Care Home: Blakenhall Community Resource Centre

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What the care home does well The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. This is a home that has a sustained track record of delivering good performance and managing improvement to ensure that people living at the home receive quality care, delivered by a skilled staff group. Staff have a wide range of qualifications and skills in the field of dementia care and older person`s mental health and these skills are applied to every day practice to achieve positive outcomes for people living at the home. Admissions to the home are well managed and an effective assessment procedure takes into account people`s needs including those regarding equality and diversity. Care is then planned to take account of these needs, individual likes and dislikes and preferences. Staff working at the home have a good understanding of people`s different needs and capabilities and enable people to make choices as part of their daily lives. The home is continually monitoring the service it provides, employing specific techniques such as Dementia Care Mapping which enables evaluation of the quality of care provided to people who, because of their illness are unable to provide accurate written or verbal feedback. The comments we received via returned Surveys included: "The home is good on health and safety. Care and communication, cleanliness and well balanced diet. On the whole the home is pleasant and very well run". "They (staff) look after me well with all my needs". "They help you, they always do their best. I`ve been very happy to be here". People who use the service are often vulnerable both physically and emotionally and the Registered Provider and the Acting Care Manager ensure that staff recruited have the ability to carry out personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and the Acting Care Manager at Blakenhall Resource Centre undertake this carefully. The home has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, safe handling of medication, Adult Protection and safeguarding issues, Dementia care and National Vocational Qualification (NVQ) Level 2. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. The home provides good standard of accommodation and facilities for people using the service. What has improved since the last inspection? People commented that: "Lots of recent improvements to decor and fittings etc. I am pleased that it is looking much better and brighter". "The facilities and the care provided by management and staff is better than previous years". The home has an experienced Acting Care Manager in post and she is managing the care home well. Conversations with staff, people using the service and their visiting relatives, indicated that the Acting Care Manager is service user focused, leads and supports an enhanced staff team providing them with improved training and supervision. This style and approach to management aims to pursue future improvements in all aspects of service. One person who lives at the home stated that "This place is a lot more peaceful and better organised now". The home has made some good improvements in their record keeping and care planning. Care Plans seen for people who use the service were informative and gave good indication of how care is to be delivered for each of them. Medication practices including safe storage of medicines have improved and more care staff have received training in safe handling of medication. The home has always aimed to provide good quality, person centred service to older people with mental health needs. However, the safeguarding referrals in late autumn of 2008 indicated that this was not being fully achieved. The Departmental senior managers and the staff at the home responded to address the issues and concerns raised. Since then, a considerable progress has been made to resolve the issues, and suspension on admissions has been lifted. An action plan is in place to ensure the communication systems are more effective; all information relating to a service user`s needs is available in one place to ensure that the things are not missed. Records of healthcare are completed accurately and reviewed regularly. Senior staff at the service carry out and record regular audits and checks are made on care files and related records. This is to ensure the outcomes for people who use the service are positive and effective in meeting their needs. What the care home could do better: Social and leisure activities enjoyed by the people who use the service should be consistently recorded, evaluated and incorporated into their individual care plans. Those members of staff who as yet have not received training in safe working practice topics, including, safe handling of medication, Dementia care, National Vocational Qualification Level 2, Adult Protection and safeguarding issues should do so as a matter of priority. This training would enable staff to improve further their care practices, knowledge and skills. As part of the annual quality assurance monitoring arrangement, the home to ensure that the feedback on the quality of care and service provided is obtained from people who use the service, their relatives/friends, and other professionals and/or stakeholders. A report on the feedback analysis and any action plan prepared and implemented on the issues raised to be provided in the home and for inspection by the CQC. The AQAA submitted prior to this visit by the Acting Care Manager stated that "We will make sure that our recording systems and service users` files are