BLANCHELANDE PARK NURSING HOME
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
REGISTRATION AND INSPECTION
OF
PRIVATE NURSING AND RESIDENTIAL HOMES
BLANCHELANDE PARK
NURSING HOME
INSPECTION REPORT
DATE: 13/03/19
This report may only be quoted in its entirety and may not be quoted in part or in any
abridged form for any public or statutory purposeHEALTH & SOCIAL CARE
REGISTRATION AND INSPECTION OF
PRIVATE NURSING AND RESIDENTIAL HOMES
INTRODUCTION
The Registration and Inspection unit of Health & Social Care has a statutory responsibility to inspect
private nursing and residential homes within the Bailiwick of Guernsey at least twice per year. The
Registration and Inspection Officer undertakes a minimum of one announced and one unannounced
inspection per year.
The inspections are undertaken in order to establish whether the care home is meeting the legal
requirements i.e. The Nursing and Residential Homes (Guernsey) Law 1976 and it’s associated
Ordinances, together with the agreed standards.
In reading the report the following factors should be borne in mind:
• The report is only accurate for the period when the home was inspected.
• Alterations to physical facilities or care practices may subsequently have occurred in
the home.
• Feedback will have been given orally to the senior person on duty at the time of the
visit.
• Both the Inspector and the Registered Home Owner/Care Manager of the home to
which it refers will agree the report as an accurate report.
• The report will show the compliance with the Regulations and Standards and the
required actions on behalf of the provider.
Name of Establishment: Blanchelande Park Nursing Home
Address: La Rocher Road, St Martins, GY4 6EN
Name of Registered Provider: BCH Holding Ltd
Name of Registered Manager: Mrs Rosalind Rix (RGN) – Care Manager
CATEGORIES/NUMBER OF REGISTERED BEDS
CATEGORY NUMBER REGISTERED
Nursing 20
Residential 21
Current occupancy 38 residents
Date of most recent inspections: 22/03/18 – Announced
25/10/18 – Unannounced
Date of inspection upon which this report is based - 13/03/19
Category of inspection – Announced
Vanessa Penney
Registration and Inspection OfficerThe Inspection findings relate to the Projet de Loi and its associated Ordinances. These are supported
by the agreed Guernsey Standards for Care Homes as examples of ‘Best Practice’ and it is against
these that form the basis of the inspection and its findings. The report follows the format of the
Guernsey Standards and the numbering shown in the report corresponds to that of the Standards.
INSPECTION REPORT
Identified below are areas addressed in the main body of the report, which are seen as health and
safety, and/or good practice issues which the registered provider should consider for
implementation.
Refer to
RECOMMENDED PRACTICE DEVELOPMENTS standard
Recommend the use of an audit tool (two audit tools provided) for guidance with monitoring 27, 31,
staffing level against dependency and the challenges the building presents (5 levels) 38
Ensure training programmes are on-going to include refresher training and for the 30, 38
development of new skills to ensure the needs of all people in your care are able to be metSTANDARD 1: INFORMATION
OUTCOME: The intended outcomes for the following set of standards are:
• Service users have the information they need to make an informed choice about where to
live.
• Each service user has a guide to the facilities.
• Each service user has a written contract/statement of purpose setting out the aims and
objectives of the home.
• Each service user understands how to contact the Health Services Inspector and other local
health and social services.
Key findings/Evidence:
Blanchelande Park has a marketing brochure in place, which provides a description of the home and
of the care and services it has to offer. The brochure also includes the views from some of the
residents who live/have lived in the home. There is a website, www.blanchelandepark.com, which is
very informative and includes the philosophy of care, facilities and services the home has to offer; as
well as pictures of both the inside and the outside of the home. This adds to the package of
information that is available to assist residents to make an informed decision about whether
Blanchelande Park is the right home for them. A leaflet is also available, which explains the process
for long term care, which is helpful.
There is a resident’s handbook, which provides much of this information and each resident is
provided with a copy of the handbook, which they can keep in their room. The handbook is indexed
and is published in large print to facilitate easy reading for a person with visual impairment. The
handbook includes the following; Blanchelande Park’s philosophy of care, the aims and objectives of
the management and the team, number of beds registered and the category of care provided,
identification of staff by the colour of their uniform, financial arrangements to include additional
charges where relevant, e.g. purchases from the shop trolley, visits by the hairdresser, telephone
charges and newspapers and periodicals etc. There is also information for visiting times, the policy for
smoking, alcohol and for pets in the home, personal possessions (valuables policy), communal
facilities and for gratuities etc. It is also acknowledged that whenever possible, residents will be
offered a choice in the gender of the person who will be assisting him/her with personal care (a male
Carer may not be available on every shift).
