Care Home: Blair House

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What the care home does well What has improved since the last inspection? Since the last inspection the home has undergone major building work. 7 extra bedrooms have been added and there has been reorganisation of day space and office space. The net result has meant that the home is now registered to accommodate 41 residents [an increase of 5 on the previous registration]. Staffing has been rationalised to accommodate the increased numbers. Following the requirements made on the last inspection staff records were checked to ensure that the home are making the necessary checks prior to recruitment of staff. The records showed that the checks are now being made and this ensures that staff employed are `fit` to work with vulnerable people and helps protect the residents in the home. Following a random inspection conducted in October 2006 concerning the events surrounding a death in the home it was recommended that more regular entries be made in the nursing reports and that the nursing staff [as well as the care staff] evidence their duty of care by also making more regular entries. This has improved overall although some further recommendations have been made in this report. The home has undergone a lot of upgrading over the past 2/3 years with two extensions to the home being added involving more bedrooms and the rationalisation of the available day space. The new rooms and day space meet required standards and also follow good practice guidelines. For example there are designated areas for women including day space meeting guidelines on safety, privacy and dignity. What the care home could do better: The assessments carried out prior to and following admission varied in standard. For example one resident had assessments completed for money management, transport safety, and rehabilitation skills. None of these were dated however so that it was difficult to put them into context regarding the residents progress. Another resident had a general assessment only half completed and again this was not signed or dated. A third resident had been admitted more recently and had visited the home for the assessment to be completed. The assessment seen was again not fully completed. Overall there was enough information to assess the resident`s main needs but the quality and consistency of the homes assessments needs further review by the manager and auditing on a more regular basis so that all care needs can be effectively identified. Not all care interventions were recorded on the care plan. For example the manager advised the inspector of some counselling sessions conducted on a regular basis with one resident but there was no indication of this on the care plan or of any evaluations. Progress here was therefore difficult to follow. The reasons why some residents did not have a copy of the care plan was not clearly recorded on the care planning documentation. One care plan had not been written up until 10 weeks following admission and is recommended that a standard is drawn up so that a care plan is made available in good time. Again some of the care plans were not signed or dated. Accurate recording should be improved by regular auditing by management. There have been various training initiatives to raise the level of awareness around abuse in the past but only two staff had attended updates in the past year. Staff interviewed were aware that procedures were available for dealing with accusations of abuse but struggled to appreciate how these concerns should be referred outside the home. Further training is recommended. Staff interviews revealed that formal supervision is patchy in that some staff receive ongoing supervision whilst others do not. It is a requirement that such support is built into the homes existing staff support systems CARE HOME ADULTS 18-65 Blair House 18 Roe Lane Southport Merseyside PR9 9DX Lead Inspector Mr Mike Perry Unannounced Inspection 18th January 2007 10:00 Blair House DS0000017227.V321846.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 Blair House DS0000017227.V321846.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. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blair House Address 18 Roe Lane Southport Merseyside PR9 9DX 01704 500123 01704 533 981 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 Doug Edmondson Mr Albert Marcel Zachariah Mr Anthony William Moran Care Home 41 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (41) of places Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. January 2006 Date of last inspection Brief Description of the Service: Blair House is a detached converted building situated on a main road in a residential area of Southport. It has easy access to Southport Town Centre and is close to Hesketh Park. The home provides accommodation and nursing care for younger adults with mental health needs. The main day space is situated on the ground floor with 3 lounge areas, a dining room and a large entrance/foyer, which is also used for recreation. Bedrooms are over 3 floors and are accessible by lift. There is a garden to the rear of the building and parking spaces at the front. The home is owned by Mr D Edmondson and one other partner and is managed by Tony Moran, a Registered Mental Nurse with many years experience. A first floor extension has been added in recent years and further upgrading work has been completed so that the home can now accommodate 41 residents. The weekly fees are £850 Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core standards the home is expected to achieve. The inspection took place over a period of two days. The inspector met with residents and spoke with 3 in more depth. The inspector also spoke with members of care staff on a one to one basis and the manager and senior nurses and the Registered Provider. The home were undergoing an annual quality audit at the time of the inspection from an external source and views were also canvassed from this person. Service user comment cards were also given out to try and gain more views as to how the home is run and what it is like to live there. Three of these were returned. A tour of the premises was carried out and this covered most areas of the home including some of the resident’s rooms [not all bedrooms were seen]. Records were examined and these included four of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well: Care plans are drawn up by the nursing staff with some involvement from residents. One care plan seen was for a resident on the rehabilitation unit on the top floor of the home and this was detailed and included aspects of daily activity such as money management, personal hygiene and aspects of health care. There was also a plan for the management of smoking so that the resident could be safe while carrying out this activity. This had followed a risk assessment. Because it was on the care plan it could be monitored on a regular basis. The resident stated that the ‘nurse discusses the care plan with me’. Care plans are formally evaluated on a six monthly basis and these are planned in advance. The reviews seen were detailed and included input from the resident. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 6 The residents in the home have differing levels of need with respect to involving themselves in community life and this is dependant on capacity and ability. There is a small group involved in more rehabilitative programmes involving managing money and shopping and this involves them in activities daily outside of the home including attending local support groups and training courses. Residents spoken to were encouraged to use local amenities and were seen to be coming in and out of the home on regular occasions. Residents commented: ‘Its good here – we all get on well’. ‘We can do what we want most of the time – staff help us’. ‘There’s a good atmosphere and you can talk to the staff’ The general atmosphere is relaxed and sociable in the home and this was evidenced at meal times. Residents had various comments regarding the food but on the whole felt that they were catered for. Residents interviewed were aware of the complaints procedure and felt that any concerns that they had would be listened to and taken seriously. One said that ‘staff are easy to talk to and will listen’. The home has a copy of the local Adult Protection Procedures and has accessed these when reporting issues of concern around possible abuse of residents. On the day of the inspection the home had 37 residents in the home. Staffing consisted of 3 trained nurses and 7 care staff. The manager is supernummery to these numbers. From the last inspection there has been little change in personnel in the home so that staffing is consistent. All care staff apart from two have NVQ training to at least level 2 so that they are competent to look after vulnerable people. Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportative and easy to approach. Staff files were inspected and the necessary recruitment checks prior to employment were available so that staff employed are ‘fit’ to work and residents are afforded some protection. The home a number of Quality Assurance [QA] initiatives that aim to seek the views of the residents. There is a yearly external quality audit [PQM], which includes a resident’s satisfaction survey as well as resident interviews with the assessor. This was being carried out during the statutory inspection. The views of both residents and staff form the basis of the quality audit. Previous surveys were seen and the overall satisfaction of residents was good. The management have consistently followed good praise guidelines as well as paying attention to the National Minimum Standards. The home has a good record of meeting any statutory requirements that are made. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 7 Health and safety records seen were clear and well organised and the knowledge of staff in this area was good. The resident’s environment is therefore maintained safely. What has improved since the last inspection? What they could do better: Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 8 The assessments carried out prior to and following admission varied in standard. For example one resident had assessments completed for money management, transport safety, and rehabilitation skills. None of these were dated however so that it was difficult to put them into context regarding the residents progress. Another resident had a general assessment only half completed and again this was not signed or dated. A third resident had been admitted more recently and had visited the home for the assessment to be completed. The assessment seen was again not fully completed. Overall there was enough information to assess the resident’s main needs but the quality and consistency of the homes assessments needs further review by the manager and auditing on a more regular basis so that all care needs can be effectively identified. Not all care interventions were recorded on the care plan. For example the manager advised the inspector of some counselling sessions conducted on a regular basis with one resident but there was no indication of this on the care plan or of any evaluations. Progress here was therefore difficult to follow. The reasons why some residents did not have a copy of the care plan was not clearly recorded on the care planning documentation. One care plan had not been written up until 10 weeks following admission and is recommended that a standard is drawn up so that a care plan is made available in good time. Again some of the care plans were not signed or dated. Accurate recording should be improved by regular auditing by management. There have been various training initiatives to raise the level of awareness around abuse in the past but only two staff had attended updates in the past year. Staff interviewed were aware that procedures were available for dealing with accusations of abuse but struggled to appreciate how these concerns should be referred outside the home. Further training is recommended. Staff interviews revealed that formal supervision is patchy in that some staff receive ongoing supervision whilst others do not. It is a requirement that such support is built into the homes existing staff support systems 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. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 9 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 Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 10 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): Standard 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments carried out prior to and following admission for 4 of the residents were looked at. These varied in standard. Two of the residents had been in the home for a number of years and only assessments completed in recent years were considered in terms of the inspection. These consisted of risk assessments and general assessments completed periodically by the staff. For example one resident had assessments completed for money management, transport safety, and rehabilitation skills. None of these were dated however so that it was difficult to put them into context regarding the residents progress. Another resident had a general assessment only half completed and again this was not signed or dated. The third resident had been admitted more recently and had visited the home for the assessment to be completed. The assessment seen was not fully completed. For example the sections on education, safety to others, self care, kitchen and public amenities had not been filled in. the residents information Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 11 sheet was again not all completed and was not signed by the member of staff responsible. All three files contained information from referring agencies and were being monitored through the care coordination programme whereby regular reviews by psychiatric services are carried out. In the case of the more recent admission there were assessments by social workers and a referring letter from the consultant who listed some of the medical and psychiatric needs, evidencing good practice. For various reasons none of the above residents had had a pre admission assessment recorded by the home. The manager did show the inspector an assessment carried out on another admission were there had been a preadmission assessment and this had been carried out effectively with care needs highlighted. Overall there was enough information to assess the resident’s main needs but the quality and consistency of the homes assessments needs further review by the manager and auditing on a more regular basis. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 12 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are drawn up by the nursing staff with some involvement from residents [although evidence of the latter varies to some extent]. One care plan seen was for a resident on the rehabilitation unit on the top floor of the home and this was detailed and included aspects of daily activity such as money management, personal hygiene and aspects of health care. The care plan was not signed or dated. There was also a plan for the management of smoking so that the resident could be safe while carrying out this activity. This had followed a risk assessment. Because it was on the care plan it could be monitored on a regular basis. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 13 The resident was knowledgeable of the care plan and was able to discuss aspects of it. The resident did want a copy of the care plan although this had been offered. He stated that the ‘nurse discusses the care plan with me’. Another residents care plan contained four elements identifying needs under triggers for self-harm, motivation for self-care, activities and family support. The resident was able to identify these as current needs. The resident asked for a copy of the care plan [fed back to management]. The reasons why some residents did not have a copy of the care plan was explained verbally but was not clearly recorded on the care planning documentation. One care plan had not been written up until 10 weeks following admission and a recommendation is made to set a standard whereby a care plan is made available more readily following admission. Not all care interventions were recorded on the care plan. For example the manager advised the inspector of some counselling sessions conducted on a regular basis with one resident but there was no indication of this on the care plan or of any evaluations. Progress here was therefore difficult to follow. Care plans are formally evaluated on a six monthly basis and these are planned in advance. The reviews seen were detailed and included input from the resident. One seen was again not signed by the staff involved in the review. There was some discussion around the need to record formal evaluations on a more regular basis. This is particularly pertinent around the management of risk. For example those residents who smoke and others who are self medicating do need more regular monitoring and evaluation so that compliance around safety is evidenced. It would be recommended that all care plans display some evidence of evaluation on a monthly basis. It is also a recommendation that care plans are audited on a more routine basis so that quality can be more consistent. There are daily recordings made by care staff and more regular entries by nursing staff following recommendations previously made so that duty of care can be better evidenced. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 14 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents in the home have differing levels of need with respect to involving themselves in community life and this is dependant on capacity and ability. There is a small group involved in more rehabilitative programmes involving managing money and shopping and this involves them in activities daily outside of the home. On the day of the inspection some were involved in planning shopping trips and others in cleaning and domestic chores. Some residents have been involved in local education courses and activity outside the home. For example a resident has recently attended a maths and English course. The home has also tried to involve the local college in art projects in-house but there have been some funding issues around this. Those Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 15 residents involved in these activities have clearly seen some benefit in terms of achievement and socialisation. A local housing group have been accessed with respect to assisting one resident to find accommodation locally allowing some success in terms of rehabilitation. Residents spoken