in in good order, consistent, and include all necessary information to provide care and support that promotes quality of life and keeps people safe". Key inspection report Care homes for older people Name: Address: Blakenhall Community Resource Centre Haggar Street Blakenhall Wolverhampton West Midlands WV2 3ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bhag Jassal     Date: 2 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Blakenhall Community Resource Centre Haggar Street Blakenhall Wolverhampton West Midlands WV2 3ET 01902553547 01902553549 Julie.Craig@wolverhampton.gov.uk www.wolverhampton.gov.uk Wolverhampton City Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carole Ann Samuels Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 29 Mental disorder, excluding learning disability or dementia (MD) 29 Old age, not falling within any other category (OP) 29 Date of last inspection 29 29 0 Over 65 0 0 29 Care Homes for Older People Page 4 of 33 Brief description of the care home Blakenhall Resource Centre provides residential care and respite care for 29 adults over the age of 50 with mental health needs. The majority of people admitted to the home have a diagnosis of dementia, but the home is also able to provide care to people with other mental health needs. There are two residential units, Warwick and Windsor which offer long - term care for twenty two older people no longer able to live at home. All of the bedrooms on these units are single and have en - suite facilities. Ludlow Unit provides respite/short term and seven single bedrooms are located on this unit, and these rooms do not have en - suite facilities but toilets and bathroom are located nearby. The home has a range of lounges and dining areas and a sensory garden is an excellent resource and enables people to access outside areas safely. The Resource Centre is managed as a joint project between the Wolverhampton City Councils Social Services Department and the Primary Care Trust and all people living at the home are funded by the local authority. The home is not aware of individual fees. Care Homes for Older People Page 5 of 33 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 Star. This means the people who use the service experience good quality outcomes. This report is on a Key Inspection, part of which includes an unannounced visit undertaken on 25th June 2009. The unannounced visit started at 09:00 and lasted 9 hours and 50 minutes. The home had 14 places occupied and 15 remains vacant. The judgements made within this report are based upon information supplied by the home, from interviews with staff, people who use the service and their relatives. During the course of inspection the assessment information and care plans were examined in detail for four people who use the service. Medication administration was checked. Staff records were seen to check staff rotas, recruitment procedures and training. Various documents were seen in order to check compliance with health and safety legislation. A tour of premises was also undertaken, and care practices and Care Homes for Older People Page 6 of 33 interaction between staff and people who use the service were observed. Discussions took place with several members of staff on duty, and several people using the service and two visiting relatives were spoken to throughout the day of inspection. The Acting Care Manager - Ms Carol Samuels was present throughout the inspection. The Social Services Departments Standards Development Officer was also present at later part of the day of inspection. On this occasion all the key Standards of the National Minimum Standards were assessed, that is those areas of service delivery that are considered essential to the running of a care home that ensure the best outcomes for people living there. Regulation 37 Notifications, concerns and complaints against the home, and Regulation 26 reports kept at the care home and an Annual Quality Assurance Assessment (AQAA), which had been completed by the Acting Care Manager and submitted to the Care Quality Commission (CQC) prior to this inspection were cinsidered and discussed with the Acting Care Manager. The AQAA is a self - assessment and a dataset that is filled in once a year by all Registered Providers. It informs us about how Registered Providers are meeting outcomes for people using their service and is an opportunity for Registered Providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed. Blakenhall Resource Centre returned their completed AQAA to CQC within the given timescale. Information within this document demonstrates that the Acting Care Manager recognises the strengths and weaknesses within the service and are able to plan for improvement. The AQAA provided information to supplement the inspection. We also received completed Surveys from three people who use the service, three relatives and three members of staff. We wish to thank the Acting Care Manager, Assistant Team Leaders, the staff, people using the service and their relatives for their assistance and co - operation on the day of inspection. Care Homes for Older People Page 7 of 33 What the care home does well: The home provides a relaxed, comfortable and friendly atmosphere where people are treated with respect and in a dignified way. The home makes every effort to provide people with good care to meet their assessed needs following a care plan. The home has a good key worker system and staff supervision system in place. The home communicates well with the families, friends and representatives of people who use the service and welcomes visitors. People