There is information regarding the procedure for making a complaint and this includes a timescale
and the title of the person who will manage the complaint. It explains that the complaint can either
be made verbally, in writing, or by using the home’s formal complaints form, which can be obtained
from the information display board in reception. Information for contacting the Registration and
Inspection Officer from within Health & Social Care (HSC) for the referral of a complaint that cannot
be resolved by the management of the home, is also discussed in the handbook. Information is
provided for obtaining a copy of the inspection report if a resident or a visitor to the home would like
access to a copy to read; a copy is also displayed on the resident’s notice board in reception and is
also available on the home’s website.Reference to quality assurance is also discussed; how the home strives to continue to develop with meeting the needs of the residents, for example, the use of a wheel chair vehicle which relatives are able to use if they wish to take their relative out (£15.00 for 4 hours use). Two residents who were spoken to said they had been provided with all of the information that they required to enable them to make an informed decision for choosing Blanchelande Park. The printed information provided, enabled these people to ask additional questions to meet their needs and they are very happy with their final decision and have settled in to the home very well. STANDARD 2: CONTRACT OUTCOME: Each service user has a written contract/statement of terms and conditions with the home. Key findings/Evidence: Each resident is provided with a contract once they have made the final decision to take up accommodation at Blanchelande Park. The contract is not easily understood as it has been written using legal terminology. However, the contract is given to a prospective resident and/or their next of kin (NOK) in advance and the home’s Administrator explains the content more clearly and in more detail at a face-to-face meeting. The prospective resident and/or their NOK can then ask any questions to ensure they understand the information, prior to signing the contract. The Administrator also provides additional written information regarding the accounting system to enable residents to understand the elements of the financial arrangements e.g. long-term care benefit grant, respite care grant and additional ‘top up’ payment required. The contract identifies the room the resident will occupy, care and services provided, financial arrangements; including deposit required, trial period, terms and conditions of occupancy, period of notice, charges during periods of absence from the home; for example, hospital admission or holiday, fixtures and fittings within the room and liability for personal effects etc. More recently a statement in relation to the General Data Protection Regulation (GDPR) has been included. This is due to the introduction of the new law in May 2018, for the sharing of information with other healthcare professionals who are involved with the person’s care and also for the information the home holds in relation to an individual. The resident and/or their NOK or their representative and the company Administrator sign the contract, and each party retains a copy of the signed agreement for their records. STANDARD 3: NEEDS ASSESSMENT + DEMENTIA STANDARD 1.1, 1.2, 1.5,1.6, 2.1 OUTCOME: No service user moves into a home without having had his/her needs assessed and been assured that these will be met. Key Findings/Evidence:
Prior to a person moving in to Blanchelande Park, the person is assessed by the Needs Assessment Panel (NAP) (unless private funder) to establish the level of care that the person requires. The NAP panel also provide the Care Manager with a snapshot summary of the assessment, which also assists with the planning of the person’s care package. The certificate is for either nursing care or residential care as Blanchelande Park is a dual registered home and therefore provides both levels of care. Care is also offered for people with early stage dementia (residential EMI certificate). However, Blanchelande Park is not a dementia specialist care home, therefore this is offered on a placement by placement assessment in agreement with the Care Manager, the person’s Social Worker, Registration & Inspection Officer and the person’s NOK. In addition to the NAP assessment, the Care Manager or her deputy also assesses the needs of each prospective resident prior to a resident moving in to the home, or to add the person’s name to their waiting list. This is to ensure that the care team are able to meet the person’s individual care needs and the person’s expectations of the home, and/or the expectations of their NOK. Also that the care home has, or can access, any specialist equipment a person may require, prior to admission. A resident or their representative sign a consent form to enable the Care Manager or the nurse in charge to request a medical history summary from the person’s GP. On admission each resident has a comprehensive assessment from which a plan of care is developed. This is to ensure that the resident’s care needs are identified and will be met. The assessment is undertaken using the Roper et al model - The Activities of Daily Living. Risk assessments are undertaken for nutrition, tissue viability, moving and transferring and for a risk of falls, the use of bed rails (where required) and for mental cognition. Additionally, physiological measurements such as blood pressure, pulse, weight and urinalysis are recorded on admission, which provides a baseline reading. These measurements are repeated each month (except urinalysis - seen), which provides valuable information for the GP if a person was to become unwell. Blood sugar levels are also recorded as directed by the medical staff for a person who has diabetes. A social activity profile is completed to record a person’s hobbies and interests and likes and dislikes, e.g. meals, activities, community social networks etc. For a resident with dementia, relatives are asked to complete a profile for the resident titled ‘This is Me’. This enables the team to develop a clearer understanding of the person’s care needs and their likes and dislikes if the person is not always able to communicate their wishes clearly themselves. This can then be used in the future with these people for reminiscence therapy. Following the assessment a person-centred care plan is developed. A copy of a person’s daily care support plan is available in the individual person’s room for example - the level of assistance a person requires with their personal care, level of observation required, or equipment required for moving and handling and for mobility etc. When a person moves in to the home it is established with the person and/or their NOK the level of input a person wishes to have with their care reviews. STANDARD 4: MEETING NEEDS OUTCOME: Service users and their representatives know that the home they enter will meet their needs.
