Nobody is assessed at present as able to self-administer his or her medicines. Forms of consent for medication were seen but these could be improved to include everything about medication. Care plans also need to reflect what choices people who live at the home are given and make about the way in which their medicines are administered and their consent to how staff handle and administer their medicines. Where consent is not possible because of Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 16 lacking capacity records are needed of the agreement that the way in which medicines are administered is in the best interests of that particular person. Two staff are always involved in administering the medicines. Ways were suggested to ensure better checks of medicines could be made in the presence of the person taking the medicine. Some improvements are needed in the way medicines are dealt with and recorded when people living at the home go out to college or on trips. Medicines are kept safely. As the medicine cupboard is very full some products are kept in another locked drawer. These would be better in another proper medicine cupboard. As there is a radiator close by the temperature in the cupboard should be checked to make sure it does not exceed 25°C, above which medicines can deteriorate. Information about expiry dates of medicines is on display and liquid medicines and creams had opening dates written on the containers, which is good practice. This should be done for any medicine as it helps with stock checks. There was a capsule in use where the manufacturer states a 6-week expiry date after opening the container. The lancing device staff use to obtain a capillary blood sample for a monitoring test from one person needs to be changed to one that is suitable for staff to use in a care home environment. More information is available from the Medicines and Healthcare products Regulatory Authority. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to express their views and concerns, which are taken seriously. There are also systems operated by the home that help to protect them and for managing complaints about the service effectively EVIDENCE: The home’s complaints procedure is now in a format that people with learning disabilities should understand better. It has simple language and pictures and each person living at the home has a copy in their bedroom. Keyworkers understand their role to advocate for their allocated people and support them individually and in meetings to express their views and concerns, which are noted and actioned. There is also a format to record complaints made about the service with actions taken, timescales and outcomes. For one matter raised since the last inspection a management strategy is in place and the manager liaised with those involved and fully documented actions taken and outcome. There are policies & procedures in relation to safeguarding vulnerable adults, prevention of abuse, home security and whistle blowing. Staff receive relevant instruction as part of induction and are expected to consider any incidence or suspicion of abuse or neglect at the end of every shift and complete a form to raise concerns if necessary. Management plans help staff to deal appropriately with aggressive and/or self-harming behaviours of people living at the home. Their personal money is dealt with carefully and when possible they can retain control over their cash and savings accounts. If staff are involved in managing their finances records are kept, with balances checked daily by senior staff. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including this visit to the service. The accommodation suitably meets the needs of people living there and offers them a very comfortable, safe and well-kept home. Appropriate arrangements are in place to keep the house safe and also clean to promote good hygiene. EVIDENCE: Blackwells is in a convenient location within walking distance of Hereford city centre and on a main bus route. It is good that the home is set back from the busy main road and also has a secure, albeit rather small, garden at the rear. The overall impression obtained of the house is homely and comfortable. Due attention has been paid to security and the safety of people living at the home and there are key pad locks on all external, kitchen, cellar and cupboard for cleaning substances doors. One care manager comments “I have always felt that service users are well supported in a safe environment”. The accommodation had been extensively upgraded and the facilities, fittings furnishings and equipment are of a high quality. There are ongoing plans for Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 19 further improvements and/or making aspects more suitable for the people who have moved there. The garden in particular has had work done since the last inspection so it provides a nicer area to use and relax in and garden furniture is to be bought. Appropriate arrangements are in place for any maintenance and repairs necessary and for regular servicing of the heating, equipment etc. People living at the home all have good-sized single bedrooms with en-suite toilets (all but one also having a shower). One bedroom is on the ground floor and so is suitable for its occupant who has mobility difficulties. Other aids such as ramps and hand rails have been provided. Bedrooms are all fitted with suitable locks and an assessment is made so those people able to hold their own key can do so. As people have moved in they have been supported to personalise their bedrooms and choose the décor etc and staff plan to develop this further as they settle in and they know their needs and wishes better. All areas seen during this visit were clean and tidy and there are cleaning checklists to help to make sure that daily tasks are undertaken and weekly overall cleanliness audits are now carried out. The home has comprehensive infection control policies & procedures, about which staff receive instruction as part of their induction. Protective gloves and clothing are also provided. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, & 35 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People who live at this home are supported by sufficient staff who are being suitably trained. Staff are well supported and work as a team to give a good quality service. Thorough recruitment procedures help to ensure only suitable people are employed at the home, for the protection of the people living there. EVIDENCE: It is confirmed staffing levels are being maintained at an appropriate level to meet the personal and social needs of the five people who are currently living at the home. The staff team comprises the manager, assistant manager, two team leaders and thirteen support workers. More staff are being recruited as new people move in and the team is deployed flexibly and can cover the home when anyone is on leave. Staff appear committed to providing individualised care and they work well together and with relevant other professionals. One care manager feels staff have the right skills and experience and comments “I have been impressed by their skills in dealing with one service user”. Robust policies & procedures for the selection and recruitment of new staff are operated. Staff and their records confirmed that a police (CRB) check and at Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 21 least two written references (one from their previous employer) were taken up. New staff are not allowed to start working at the home until satisfactory checks are received. Copies of relevant documents are obtained and application forms are completed, which appropriately include a health statement and a full employment history. One of the manager’s plans is to involve the people living at the home more in staff selection, which would be a positive development. New staff undertake a six month probationary period before their employment is confirmed. During this time they complete the provider’s comprehensive induction programme. This includes information on specialist areas in relation to people with learning disabilities and such as autism, diabetes, dementia and bipolar disorder. Other relevant care related topics are covered e.g. medication management, protection and abuse. They also go through the care records and the home’s policies & procedures and sign a checklist when they have read and understood them as well as a confidentiality statement. The Standards specify that staff in care homes for people with learning disabilities should undertake accredited training and the manager is currently liaising to obtain places for staff on the new LDQ (Learning & Development Qualification). Staff complete mandatory health & safety training topics and move onto an NVQ (National Vocational Qualification) in care. Although only five staff are qualified so far three more are doing the training. There is a staff development programme and the manager continually reviews training. He is clear the team and individual staff would benefit from further training to increase their skills and knowledge so they can meet the needs of people living at the home better. Staff receive individual supervision at least two monthly that includes feedback on their work performance, relationships with staff and the people living at the home and their training & development needs. Records of sessions are made and the manager and each staff member sign and keep a copy. Staff feel they are consulted and communication is effective through records, daily reports and shift handovers. Monthly staff and team leader meetings are also held when they can raise issues and make suggestions, which they feel are listened to and taken up positively. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at Blackwells receive good individualised care at a well run home. The quality of the service is monitored and reviewed so it continually improves as they wish and/or for their benefit. Policies, procedures and staff working practices help to protect the people who are living and working there. EVIDENCE: The home’s manager (Carl Gillson) is suitably qualified and experienced having an NVQ level 4 qualification in care & management. Mr Gillson has completed much other relevant training and is currently doing a distance learning degree course in Applied Psychology for people with learning disabilities. Management arrangements are appropriate and the assistant manager and team leaders are delegated responsibility for certain administrative tasks, staff supervision etc. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 23 This key inspection confirmed that the staff team are committed to providing a good quality service and there is a good team work ethic with an open and positive management approach. The home and manager are well supported by the provider. This includes in respect of budgets and the manager now has more autonomy to allocate resources as needed and attends monthly meetings with other managers for peer support and to discuss changes in legislation etc. A formal system to monitor, review and assure service quality is in place. This includes required monthly visits from a representative of the provider when all aspects are checked with regular audits and plans with actions and timescales are made to address any identified shortfalls. The home also carries out other daily and weekly audits and completes monitoring sheets on such as incidents, medication, cleanliness and food hygiene. This all appropriately results in an annual development plan for the home. The views of people living there must be reflected in the annual plan and feedback is obtained through keyworkers and meetings. As yet other stakeholders do not input formally to this process. Regarding health & safety in the home staff receive training in the mandatory topics such as fire safety, first aid and moving & handling. The following is also confirmed:• The heating system and gas installations are serviced regularly. • Risk assessments are carried out, including COSHH. • Checks are made on such as the window restrictors, water, fridge and freezer temperatures and the call alarm system. • Staff complete the required fire safety checks at the specified intervals. There is a clear procedure for staff to report any safety hazards and there were none noted during this inspection visit. Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 25 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations Care plans should reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. Provide an additional medicine cupboard. The lancing device staff use for one person must be safe to use in a care home environment as described in Medical Device Alert MDA/2006/066 issued by MHRA in December 2006. This is to reduce the risk of cross infection linked with the use of the wrong sort of device. 2. 3 YA20 YA20 Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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 Blackwells DS0000061934.V351580.R01.S.doc Version 5.2 Page 27 - 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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