who use the service say they are happy and content with living in a homely and caring place. This is a home that has a sustained track record of delivering good performance and managing improvement to ensure that people living at the home receive quality care, delivered by a skilled staff group. Staff have a wide range of qualifications and skills in the field of dementia care and older persons mental health and these skills are applied to every day practice to achieve positive outcomes for people living at the home. Admissions to the home are well managed and an effective assessment procedure takes into account peoples needs including those regarding equality and diversity. Care is then planned to take account of these needs, individual likes and dislikes and preferences. Staff working at the home have a good understanding of peoples different needs and capabilities and enable people to make choices as part of their daily lives. The home is continually monitoring the service it provides, employing specific techniques such as Dementia Care Mapping which enables evaluation of the quality of care provided to people who, because of their illness are unable to provide accurate written or verbal feedback. The comments we received via returned Surveys included: The home is good on health and safety. Care and communication, cleanliness and well balanced diet. On the whole the home is pleasant and very well run. They (staff) look after me well with all my needs. They help you, they always do their best. Ive been very happy to be here. People who use the service are often vulnerable both physically and emotionally and the Registered Provider and the Acting Care Manager ensure that staff recruited have the ability to carry out personal care services for people sensitively and tactfully. The recruitment of good caring staff is critical to the running of care homes and the Registered Provider and the Acting Care Manager at Blakenhall Resource Centre undertake this carefully. The home has a good staff training and development programme in place. A majority of staff have received mandatory training in safe working practice topics, safe handling of medication, Adult Protection and safeguarding issues, Dementia care and National Vocational Qualification (NVQ) Level 2. Thus this training will ensure that the staff have improved their knowledge and skills to meet the changing needs of people who use the service. Care Homes for Older People Page 8 of 33 The home provides good standard of accommodation and facilities for people using the service. What has improved since the last inspection? What they could do better: Social and leisure activities enjoyed by the people who use the service should be consistently recorded, evaluated and incorporated into their individual care plans. Those members of staff who as yet have not received training in safe working practice topics, including, safe handling of medication, Dementia care, National Vocational Qualification Level 2, Adult Protection and safeguarding issues should do so as a matter of priority. This training would enable staff to improve further their care practices, knowledge and skills. As part of the annual quality assurance monitoring arrangement, Care Homes for Older People Page 9 of 33 the home to ensure that the feedback on the quality of care and service provided is obtained from people who use the service, their relatives/friends, and other professionals and/or stakeholders. A report on the feedback analysis and any action plan prepared and implemented on the issues raised to be provided in the home and for inspection by the CQC. The AQAA submitted prior to this visit by the Acting Care Manager stated that We will make sure that our recording systems and service users files are in in good order, consistent, and include all necessary information to provide care and support that promotes quality of life and keeps people safe. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The home has a good assessment and admission procedure, which ensures that the home is able to meet peoples needs. Evidence: Prospective service users and relatives and carers have an opportunity to visit Blakenhall Resource Centre and meet the staff enabling them to decide if its right for them. Trial visits or stays are offered. Where possible home visits are made to service users with their consent prior to any decision being taken. Prospective service users are offered a service following a full assessment undertaken by health and social care professionals. The service has a strong commitment to enable service users to contribute in the development of their person centred care plans, promoting choice and independence. This includes information obtained during the referral process on the persons religion, ethnicity, language and any barriers to Care Homes for Older People Page 12 of 33 Evidence: communication. Person - centred assessment forms, have pictures and symbols to assist people with communication difficulties to make choices and specify their likes and dislikes and a staff member explained how they are continually updated depending on changing needs and preferences. Each care file contained a life history of the person based on information provided by the person and/or their significant other and this provides staff with an insight about the person prior to and during their illness. It was seen that this information had been incorporated into care plans to enable individualised care to be promoted. All care files contained information on funding agreements. The AQAA completed by the new Acting Care Manager