Key findings/Evidence: Blanchelande Park is a dual registered care home, which provides care and support for people who require residential or nursing care and who have varying levels of physical dependency and psychological needs. Care and support is also provided for a person with early stage dementia. Blanchelande Park does not have a specialist facility to provide care for people with advanced dementia who like to wander, as they do not have a locked door policy. However, there is a wander guard system in place to minimise the risk of a person wandering out of the home independently, if the person is not safe to do so. The person wears a ‘bracelet’, which is linked up to an alarm. If the person walks near to the door an alarm is sounded to alert the staff who can then assist the person by providing distraction techniques, or by providing supervision for a person to go outside (currently 5 people are using this equipment). A person is cared for in the home for as long as possible, with support from the Community Psychiatric Nurse, Social Worker and from the person’s GP. If a person is looking to wander away from the home continuously, or there is deterioration in the person’s behaviour, which is affecting other people who are living in the home and becomes difficult for the staff to manage, a care review is undertaken. A person may then at this time be required to transfer to a specialist dementia care home, where the environment would be more appropriate to meet the person’s current care needs. In the first instance, advice is sought from the dementia care specialist team. If it is likely that a person will need to transfer to a more appropriate facility to support them, this is discussed with the person’s NOK prior to a final decision being made. The care team undertake regular refresher training for dementia care. The most recent refresher training was a 2-day course in September 2018, which was provided by an accredited trainer (Mental Health Nurse Specialist). Carers are encouraged to build on their current level of knowledge and skill for providing care for this client group and to keep up to date through the home’s successful ongoing VQ programmes. Additional programmes of training are organised by the home and include both formal and informal training and discussions; both at the home and through other accredited trainers. There is a Registered Nurse (RN) on duty 24/7 and the RNs are offered quality training, for example, at the Institute of Health and Social Care Studies (IHSCS). The RNs have also taken advantage of belonging to an established link nurse system with the specialist nurses from within HSC. This includes; tissue viability and wound management, the management of incontinence, infection control, diabetes and speech and language therapy (for swallowing assessments). Support is also sought from the falls clinic and from the wheelchair clinic as required. The management subscribes to several journals relevant to their client group, for example, Care of Older People and there is access to the internet for research. The Care Manager also invites various visiting speakers including the specialist nurses to provide refresher sessions to ensure continued best practice guidelines are followed.
