Care Home: Boulevard House

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What the care home does well People said they felt safe living in the home. Staff help people to enjoy their everyday lives. Family members are encouraged to visit. What has improved since the last inspection? Records now tell us more about the people living in the home and the help they need. Staff have recieved more training so that they can help people staying in the home with their problems. . What the care home could do better: There are rooms in the home which need decorating. Staff must always make sure that people can take their medication safely. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Boulevard House 1 The Boulevard Mablethorpe Lincs LN12 2AD The quality rating for this care home is: three star excellent 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: Ken Hague Date: 2 1 0 8 2 0 0 9 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 28 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Boulevard House 1 The Boulevard Mablethorpe Lincs LN12 2AD 01507473228 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Boulevard Care care home 18 Number of places (if applicable): Under 65 Over 65 18 0 learning disability Additional conditions: One named resident with a physical disability under 65 years Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home Boulevard House is situated in Mablethorpe in a residential area close to the centre of the resort, beach and local facilities, Boulevard House has been converted from a former domestic and hotel premises to the present accommodation. The home is registered for 15 service users with learning disabilities. Although it has 4 rooms registered to occupy 2 people, all but one is at present occupied on a single occupancy basis. The homes service user guide states that the home aims to provide a caring environment for individuals to reach their optimum potential intellectually and socially in small supported living accommodation. The home is owned by Boulevard Care. The home charges £850 to £1400 per week for accomerdation. A copy of the service users guide is given to all new residents. A copy of the homes statement of purpose is available to be seen by all residents and is kept in the care homes office. Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent 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 28 How we did our inspection: This is what the inspector did when they were at the care home We visited and spoke to people living in the home. They told us how staff helped them with their daily lives. We looked at the files to see how people were being helped. What the care home does well What has got better from the last inspection Records now tell us more about the people living in the home and the help they need. Staff have recieved more training so that they can help people staying in the home with their problems. . Care Homes for Adults (18-65 years) Page 7 of 28 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 Ken Hague 33 Greycoat Street London SW1P 2QF 02079792000 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. Care Homes for Adults (18-65 years) Page 8 of 28 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 Adults (18-65 years) Page 9 of 28 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 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People receive a detailed assessment to ensure that their identified needs can be met by the home. Resident receive written confirmation that their needs can be met. Evidence: The individual care records for four residents were examined as part of the case tracking process.They all contained a structured, comprehensive and detailed assessment, completed prior to the resident being admitted to the care home. There was evidence of the resident, the residents family and any professionals working with the new resident being involved in this initial assessment. The initial assessment considered all potential areas of need. There were details of family histories and a pen picture of each resident. There was factual information recorded and details of professionals involved with the resident which included general practitioners and consultants. A social assessment was made with the resident which detailed how they wished to spend their social time. A detailed assessment was completed of their levels of mobility, communication, nutrition, and medical needs. The assessor carried out a risk assessment and where any risk was identified a Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: management strategy for that risk was recorded on the assessment and transferred onto the initial care plan. The initial assessment was seen to provide staff with all of the information they required to write a care plan and to provide safe care using the resources of the care home. The individual care records for each resident were filed in a consistent manner. Information was easy to understand. Care Homes for Adults (18-65 years) Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual needs are reflected in clear comprehensive and up to date care plans and the privacy and dignity of residents is maintained. Evidence: Care plans are in place and cross-referenced with assessed needs. They set out the care required for mobility, relationships and personal hygiene. Records show that the plans are reviewed monthly. Residents said that staff talk to them regularly about their care plans and they sign their own individual care plans. Care records show that all residents are provided with advocacy services. The long-term goals and dreams of the residents are recorded on their care records. All of the care records which lead onto a care plan were filed in a consistent manner. The process starts with the initial assessment, leading to social needs and individual care needs being identified. This information is then transferred onto a detailed comprehensive care plan. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: Care Plans refer to maintaining privacy, letting new staff khow this can be maintained while carrying out care tasks. Residents said that they have keys to their rooms for privacy and staff talk to them with respect. Staff on duty were observed talking to residents in private about their needs making sure they knocked on residents doors before entering and using each residents preferred form of address. Maintaining privacy and dignity is also referred to in the statement of values for the home. Risk assessments are in place for self-medication and trips and falls. The risk assessments are kept in personal files. Residents said that staff know how to help them and will remind them when it is time for appointments such as chiropody, dentist or opticians. They also said that staff help them to see their doctors and district nurses. Care Homes for Adults (18-65 years) Page 14 of 28 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 . People living in the home are offered activities that are meaningful to them. People are assisted to make choices about activities and food, and this enhances their life. Evidence: There is evidence in records and through feedback from residents that activities are available at the Orby day centre in the community and at the care home. Residents are offered opportunities to learn new skills and follow their individual choice of hobbies. It is possible for residents to attend local colleges should an appropriate course be identified. Residents said that they are able to make their own minds up about everything they do and they are able to have their own furniture brought into the home. Staff were seen to provide information and support residents when making choices and decisions. Choice, fulfilment and independence are referred to in the homes statement of values and the registered manager said that literature is available to staff about recent Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: legislation including the Mental Capacity Act 2007. Residents use the local community daily, going out to shops and visiting cinemas and restaurants. A number of the residents go swimming. Day outings are organised by the care home. Residents said that there is always plenty to do and staff are very kind to their visitors. The registered manager states in the pre-inspection information that regular activities including outings are arranged for all residents. The registered manager supplied a copy of the menu which demonstrated choices. Comments from residents regarding the menu were all positive. A resident stated the food is excellent here you could not ask for better. A second resident stated I like the food here, we do have choices and it is always nice. No negative comments were received from any residents regarding the food and the menu. The likes and dislikes of each resident were recorded on their individual care records. Staff described the choices of each residents being case tracked in respect of their dietary needs. Care Homes for Adults (18-65 years) Page 16 of 28 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 . Peoples health care needs are met in the way they personally choose to receive help. The updated medication policy of the care home if followed will ensure that medication is administered safely. Evidence: Care records instruct staff how to ensure the dignity and privacy of residents is maintained while providing personal support. The way residents prefer support to be given is recorded in their individual care plans. Staff were seen to speak sensitively to residents and to listen carefully to them on the day of the visit. Staff sought permission to enter bedrooms and knocked on the door before entering the room. Care plans set out in detail the personality of each resident and behaviours which could indicate a resident is unhappy. A staff member stated we know each resident very well and it is important to ensure we help them sensitivity and provide support in a way which is comfortable to each individual resident. Care records contained detailed recordings of the support provided by healthcare professionals. These included general practitioners, consultants and district nurses. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: The residents choose which dentist and opticians they attend. Records state residents are encouraged to choose their own hairdresser and chiropodist. Care plans state how frequent these visits should be. A residents stated staff help us to keep our appointments with our doctor. A resident was taken to see his GP on the day of the site visit. The home has a medication procedure which if followed would ensure the safe administration and storage of medication. A spot check was made on the storage facilities and records for medication. These were found to be satisfactory. A pharmacy report also stated that medication was being stored safely. However, it was observed that a member of staff signed a medication record without giving the medication personally. This is not acceptable practice and the registered manager took immediate action to ensure this will not happen again. The four individual files seen during this visit all contained the wishes of the residents regarding the action to be taken in the event of their death. Care Homes for Adults (18-65 years) Page 18 of 28 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 . Updated policy and procedures are in place and followed by staff which ensures complaints are listened to and people are safeguarded. Evidence: The registered manager stated that the care home has a detailed up-to-date complaints procedure which is given to all residents and displayed in the care home. Discussion with residents provided evidence that they know how to make a complaint. A resident stated we can approach the manager or any member of staff at any time if we are unhappy. A second resident said staff ask us if we have any problems. The home also holds residents meetings on a regular basis where any concerns can be raised. Staff confirmed that they were aware of the homes whistle blowing policy and stated that they would use it if they have any concerns about care practice. The registered manager stated that all staff have been trained in the prevention and recognition of abuse. Staff confirmed that this statement was correct. Care Homes for Adults (18-65 years) Page 19 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a clean and well-maintained care home, which provides them with a comfortable and safe accommodation. Evidence: The home was found to be