states that Consideration is given to the mental health needs of service users enabling access to advocacy services when necessary. Specialist services from relevant health care professionals are accessible to meet individual health needs, for example, consultant psychiatrist, physiotherapist, continence advisor and occupational therapist. Observations and discussions with people who use the service and their visiting relatives, Acting Care Manager and staff on duty indicated that the service continues to meet the needs of people who use the service in a satisfactory and sensitive manner. It was noted from the staff training records that a large group of staff have undertaken training in Dementia care, mental health needs and safeguarding issues. The home does not provide a service for those assessed solely for immediate care, who require help to maximise their independence and return home. Care Homes for Older People Page 13 of 33 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. There is clear and consistent care planning in place, which focuses on the individual needs of people living at the home and provides staff with the information they require to meet peoples needs. Evidence of regular review and good multi - disciplinary working ensures that the health and personal needs of people living at the home are met. Evidence: People who use the service undergo an assessment of their needs prior to admission to the care home. A Care Plan is produced, which is based on the assessment of needs. The home operates a good key worker system, which helps to ensure that the recommendations arising from the care plan reviews are implemented. Four Care Plans of people using the service were inspected and examined in detail. There was evidence to show that goals, aims and objectives were clearly identified and appropriate interventions required to meet the individual needs of people who use the service were also identified. Care Homes for Older People Page 14 of 33 Evidence: Observation of four peoples care files showed that the home assesses and plans care effectively. Care plans were seen to be clear, up to date and reviewed regularly, providing information to staff on how to meet each persons needs including mental health, personal care, mobility, safety, and social care needs. A range of risk assessments provides additional information on any recognised or potential risks to the individual. Regular Dementia Care Mapping is carried out by the home as a way of observing and examining the quality of care from the perspective of the person with dementia, and information on the results of this process was contained within care files and any action for improvement noted. Comprehensive recording within care files confirms that people receive regular input from health and social care professionals including regular formal reviews involving the person, their social worker, family representative and link worker from the home. Care files also contained detailed information on caring for the person should their condition deteriorate, recognising religious and cultural needs through illness and in the event of the persons death. Staff were seen to promote peoples dignity, any personal care interventions were carried out away from communal areas and during meals staff provided sensitive assistance to people who needed help with eating. Discussion with people who use the service showed that the home has a good ethos of involving them in all aspects of their life. The care plans that were read were clearly written and included an element of risk assessment. Information from the initial assessments had been written into plans of care. The care plans are reviewed on a monthly basis by senior staff. Care Plans also demonstrated that the staff actively promoted the rights of people who use the service of access to the health services both within the home and the community. Appointments are planned or arrangements are made for professionals to visit frail people using the service. Whenever possible continuity of care for the declining state of health of people who use the service is assured. District Nurses are called upon to assist with clinical help, equipment and advice where necessary. The Acting Care Manager promotes the key worker system so that relationships between staff and individuals are enhanced. Visitors are able to meet people using the service in their bedrooms, in the Units lounges and/or in the visitors room. It was observed that people who use the service were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. Care Homes for Older People Page 15 of 33 Evidence: We spoke at length with several people using the service and all of them commented positively about their care and felt they have everything that they need. Four people who use the service stated that The carers are very good and kind and they look after us very well. Two other people who use the service said The carers are always there to help us. The completed Surveys received from people who live at the home states The home makes me feel very welcome and reassured when I get worried. Everything is kept clean and well organised so I feel safe. Everyone is very kind to me, thank you. They look after me well with all my needs. The girls (staff) work very hard. They (carers) help you, they always do their best. Ive been very happy to be here. A completed Survey received from a relative states The home is very helpful and reassuring when having to decide for mother to go into permanent care. All people who use the service seen during the inspection appeared to be well - looked after, content