STANDARD 5: TRIAL VISITS OUTCOME: Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Key findings/Evidence: When a room becomes available a prospective resident is offered a 3-week trial prior to being ‘locked in’ to the contract. The person and their NOK are encouraged to visit the home before making a final decision to take up residency in the home (Administrator provides information for the person to take away and read at their own leisure). This enables the person to have a look around and to talk to some of the residents and staff who already live or work at Blanchelande Park. If this were not possible, the Care Manager visits a person in hospital, at their home, or other place of residence if necessary (other care home). If a person is apprehensive about moving in to the home; the Care Manager suggests a gradual introduction to the home, for example, visit the home for coffee or to stay for the day, followed by spending a weekend in the home, or to move in to the home for a period of respite while a relative/carer has a holiday etc. This is excellent and demonstrates that the management understand the difficulties and mixed emotions that some people may feel with making adjustments to their lifestyle and family contact. An emergency admission is accepted in to the home if there is a vacant room at the time of need. If a person transfers into the home as an emergency admission, assessments and care plans are developed as for all long term care residents. All residents who were asked, said that he/she/NOK/ representative had visited the home to have a look around prior to making their final decision. All of these residents said that they are satisfied with their choice. One resident said the home exceeded her expectations. STANDARD 6: INTERMEDIATE CARE OUTCOME: Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. Key findings/Evidence: Blanchelande Park does not have dedicated beds for respite care, however, respite care is still available if there is a vacant room at the time of need. Specialised services, if not already available in the home, are sought as necessary through the Community Nurses, Specialist Nurses, Physiotherapist or Occupational Therapist etc. For people who do not require more specialised treatment/care, staff actively manage a person’s level of independence and mobility to ensure that as much independence is maintained as the
person’s health and well-being allows, to enable the person to return home. The RNs also provide training, supervision and support for the Carers as required. STANDARD 7: SERVICE USER PLAN + DEMENTIA STANDARD 2.2, 2.3, 3.1, 3.2 OUTCOME: Service user’s health and social care needs are set out in an individual plan of care. Key findings/Evidence: Each resident has a care record, which is held securely in an electronic care package system. To meet the requirements for data protection, staff have an individual password to log in to the part of the electronic program that he/she has authority to access. GP medical notes are also held securely on this system. On examination of the care plans an assessment of the person’s care needs is undertaken and areas of risk are highlighted. A risk assessment is then documented from which a care plan is developed. The care plans that were examined had been reviewed by the person’s key nurse. The paper copies for the Carer’s to refer to, which are in each resident’s room, are also kept updated so that they mirror the information, which is held electronically. Risk assessments are undertaken for moving and handling and the risk of falls, nutrition, tissue viability (using Braden score), mental cognition, environmental safety and for the use of bedrails (where in place). A person who is at risk of falls, or who has had falls, has been referred to HSC’s falls clinic for further assessment and support, where relevant. The cognition of a person who has dementia and the triggers that can cause upset or frustration to an individual is also included. There is a wander guard system available (if needed) for a person who is not safe to wander outside of the home independently. When the wander guard is required, a risk assessment is undertaken and discussion takes place with the person’s NOK, GP and with the person’s Social Worker. Agreement is made between all parties concerned and is recorded prior to the wander guard being activated. The Care Manager conducts a regular health and safety walk-through with the Estate Manager to monitor environmental hazards. The outcome is then recorded and is addressed with the relevant department to action e.g. maintenance, housekeeping, care team etc. A maintenance audit program is in place and includes daily and annual checks for various items or equipment, which is good practice. All care plans are generally reviewed monthly or at least within the 3-monthly recommended timescale, if no changes are required before this time. If a person’s care needs or treatment changes before this time, the plan of care is reviewed and is updated immediately (new system flags up when reviews are due). Handovers consist of a combination of both written and verbal information as a print out of the communication log for all of the residents is used for the handover. This is to ensure that important