to were encouraged to use local amenities and were seen to be coming in and out of the home on regular occasions. One resident mentioned a recent outing with a resident from another home and residents generally talked about the frequent trips organised. There are no residents employed outside the home but there are some inhouse paid jobs and residents expressed some satisfaction that they are contributing to community life within the home. ‘Its good here – we all get on well’. ‘We can do what we want most of the time – staff help us’. ‘there’s a good atmosphere and you can talk to the staff’ Meal times are under continual review and residents are asked about the quality of food and what they prefer. The dining room is well appointed and tables are well presented. The general atmosphere is relaxed and sociable. Meals are ordered before and plated up and served at tables. There were two choices of dinnertime meal during the inspection and the quality of food was good. Residents had various comments regarding the food but on the whole felt that they were catered for. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 16 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care documentation included regular reviews for all residents with respect to ongoing psychiatric conditions. There is regular review with the Community Mental health Team [CMHT] and these are recorded. Residents spoken to either attend the nearby hospital or, in some cases, reviews are held at the home. One resident has ongoing needs around managing diabetes and is receiving regular input from diabetic nurse specialists. Another resident discussed how regular physiotherapy sessions at the local hospital were helping to assist with walking. Diversity around health care needs is evidenced by the homes ability to meet the needs of a resident who is very poor of sight. The home has supported the Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 17 resident through hospital referrals. Care staff were also clear about how to accommodate needs with reference to daily routine care. Some residents do require support from care staff regarding personal care needs. Residents reported that mostly this is given with due regard to both dignity and privacy. It was observed, however, that some staff do not wait for an answer once having knocked on bedroom doors and simply go straight in. This was commented on by some residents and the manager needs to remind staff of the importance of respecting privacy at all times. There are 3 residents in the home who self medicate to some degree. All have been assessed for any risk and this is ongoing although formal evaluations are not recorded regularly and the inspector would recommend that these be carried out at least monthly [see care planning] so that compliance can be better monitored. Medicine administration and recording records [MAR] were seen and were clear and easy to follow. Medications coming into the home are recorded on these sheets. Medications returned are recorded in a separate book. The MAR sheets for some residents showed omissions on one particular day and this was pointed out to the manager. Also, on the same day, a medication error had occurred involving the administration of a drug in error. In house procedures around monitoring and referral for medical opinion where recorded. It was pointed out that the notification to the inspection unit [Regulation 37] had not been made. The manager must review both events and a notification must be made to the Commission. Policy and procedures for the safe administration of medicines were available. Residents spoken to stated that there medicines were given on time. Staff spoken to were knowledgeable about medicines given to residents. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 18 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents interviewed were aware of the complaints procedure and felt that any concerns that they had would be listened to and taken seriously. One said that ‘staff are easy to talk to and will listen’. There is a complaints procedure on the notice board near the dining room and a copy of the procedure is also in the residents information pack. The manager keeps a record of complains and these had been addressed satisfactorily. The home has a copy of the local Adult Protection Procedures and has accessed these when reporting issues of concern around possible abuse of residents. Staff were able to demonstrate an understanding of good care principals and there has been various training initiatives to raise the level of awareness around abuse in the past but only two staff had attended updates in the past year. Staff interviewed were aware that procedures were available for dealing with accusations of abuse but struggled to appreciate how these concerns should be referred outside the home. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 19 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has undergone a lot of upgrading over the past 2/3 years with two extensions to the home being added involving more bedrooms and the rationalisation of the available day space. This has resulted in the home increasing its registration from 36 to 41 beds. The new rooms and day space meet required standards and also follow good practice guidelines. For example there are designated areas for women including day space meeting guidelines on safety, privacy and dignity. Most areas have been redecorated as part of the upgrading and day areas are, in the main, clean, homely and well presented. This was commented in by Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 20 some residents who had lived in the home for a number of years and were pleased with the way the general environment had been improved. There remain some areas that need attention such as the day room and corridor areas in the last extension [carpets] but the manager explained that these would be upgraded in the near future. The residents spoken with advised the inspector that bedrooms are regularly cleaned although ‘we are expected to clean our own rooms and keep things tidy’. Areas visited were clean and well presented. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 21 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): Standards 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home had 37 residents in the home. Staffing consisted of 3 trained nurses and 7 care staff. The manager is supernummery to these numbers. There were adequate ancillary staff as well as full time and part time administrators employed. From the last inspection there has been little change in personnel in the home so that staffing is consistent. The trained staff have a skill mix that includes Mental Nurse cover [RMN] and also nursing staff who are originally trained in Learning Disability but have had many years experience in working with people with mental illness. Trained staff have also had extra training in skills such as aroma therapy, counselling and reflexology. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 22 Care staff have attended appropriate training with respect to residents in the home. For example updates in ethical/moral issues in social care and some staff have attended an introductory course in counselling. All care staff apart from two have NVQ training to at least level 2 so that they are competent to look after vulnerable people. Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportative and easy to approach. Most of the residents knew who their key worker was and found this relationship helpful. Staff files were inspected and the necessary recruitment checks prior to employment were available so that staff employed are ‘fit’ to work and residents are afforded some protection. Staff interviews revealed that formal supervision is patchy in that some staff receive ongoing supervision whilst others do not. There was some discussion with the manager about this and how such support can be used and built into the homes existing support systems. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 23 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): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is Tony Moran. Tony is a Registered Mental Nurse [RMN] who has had extensive experience at management level working in both NHS and special hospital settings. The manager was described as approachable by both staff and residents and has a good record of being open and communicative with external bodies such as the Commission. The owner of the home is a daily visitor and has positive input with staff and residents so that the manager can feel supported in his role. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 24 The home a number of Quality Assurance [QA] initiatives that aim to seek the views of the residents. There is a yearly external quality audit [PQM], which includes a resident’s satisfaction survey as well as resident interviews with the assessor. This was being carried out during the statutory inspection. The views of both residents and staff form the basis of the quality audit. Previous surveys were seen and the overall satisfaction of residents was good. There are regular resident meetings held and again residents are free to air any issues through his forum. The home has made good links with the local psychiatric service and at least one consultant is a regular visitor to the home in order to review residents. Any views regarding the care are canvassed at these meetings. The management have consistently followed good praise guidelines as well as paying attention to the National Minimum Standards. The home has a good record of meeting any statutory requirements that are made. Health and safety management is organised with key staff having responsibility for organising policy and routine checks and risk assessments of the environment. Records seen were clear and well organised and the knowledge of staff in this area was good. The residents environment is therefore maintained safely. Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 25 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 N/A 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 x Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15[1] Requirement The home, in consultation with the service user, prepare a written plan as to how the service users needs in respect of health and welfare are to be met therefore: All care interventions must be recorded on the plan. The resident must have a copy of the care plan unless the reasons for this are made clear in the care planning documentation. The Registered Person shall give 20/02/07 notice to the Commission without delay of the occurrence of any event which adversely affects the well being or safety of residents; therefore the manager must review the incidents regarding drug errors discussed on the inspection and send a notification to the Commission. The Registered person shall 01/03/07 ensure that persons working at the care home are appropriately supervised. Therefore staff must have regular recorded DS0000017227.V321846.R01.S.doc Version 5.2 Page 27 Timescale for action 01/03/07 2 YA20 37[1] c 3 YA36 18(2) Blair House supervision sessions at least six times a year in addition to regular contact on a day-to-day basis [previous requirement not met]. 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 YA2 Good Practice Recommendations All assessments completed prior to and following admission need to be thorough with all areas assessed. Assessments need to be signed and dated by the nurse responsible. It is recommended that residents care plans be evaluated more regularly on a monthly basis so that care interventions, particularly concerning risk factors [including those who self medicate], can be more routinely monitored. There should be a standard set whereby the residents care plan is drawn up by specified time. [One resident’s care plan dated 10 weeks following admission]. Staff should be reminded of the importance of waiting to be invited into resident’s rooms having knocked on the door. Staff training should include updates in abuse awareness [POVA]. The manager should contact the local authority social service dept for information. The upgrading of the general environment includes new flooring in the areas discussed. 2 YA6 3 4 5 6 YA6 YA18 YA23 YA19 Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Blair House DS0000017227.V321846.R01.S.doc Version 5.2 Page 29 - 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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