and comfortable, and also showed signs of well - being. They were complimentary regarding the quality of their lives and care they were receiving at Blakenhall Resource Centre. There are appropriate policies and procedures in place for the administration of medication. It was noted that the care plans contained a list of current medication. The Acting Care Manager stated that reviews are carried out on a regular basis of all the care plans to ensure that medication details are up to date. Appropriate records are kept of all medicines received, administered and leaving the home. Random sample of medication and administration sheets were seen at the inspection and there were no discrepancies. All the medicines are stored in the medication room kept under lock and key. Daily checks are taken of the temperature of the medicines in the refrigerator and the medication room. There are no controlled drugs used at present by any service user at the care home. However, if there is a need to store such drugs securely and safely in a lockable metal cupboard, which is available in the the medication room. Medication rounds were observed during the inspection. Care staff were seen to administer and record when medicines had been given. The Acting Care Manager stated that all Care staff responsible for administering medication were appropriately Care Homes for Older People Page 16 of 33 Evidence: trained in safe handling of medication. Care Homes for Older People Page 17 of 33 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People who use the service are able to exercise choice with regard to social and leisure activities at the home. Activities provided meet the needs of the people using the service. Relatives and friends are encouraged and assisted to maintain contact with the people using the service. The food at the home is of good quality and choices are always available. Evidence: The home provides an activities programme in accordance with everyone using the service, their choices, preferences and capacities in relation to social, leisure and cultural interests. People using the service, who were able to give opinion, were very complimentary about the activities provided, and particularly indoor by the staff and the external entertainers. People who use the service are enabled to enjoy a full and stimulating life style with a variety of options to choose from. A record of activities participated in is kept and photographs of major events displayed in the home. However, the activities enjoyed by the people who use the service need to be evaluated, consistently recorded and incorporated into their individual care plans. People using the service were seen sitting in the lounges chatting to staff and visiting relatives and in other communal areas within the home. Three people who use the Care Homes for Older People Page 18 of 33 Evidence: service stated that they preferred to sometimes sit quietly in their bedrooms and the staff respected this. After lunch time a number of people who use the service were engaged in playing different games or watching television. The homes AQAA states Biographical information is collated to identify an individuals life history, hobbies and leisure interests. Activities are based around individual choice, preference and abilty. Outings are arranged following consultation with service users. Service users are provided with the opportunity to do their personal shopping with support from their designated Link worker. Arrangements are made for people who use the service to participate in religious observance if they choose. An entertainment programme is in place including musical entertainers and pantomime productions. The entertainment provides the opportunity for individuals who choose not, or are unable, to go out of the Centre to maintain links with the community. The home has a programme for the use and implementation of Dementia Care Mapping on all units. This tool is used to improve and adapt care plans and support is offered to services users, through the observations carried out by the staff trained in the use of Dementia Care Mapping. Doll Therapy is the use of dolls to encourage communication and interaction with and for service users. Through stimulation of the senses. Observation of the use of the dolls for each service user is carried out daily, to monitor the effects it is having on individuals well being. The staff are knowledgeable about advances in Dementia Care, for example, the home has piloted and found doll therapy beneficial for some individuals. This was seen to be used and monitored appropriately during the inspection. The home has an excellent sensory garden, which provides people living at the home with an outside space specifically designed to promote sensory awareness; raised flower beds enable people to smell and touch flowers and plants with different textures. As an ongoing project the home is developing memory boxes containing personal possessions, photographs and objects, and the care plans confirmed the use of these. Signs are in place throughout the home to aid orientation and these incorporate pictorial representation and translation into alternative languages. Care Homes for Older People Page 19 of 33 Evidence: The provision of a visitors room provides a quiet place for people and/or their relatives/ representatives to meet and relax. Several people using the service spoken to stated that they were in regular contact with their family members and friends, and spoke about their visitors involvement and interest in their care matters. The visitors book kept in the home