information is not forgotten and is passed on to the next shift accurately. STANDARD 8: HEALTH AND PERSONAL CARE + DEMENTIA STANDARD 4.1, 4.2, 4.6 OUTCOME: Service user’s health care needs are fully met. Key findings/Evidence: Private visits or consultations are undertaken in the resident’s own room or in the Nurses’ office. Each resident has a key Nurse who is responsible for organising their resident’s care, treatment and appointments etc with the person or their NOK (as relevant) and also for updating their resident’s care plan. It is important that the Nurse establishes on admission the level of input a person’s NOK wishes to have (with person’s consent) so that they can be included in regular reviews and updates with their relative’s key Nurse e.g. care plan reviews. Each resident also has a key Carer who is responsible for ensuring that their resident has sufficient clothing and toiletries and liaises with the person’s NOK to purchase the additional items as needed. The key Carers are also involved in the person’s social care (if appropriate) and are responsible for undertaking the person’s monthly observations and for reporting the findings to the person’s key Nurse (NVQ/VQ level 3 qualified Carers undertake). This demonstrates a team approach and enables the Senior Carers to maintain the skills that they have learnt as part of the NVQ/VQ training program and it also facilitates continuity of holistic care. The name of the person’s key Nurse and key Carer is displayed in each person’s room so both of them can work together with the person and their family. There is one person in the home with a pressure sore, further investigation indicated that the person is receiving end of life care and appropriate measures are in place for ongoing care. Pressure-relieving equipment is available in the home for a person whose pressure areas are at risk. A person’s skin status is assessed on admission and is then regularly re-assessed (monthly) using the Braden scale; whereby a person's risk and a need for preventative measures can be determined, before any skin damage occurs. The RNs also consult with the Tissue Viability Specialist Nurse, or with the Community Nurses from within HSC, for additional guidance when required. There is also a selection of hoists and moving and handling equipment to help meet the needs of all of the residents in the home. Residents who were spoken to had no complaints to raise in relation to the care they received. They said that the staff are kind and friendly and always provide assistance where needed in an encouraging and patient manner. STANDARD 9: MEDICATION OUTCOME: Service users where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Key findings/Evidence: Blanchelande Park uses the Bio Dose System for the administration of medication. The Care Manager and the RNs have developed a good working relationship with the Pharmacist and are able to contact
him for guidance whenever this is necessary. The Pharmacist audits and reviews medication on the monthly medication cycle; any concerns are reported to the RNs at the home and the Pharmacist contacts the resident’s GP. The RNs dispense the medications from the Bio Dose trays, which are stored securely in a locked treatment room. Residents, who self medicate, have a locked drawer/cupboard within their room in which to store their medication. Each person has a risk assessment completed to demonstrate that the person is safe to self-medicate and the person signs the form to acknowledge their responsibility. These residents are re-assessed daily as the RNs discuss this when giving out medications. A person’s NOK may also raise a concern with the Care Manager or RN in charge if he/she has concerns that their relative is having difficulty with managing their medications. The Care Manager or RN in charge then discusses their concerns with the resident and/or their NOK (where relevant) and organises to take over the administration of their medication if necessary. This may be just while the person is unwell and is unable to manage their medication at that current time, or on a more permanent basis if further problems are evident. This is good practice as it demonstrates safe practice; yet promotes independence and autonomy for the resident. There is an up-to-date British National Formulary (BNF) for the RNs and visiting healthcare professionals to refer to as needed. The Deputy Chief Pharmacist from within HSC undertook a medication inspection in April 2018 where the medication system was found to be in good order. A recommendation was made for the RNs to undertake formal training for the management of a person receiving oxygen therapy and this has been completed. All medication including controlled drugs, are stored and are recorded in compliance with regulations and codes of practice. There is a signature list at the front of the medication record files with the signatures of all of the RNs in the home who administer medication to the residents. There is a Medication Administration Record (MAR) for each resident. Each MAR includes the resident’s name, date of birth, known allergies and the name of the resident’s GP. The record also displays further necessary information, for example if the resident is diabetic. There is also a photograph of each resident with his/her MAR chart. The MARs are audited 3-monthly. Each resident’s medication is reviewed by their own GP at least 3-6 monthly; this may be undertaken more frequently if a resident is visited by their GP if the person has been unwell. There are policies and procedures for the receipt, recording, storage, handling, administration, disposal, self-medication, errors and reordering of medications and records are kept for the following; medications received by the home, medications administered to residents and medications which have been returned to pharmacy. All residents in the home are offered an annual flu vaccination, which is also discussed in the resident’s handbook. Staff are also offered the flu vaccination, which is good practice for infection control within the home. The Care Manager retains records for this.