well-maintained, decorated to a high standard and clean throughout. The registered manager stated in the AQAA that improvements have been made to the general appearance of the home, and particularly the main entrance. Bedrooms and communal areas were found to be clean, tidy and homely in atmosphere. There were photographs of residents taking part in activities and holidays and other personal items in lounges and on the notice board. A resident said I can choose where I wish to spend my time. Residents told us that they were happy with their bedrooms and they found the home a comfortable place to live. The area outside the home is well-maintained and safe. Residents are encouraged to bring possessions into their rooms and to make them homely. Each room is individually furnished. There are enough bathrooms and toilets to meet the needs of the residents and appropriately serviced equipment is in place to support residents needs as appropriate. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Staff confirmed they regard the needs and safety of residents as central to their role. The staff interviewed confirmed that fire alarms are tested weekly, and were able to describe the appropriate action they would take in order to maintain residents and staff safety in the event of a fire. They confirmed a fire drill had been carried out recently. Residents stated their satisfaction with the environment of the care home. One stated my room lovely. A second resident said I am very happy living here. Care Homes for Adults (18-65 years) Page 21 of 28 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 . Staff are well trained, competent and safely recruited; and therefore able to meet the assessed needs of the people staying in the home . Evidence: Residents stated that they felt there was sufficient staff on duty to meet their needs The recruitment files for new staff include application forms, criminal record bureau checks, references, identification and terms and conditions of employment. Policies are available for recruitment and disciplinary procedures. All new staff have been recruited in accordance with the homes updated recruitment procedure which ensure staff are recruited safely. Staff stated that communication between the staff is good. They also believe teamwork is good with all members of staff working well together. The company has reviewed the training needs of staff and written a new comprehensive training plan. It is acknowledged by the company that additional training is required, particularly on new legistration. During the site visit a relaxed atmosphere was evident and residents were offered sensitive help promptly. Staff demonstrated efficient management of residents needs. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Records show that all staff are studying for, or have achieved nationally recognised care qualifications at various levels and this was confirmed during discussions with staff. Records and pre-inspection information also show that updated training has taken place for subjects such as moving and handling, food hygiene, first aid and infection control. Induction records show that staff are made aware of equality and diversity issues and staff demonstrated their understanding of these issues throughout the visit. There are also records of staff meetings, which show that they have the opportunity to discuss things like training needs and rotas. Care Homes for Adults (18-65 years) Page 23 of 28 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 . The home is well managed in the best interests of the residents and the quality assurance systems enable residents to contribute to the development of the service. Evidence: The registered manager has worked at the home for a number of years. Staff said that she is approachable and they feel confident to go to her with any issues or concerns. Residents said that she is always around for them to speak to and always helps them when they need anything. Pre-inspection information shows that regular residents meetings are held and quality assurance surveys are carried out. Minutes of meetings were seen and demonstrated that residents meetings do take place and action is taken to adress any issues raised. QA surveys showed that residents are happy with the services they receive. The registered manager said that she has carried out staff supervision and appraisals Staff confirmed that they had received formal supervision. Staff said that the registered manager supports them in their work and helps them to develop their skills. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: There are financial procedures in place to ensure that residents financial interests are safeguarded and protected. No health and safety issues were identified at this key inspection. Residents said that they could raise any complaints or concerns with the manager or any member of the staff team. A resident stated we have very good manager I can always talk to her. A second resident stated we have residents meetings and the registered manager always listens to what we say. The recruitment procedure of the care home has been followed ensuring the safe recruitment of staff. The individual files for two new members of staff were seen and found to contain the information required before a member of staff is offered employment. This included criminal record bureau checks, references and proof of identification. Staff skills are being developed by offering specialised training courses to ensure that residents needs can always be met. The manager sends out quality assurance assessments. These were sampled and found to contain only positive comments. We found that the infection control procedure and health and safety procedure of the home was being followed by all staff. The home was found to be clean, comfortable and smelt fresh. Staff and residents confirmed that the home was well-managed and a safe place in which to live or work. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 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 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone : or 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) 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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