showed a considerable activity. People who use the service also keep contacts with the local community, for example, church services, pubs, shops and park. Five people who use the service told us that they are happy with the care and social activities offered by the care home. They further added the home provides a good service and the staff are very caring and they are pleasant. The home also provides a variety of indoor activities, including festive and birthday parties. The Acting Care Manager stated that the people who use the service were positively encouraged and helped to exercise their choices, and control over their lives and daily living, subject to risk assessments in terms of safety, security and capacity to make certain decisions. The Acting Care Manager also stated that a close liaison is maintained with the relatives and representatives, where the people using the service are not able to make certain decisions. The relatives of people using the service and their representatives are informed of the availability of Advocacy Service based at the local Age Concern. The information about the Advocacy Service is included in the homes Statement of Purpose and Service Users Guide. A varied and cultural nutritional menu is in place that is also available in pictorial format to assist individuals with verbal communication difficulties to continue to be able to make choices. The home have flexible meal times to accommodate service users who do not wish to eat at set times of the day. The home has introduced a programme for staff to dine with service users occasionally to make sure that individuals are receiving the nutrition and support they need. A loop system is in place to aid people with hearing impairments. Several people who use the service told us The home is very good and its peace and quiet here. The food was very nice well cooked and tasty. The consensus of people using the service was the range, quality and choice of food provided was very good and the home catered for those people using the service, who have individual preferences and medical needs. The Acting Care Manager stated that the menu is changed regularly in consultation with the people who use the service. This is usually done in accordance with seasonal changes as well. Care Homes for Older People Page 20 of 33 Evidence: The kitchen is well equipped and kept clean and tidy. The catering staff are trained in food safety and hygiene matters. Care Homes for Older People Page 21 of 33 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 home ensures that people have access to a clear complaints procedure, which enables concerns or complaints to be dealt with promptly and professionally. Staff are provided with training to equip them with the knowledge and skills to safeguard adults from the risk of abuse or neglect. Evidence: The home has a good Complaints Procedure in place, which is referred to in the homes Service Users Guide and in the Statement of Purpose. There is a system of recording concerns and complaints. The AQAA completed by the Acting Care Manager states The service recently has been the subject of a number of safeguarding adults referrals of which the Care Quality Commison is aware. This has resulted in a detailed Action Plan being developed by the service and montiored via the Adults safeguarding process. The Acting Care Manager stated that the complaints are dealt with in a timely manner following investigation. Compliments and complaints leaflets are displayed in the Centre for service users and visitors to access freely. Records concerning compliments and complaints are forwarded to the Departments Customer Relations Manager once a month. Records of all compliments and complaints are held at the centre for reference. Care Homes for Older People Page 22 of 33 Evidence: The Service also works to a number of departmental policies and procedures to protect and safeguard service users and staff including, the Wolverhampton Inter agency Safeguarding adults policy, whistle - blowing procedure, reporting accidents and incidents. All staff are trained in these procedures. All staff have undertaken Management of Actual and Potential Aggression (MAPA) training to enable them to respond to different behaviours using diversion techniques. Procedures and risk assessments are in place to support people using the service with their financial affairs. These systems are audited on a regular basis and help to protect the individual or member of staff involved in any financial transactions. The service are able to access advocates or an Independent Mental Capacity Advocate (IMCA) where an individual lacks capacity to make decisions. People, who use the service, when asked, were certain of how to formally make a complaint but they said they would quite happily talk to one of the staff or the Manager. The Acting Care Manager stated that adult protection/safeguarding issues are discussed during induction training and supervision meetings. The Acting Care Manager also stated that almost all of staff have received formal training in safeguarding/protection of vulnerable adults and those who as yet have not received this mode of training will do so shortly. Several people who use the service stated they are satisfied with the service provision, feel safe and well supported by staff that have their protection and safety as a priority. Care Homes for Older People Page 23 of 33 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, 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. 