STANDARD 10: PRIVACY AND DIGNITY OUTCOME: Service users are treated with respect and their right to privacy is upheld. Key findings/Evidence: The majority of rooms at Blanchelande Park are single occupancy. There are 6 double rooms for a married couple or for siblings; currently 2 of these rooms are single occupancy and 1 room is double occupancy. All rooms at Blanchelande Park are en-suite. Residents are able to have their own telephone in their room for which they pay for the line and calls. All telephones have an additional volume control and have large number keys; however residents can provide their own telephone if they prefer. Some of the residents have installed portable telephones and others have a personal mobile telephone, or have brought in a laptop/ipad. Residents also have access to a computer in Treetops (communal social room). Residents who were spoken to said that they wear and choose their own clothing, which is labelled; this assists staff if searching for mislaid items. Residents continue to be satisfied with the laundry service; permanent mislaid items do not appear to be a regular occurrence. People who were spoken to said the staff address them by their preferred choice of name, which for the majority of them is by their Christian name or the person’s chosen ‘nickname’ and staff always knock on a person’s bedroom door and wait for a reply before entering (observed during day of inspection). This demonstrates that staff understand the need to preserve a person’s privacy and dignity, and people are treated with respect. Staff do not open a person’s mail. If a relative requested this to be done, for example if a person is expecting birthday cards or an appointment etc, the Care Manager or RN in charge would open it. However, mail is generally forwarded to the NOK for people who are unable to manage their own affairs. There are policies and procedures for the protection of vulnerable adults, privacy and dignity and for confidentiality, which are also included in the home’s induction programme. STANDARD 11: DYING AND DEATH OUTCOME: Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Key findings/Evidence: A person who is receiving end of life care is cared for in the home with support from the Palliative Care Specialist Nurses as required. This is to ensure that the person’s changing needs are met for comfort and pain relief and for nutrition. Blanchelande has a syringe driver and the RNs undertake
refresher training with the RNs at Les Bourg’s Hospice to update their knowledge and skills in this area of practice. The RNs undertake training for end of life care planning and provide training and supervision for the rest of the care team. A person’s needs are respected both culturally and religiously. The staff also aim to meet the needs of the relatives as much as is possible and offer refreshments, comfort and support. The RNs also make provision for a relative to stay with their relative if they want to do so (able to use a vacant room if available at that time, or provided with a recliner chair in their relative’s room). There are policies and procedures in place for end of life care and for resuscitation and all residents have a documented resuscitation status. STANDARD 12: SOCIAL CONTACTS AND ACTIVITIES + DEMENTIA STANDARDS 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8 OUTCOME: Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Key findings/Evidence: Two Activity Assistants provide 40 hours of activity time per week. However this is flexible and is increased depending on the activity taking place e.g. if there is an outing away from the home, additional staff may need to be on duty during that period to ensure there are sufficient Carers to provide supervision on the outing, as well as sufficient Carers remaining at the home. An activity profile is developed for each person when he/she moves in to Blanchelande Park; it has been acknowledged that completing such profiles really helps to engage the individual as a person; knowing what their interests are, particularly for those people who have some cognitive impairment. Having individualised activities organised for people on a one-to-one basis ensures that each person is encouraged to pursue individual hobbies as well as group activities. It is particularly important for those people who choose not to, or who are not able to socialise much during the day, that they are encouraged to pursue some leisure activity. The Activity Assistants also record whether a person enjoyed participating or not. This then enables the Activity Assistants to plan more suitable activities for individuals. The Care Manager has a document titled “This is me”, (a social profile for people with dementia). This is given to a person’s NOK to complete and return to the home so that it can be used as meaningful activity for these people; however, on many occasions this information is not returned, which is a shame. Blanchelande Park has an extensive activities programme (no activities on a Sunday – unless a one off social event is taking place e.g. tea party within the community). This is residents’ choice due to the number of visitors at the weekend (confirmed by residents). A copy of the activity program is delivered to each room to inform residents of the activities for the following week. This is so that provision can be made for a person to take part if the person cannot move around independently. Due to continued increase in the dependency of the residents, the Activity Assistant said more one- to-one activities take place; some with a person in their room. The Activity Assistant said that they
