Care Home: Blair House Nursing Home

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Blair House Nursing Home Skirth Road Billinghay Lincs LN4 4AY The quality rating for this care home is: two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Western Date: 1 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 25 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Blair House Nursing Home Skirth Road Billinghay Lincs LN4 4AY 01526860432 F/P01526860432 blair.house@craegmore.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Parkcare Homes Ltd Name of registered manager (if applicable) Mrs Glynis Branson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 29 1 care home 30 learning disability Additional conditions: Condition of Registration A Condition of Registration is that the maximum number of service users in each category is as follows:- 16 LD (Nursing) 13 LD (Personal Care) 1 LD(E) (Personal Care) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 25 A bit about the care home Blair House is part of the Craegmoor Group of homes. The home is located on the edge of the village of Billinghay. Blair House provides personal and nursing care for up to thirty (30) people with a learning disability from the age of eighteen years and above. The home consists of a two storey main house with ground level extensions that overlook either gardens or enclosed patio area. The home stands in its own grounds with gardens to front, rear, and car parking to the front and side of the building. Residents individual accommodation is provided in both single use and double occupancy bedrooms. Eleven of the bedrooms have en suite facilities. Blair House also provides day care for some permanent residents and offers two day-care places. The village itself offers a variety of amenities such as pub, shops and post office. The home provides transport to enable service users to participate in educational and recreational activities outside of the village. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 25 How we did our inspection: This is what the inspector did when they were at the care home This inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager and residents about Blair House and by undertaking a visit to the home, which took three hours to complete with the inspector using a method of inspection called case tracking. This method involved identifying individual residents who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspection was also used to check that information provided about how the care needs are currently met matched the individual experiences of records. this was achieved by talking to residents, the manager and care staff whilst observing day-to-day practices within the home. The commission are trying to improve the way that we engage with people who use the services so that we gain a real understanding of their views and experiences of social care services. We used a method of working where experts by experience are an important part of the inspection team and help inspectors to get a picture of what it is like to live in or use a social care service. The term experts by experience describes people Care Homes for Adults (18-65 years) Page 7 of 25 whose knowledge about social care services comes directly from using them. The expert and her supporter met with service users and staff on their own. The area manager was present throughout the inspection as the manager was on leave. What the care home does well What has got better from the last inspection The major refurbishment undertaken by Blair House is now nearing completion, with the final building work to be carried out within the next few weeks. All bedrooms and communal rooms have now been completely redecorated including new carpeting and much of the furniture has been replaced. More staff and residents are now involved in the Your Voice meetings, with the result that more residents are having their views heard and their wishes carried out. Care Homes for Adults (18-65 years) Page 8 of 25 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie Western Cambridge Local Office cp1 Capital Business Park Fulbourn Cambridge CB21 5XE 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users have a good range of information to help them to decide whether the home is suitable for their needs. Evidence: The statement of purpose is available for people and visitors to look at; it gives details about the charges made for care and how the home provides support for those who live at Blair House. the service user guide is easy to read and tells people about the home and what they should expect either before or when they move in. The area manager said that the manager or a senior carer assessed prospective residents in their own homes or in a care setting and completed an initial assessment form; records supported this. A resident said I came from home and they visited me and my Mum, then I stayed here for a night so I could make up my mind about living here. Care Homes for Adults (18-65 years) Page 11 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans accurately describe service users support needs and service users are well consulted. There are good assessments in place to minimise risks to service users. Evidence: Care plans have a wide range of information about service users daily support needs. They contain good personal information with likes, dislikes and preferred routines being well recorded. They are signed where appropriate and dated. Risk assessments seen were clear and up to date. Some care plans had no background or past history to enable staff to meet peoples needs better. Some information was out of date and needed to be archived. Staff were seen to use a variety of methods to enable people to make decisions. The expert by experience found that residents are allowed to see their care plans. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users are encouraged to make choices about how they wish to live and the range of activities they take part in. They can choose what to eat from a varied, balanced diet. Evidence: Blair House has an activities organiser who works Monday to Friday and provides additional support for some people during the day. Care plans showed that each person had a key worker who helps plan the chosen activities. A range of in-house activities is available every day and on the day of the inspection, several people were doing arts and crafts. Comunity activities included going bowling, atending church services, to the local pub, to coffee mornings each Thursday and out for trips in the homes two mini-buses, one with a tail-lift for wheelchair users or people who have difficulty getting in and out of cars. One resident described having cinema afternoons, complete with popcorn, on a large Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: screen in the activities room. The area manager said that this year people had had a choice of three holidays; Butlins, York or Blackpool, all funded by Craegmoor. On the day of the inspection eight residents were going to two day centres in Sleaford; these took a packed lunch and had their main meal on their return. Menus are planned four weeks in advance and people said they liked the food they have. Some people needed food to be prepared in a different way to enable them to eat it easily.The cook keeps a list showing peoples needs, likes and dislikes and a comments book so that people can say whether they liked the food they eat. One resident described asisting with cooking and making snacks. The expert by experience found that people can go to the shop with key workers and others. One person had visitors when she wanted and she picks her own clothes. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The personal and healthcare needs of people are met by the staff team in a way that encourages independence as far as is possible. Records are used to ensure that the right support is given to help people with their medicines. The expert by experience found that one person could pick what he wanted - either a shower or a bath. Evidence: The area manager said that the assessments and care plan reviews are completed individually and with the assistance of family carers to encourage people to be as independent as possible with support. Care plans provided clear and up to date details about the medication needs of people showing what time support was given and by whom. Currently all the people living at Blair House need some kind of support with medication. Medication is stored in a locked room within locked cabinets and the area manager confirmed that only nursing staff who have received training are allowed to support people with medication. The most recent visit by a pharmacist was 09/06/08 and records showed that there Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: were no issues of concern from this. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The complaints procedures ensure that issues are resolved with people and carers as soon as they are evident. The care team know how to act in order to protect people from harm. Evidence: Company policies are used to help both staff and residents to understand how to raise concerns. One resident said I would go to my key worker if I was unhappy and another said I would go to the manager. The area manager confirmed that there were several formal complaints since the last inspection; these all concerned one resident and action was taken to ensure that these did not happen again. This action was recorded and there have been no further incidents since. Staff members were aware of the policy for raising concerns and knowledgeable on how to act; the area manager confirmed that training on safeguarding issues was mandatory for all staff. The expert by experience found that one person said he liked the people he lived with and was happy. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well decorated and furnished, providing service users with a comfortable place to stay. The grounds are in need of tidying. Evidence: The area manager stated that the planned refurbishment of the home is nearing completion with the final major areas, the entrance porch nad the conservatory, planned for the next few weeks. All communal areas have now been redecorated and include new furniture and carpeting. Bedrooms have been redecorated and are well personalised. A resident said that it was lovely now and described how she had chosen the colours for her room. The kitchen has been completely renewed and the visiting envoronmental health officer awarded it three stars in the local award scheme for hygiene. The gardens were still neglected in areas, with the entrance to the drive overgrown and flower beds full of weeds, although the lawns had recenlty been mown. The area manager said that a new gardener had been appointed to work twice a week, to improve the gardens and that a sensory garden was planned. The expert by experience found that the home was clean and tidy and the rooms were homely. There were a lot of steps so wheelchair users could not get to all parts of the home. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are enough staff to meet the needs of people. Staff are well trained and recruitment and selection procedures protect people. Evidence: The staffing rota showed that, besides the manager, who works Monday to Friday, there was normally one qualified nurse and five carers for 25 people. Staff spoken with said they were able to complete their tasks on time and observations confirmed this. In addition, there was a cook, a cleaner and a maintenance person. A gardener has recently commenced working twice a week. There is one vacancy, for the activities co-ordinator post, since the current one is leaving. A staff member confirmed that she had two interviews for the post, gave references, underwent safeguarding checks [CRB and POVA] and had an induction before commencing her duties. Staff records confirmed this. The area manager said that service users were involved in staff interviews where appropriate. Training records showed that six staff members had the National Vocational Qualifications at Level 2, with two working towards it. One had attained Level 3 and a further three were working towards it. Records showed that most staff members had received mandatory staff training with some staff still to carry out training in manual handling and abuse. There was evidence of regular staff meetings but supervisions were inconsistent. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: The expert by experience found that staff were nice and were good to the residents. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There is a competent registered manager in post, who understands the needs of each individual person. Robust procedures ensure that residents can have their say in the running of the home. Residents are safe and well supported by a competent management team and by good policies and procedures. Evidence: The registered manager was not available for this inspection and the area manager attended, accompanied by the nurse in charge of the shift. They demonstrated an open, inclusive policy, which residents responded to positively. The registered manager, deputy and five staff members are qualified nurses. Formal monthly residents meetings, called Your Voice are held in the lounge and people are invited to make decisions about the running of the home; a resident said We decided where we wanted to go for out holidays this year. Each home in the company conducts a monthly quality assurance audit, looking at the whole service and then focusing on specific areas. There is a full set of policies and procedures, with easy-read policies for service users. A fire manual is completed regularly by the maintenance person. The expert by experience spoke with three residents and found that they all liked living Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: in the home and felt safe. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 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 Description Timescale for action 1 24 23 External grounds must be 14/01/2009 suitable and safe for service users and appropriately maintained. To provide people with a well maintained and attractive place to be in. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 1 6 Each persons care plan should contain some information on their background and past history, to ensure that their needs can be fully met. Staff should have regular supervision to ensure that they have the support to meet the needs of people. 2 36 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 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. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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