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 home has a well - maintained environment, which provides aids and equipment to meet the care needs of service users. Evidence: The home continues to be maintained to a good standard providing safe and homely accommodation. A selection of bedrooms on the two residential units, Warwick and Windsor, which were observed were all in a good state of decor and all of these bedrooms have en - suite facilities, which were found to be very clean and well equipped with walk - in shower facilities. Ludlow unit does not have en - suite facilities although toilets and bathrooms are in close proximity to bedrooms. The decor on Ludlow unit was satisfactory. The home has a range of communal lounges and dining areas, which are generally spacious, apart from on Ludlow unit where these areas are quite cramped. All parts of the home were observed to be clean. Training records show that staff have received training in infection control and observations show that this is put into practice as staff were seen using protective clothing appropriately during care activities and at mealtimes. There are good, secure and accessible patio and garden areas for the use of people living at Blakenhall. In addition, the home has an excellent sensory garden area, which provides people Care Homes for Older People Page 24 of 33 Evidence: living at the home with an outside space specifically designed to promote sensory awareness; raised flower beds enable people to smell and touch flowers and plants with different textures. Care Homes for Older People Page 25 of 33 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Training opportunities within the home are good which ensures that staff are appropriately skilled and competent to carry out the duties for which they are employed. Evidence: Staffing rotas for the May and June 2009 show that levels are maintained at a minimum of seven care staff each day plus an assistant team leader in the morning and at night. The manager is supernumerary and is available on - call outside normal hours. Staffing levels appeared satisfactory on the day of inspection, people had their needs attended to promptly and sufficient staff were available to supervise people if they wandered around the home. Staff spoke of how the levels had improved although occasional short notice staff sickness and vacancies could cause staffing difficulties. The Acting Care Manager confirmed that the home currently has staff vacancies, so agency staff are still used to supplement homes staff. It was also identified that delays in the decision to recruit staff can lead to lengthy delays in recruiting staff to vacant posts. Four staff files were examined in detail in order to check compliance with the recruitment requirements. All four files staff files checked showed that pre employment checks had been undertaken. However, other information pertaining to recruitment and selection is held centrally (Human Resources Section) and an Care Homes for Older People Page 26 of 33 Evidence: assessment of these processes will be undertaken in the near future. There was evidence on staff files that all four had been subject to satisfactory Criminal Records Bureau (CRB) and (Protection of Vulnerable Adults) POVA checks prior to being appointed. There was evidence on files that staff have received the statements of their terms and conditions of employment. All staff have an individual training profiles and observation of training records show that in addition to mandatory safe working practice topics training, the staff are also provided with a wide range of training, including, person - centred care planning, multi - sensory stimulation (SONAS), dementia care, ageism and observation of a training plan shows that future training includes nutrition in mental health and Management of Violence and Potential Aggression (MAPA) updates, Mental Capacity Act Awareness and Deprivation of Liberty Safeguards and Adult Protection/Safeguarding Awareness for all staff. The Acting Care Manager stated that over 50 of care staff have completed their National Vocational Qualification (NVQ) Level 2 training. Staff confirmed that the home support the provision of NVQ Level 2 training. The Acting Care Manager stated that all those members of staff who as yet have not undertaken any mandatory safe practice topics training or updates and also in Mental Capacity Act 2005, including Deprivation of Librty (DoLS), Adult protection/safeguarding and Dementia care will be provided as a matter of priority. The home provides a comprehensive induction programme, which incorporates a theory based induction pack and a period of shadowing the new member of staff, and a staff member provided confirmation that this induction is provided. All members of staff receive formal supervision from their respective line managers at the required regular intervals. During our discussions with people who use the service, their feedback was positive about the staff. For example, one person stated that I am happy here, staff are good, they are always around to help. One visiting relative stated that The Centre is run well and staff are very good in helping people who live here. They are committed to providing good care and keep people happy, secure and safe. Care Homes for Older People Page 27 of 33 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. People who use the service can be assured that the home is run in their interests. Financial interests of people using the service are safeguarded. The home promotes the health, safety and welfare of people who use the service. Evidence: Blakenhall Resource Centre has appointed a new Acting Care Manager in March 2009. The Acting Care Manager, Ms Carol Samuels has already made an application to be registered with the CSCI (CQC) and her application is now proceeding through the registration process. Ms Samuels has undertaken her Registered Managers Award and NVQ Level 4 in care qualification. She appears to be managing the home well. There are clear lines of accountability within the home and the Acting Care Manager is well supported by the Registered Provider, and her Line Manager. The home has a formal staff supervision system in place, and Ms Samuels is implementing the system of supervision of staff and meetings both with staff and people using the service. Observations made and discussions with people who use the service and their Care Homes for Older People Page 28 of 33 Evidence: relatives and staff have indicated that the Acting Care Manager is very approachable and she operates an open door policy. People who use the service, who could express themselves stated that they are happy to approach the manager and staff with any problems they might have and were confident that they would respond to them appropriately. Equality and diversity for people who use the service were seen to be promoted throughout the home within the assessments, care plans and activities. Equality for staff is promoted through the opportunities for training at all levels. The home has a Quality Assurance monitoring system in place. Quality Assurance takes place throughout the service in both a formal and informal manner. Meetings and day to day contacts all provide records to show that satisfaction is at the heart of the service for people who use the service. Surveys for the year 2009 is to be carried out shortly. Then a report on the result of the feedback from people who use the service and their relatives will be prepared and made available in the home. In addition, other stakeholders survey will also be carried out and the feedback will be analysed and report will also be made available in the home. The copies of reports of visits made to the service by the Registered Provider under Regulation 26 of the Care Homes Regulations 2001 are made available in the home and for inspection by the Care Quality Commission. Financial records and administrative procedures relating to the handling of the monies of people who use the service were looked at and were found to be well ordered and maintained. The home actively encourages people using the service, where able, to manage their own money. Observation of financial records confirm a robust process of managing peoples finances. All transactions are checked by two staff members and the Manager together with an Assistant Team Leader audits these records on a regular basis. The home keeps records to show that health and safety of people who use the service is promoted and protected. It was noted that the hot water supply temperature in all hot water outlets is tested and appropriate records maintained at the recommended level of hot water temperature of close to 43 Degrees C at all times to ensure the safety of people who use the service. The Acting Care Manager also stated that the issues identified in the Fire Safety Officers inspection report 19th March 2009 have been addressed. However, it was noted from records that the Fire Alarm System was not tested for two weeks and the senior staff did undertake this test towards the end of inspection and all appeared to be satisfactory and in order. Care Homes for Older People Page 29 of 33 Evidence: The staff training records showed that a majority of staff have received their mandatory training in safe working practice topics, e.g. moving and handling, food hygiene, first aid, health and safety, infection control and fire safety. The Acting Care Manager stated that all those members of staff who as yet have not received this training will do so shortly. They will also receive training in Adult Protection and safeguarding issues, safe handling of medication, NVQ Level 2, Mental Capacity Act 2005 and Dementia care as soon as practicable. People who use the service spoken with were very complimentary about the Acting Care Manager and staff in the home. Many of them knew who they were by name and looked at ease in their presence. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Requirement 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 12 It is recommended that the Manager takes appropriate action to ensure that the social and leisure activities enjoyed by people using the service should be consistently recorded, evaluated and incorporated into their individual care plans, in order to monitor the quality of social stimulation and its impact on social life of individuals living at Blakenhall Resource Centre. It is recommended that the Manager ensure that all those members of staff who as yet have not received mandatory training or updates in safe working practice topics; and Mental Capacity Act 2005, including Deprivation of Liberty (DoLS), Adult protection/safeguarding and Dementia care should be provided as soon as practicable. It is recommended that the Manager takes appropriate action to ensure that the feedback on the quality of care and service provided is obtained from people who use the service, their relatives/friends and other professionals and/or stakeholders. A report on the feedback analysis and any action plan prepared and implemented on the issues raised be provided in the home and for inspection by the Care Quality Commision (CQC). Page 32 of 33 2 30 3 33 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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