aim to do an activity with every resident in the home each week (as wanted/needed). Residents were asked what sort of activities they would like to add to the activity program. Residents said they could not think of anything at this time and felt the activity programme provided a good variety of social stimulation. One person said she spends most of her time in her room doing her own activities. She does go down to the communal lounge if there is something in particular going on that she enjoys, such as music and singing sessions, or an exercise class. Another person said that she is unable to mobilise independently, however, the staff know the activities she enjoys and always come up to her room to remind her and then to collect her for the activity. The Activity Assistants offer activities such as quizzes, cards, crossword groups, sing along sessions, exercise classes, pampering sessions and weekly visits by a hairdresser etc. There is a library room and a cinema room where a movie session is held on a Friday and a Sunday afternoon for those residents who wish to join in. There is a weekly bus trip. On a Monday morning a shopping trip is offered to town and during the afternoon a coastal drive and a stop for a cup of tea or an ice cream is offered (subject to weather). During the winter months residents choose to go on outings less frequently so the smaller vehicle (Blanche) is used to take out 1-4 people out at a time (if they want to go). Visits are also encouraged from outside organisations and entertainers e.g. dog training group and the Healing Music Trust, which is excellent and promotes the home as a place in the community for socialising and also helps people to maintain their social networks. There are several outdoor activities for residents to enjoy within the home’s grounds; there is petanque, pitch and putt, croquet and a bowling green. Relatives are also able to use these areas with their relative. There is a sunken garden behind Treetops and there is a seating area to the front of the home, which provides some lovely flowers and plants and several of the residents enjoy sitting there in the sun watching visitors come and go and having a quick chat with them. There is a picnic area, which has been paved so it is user friendly for a person who is dependent upon a wheelchair or a walking aid, for mobilising around the home. Blanchelande Park also has a swimming pool, which can be used by residents but over the years with residents less mobile, this facility is seldom used by the residents in the home. The home enjoys entertaining the residents and often holds celebratory or themed days e.g. Easter celebrations, Liberation Day etc. The music room can also be used if a resident wants to hold a private celebration with family and friends. When it is a person’s birthday he/she is also able to choose the meal for that day and have one suggestion for an activity they would like to do e.g. a visit to Candie Gardens or to a garden centre etc. The Activity Assistant said she recently attended a meeting, which was set up for Activity Assistants in care homes. She found this very useful to discuss with other Activity Assistants how their activity programme worked and to share ideas and information. She said this was an excellent support network, which provided motivation through the introduction of new ideas and she hoped the group support would continue with regular meetings. Residents are able to be involved in the day-to-day running of the home if they wish e.g. potter about the garden or tending to the vases of flowers in the communal areas etc. Some residents still like to make their own beds, one person likes to help to collect the cups after morning coffee or afternoon
tea. This is important as it helps to give these people a feeling of purpose and can help maintain well- being and self-esteem and encourages a feeling of a home environment. STANDARD 13: COMMUNITY CONTACT + DEMENTIA STANDARD 5.4 OUTCOME: Service users maintain contact with family/friends/representatives and the local community as they wish. Key findings/Evidence: The staff encourage and support people to maintain current social networks. Residents are able to come and go independently as they wish; providing they have been risk assessed as safe to do so. Several people attend social groups e.g. The Ron Short Centre, Parkinson’s Society meetings and the Centre for the Blind. Several other people go out to lunch frequently with family and friends and some residents visit family abroad, further promoting normal family living. There is an open visiting policy. Visitors are encouraged to avoid meal times when the residents are in the dining room as a mark of respect to the other residents in the home; unless they are assisting their relative with their meal. The doors to the home are locked at 20.00 hours; therefore people returning later in the evening are required to ring the doorbell. There is a visitor’s book in the entrance to the home so that visitors can sign in and out and residents have an in and out board, which is good practice for additional security and also for fire safety. There is also CCTV at the entrance to the home and there are signs to indicate this. More recently the button to press to exit the home has been relocated for additional security for people who are not safe to leave the home independently. There is opportunity for residents to receive visitors in their own room, or in any of the communal areas as they wish. Relatives and residents are encouraged to make themselves a cup of tea in the dining area if they are safe to do so. This is excellent and contributes to normal practice of inviting someone into your home and offering them a cup of tea. Relatives and friends are also able to make arrangements to have a meal with their friend/relative if they wish (for a small cost) and several relatives and friends make use of this service. As previously discussed in this report the music room can be set up for family lunches, special occasions, or for private visits if this is requested. The RNs ensure that all residents have a choice of the people who visit. If there were any persons a resident did not wish to see, the RNs would respect this and measures would be put in place to ensure that all staff are informed. This would also be documented in the person’s care plan. STANDARD 14: AUTONOMY AND CHOICE OUTCOME: Service users are helped to exercise choice and control over their lives. Key findings/Evidence: Residents are encouraged to bring in personal items for their room, including pieces of furniture, pictures and ornaments etc and each room reflects the resident’s personality and interests. Each
resident has access to a secure lockable drawer for personal items such as medication and documents, or jewellery and valuables. People are advised not to keep a large amount of money or ‘high end’ valuables in their room. As each room is re-decorated a small safe is now being installed. However, there is a safe in the Administrator’s office for a person who prefers to keep some small items or money in the home and records are kept for items held within and withdrawn from the safe. Residents and/or their NOK or representative (where relevant) are encouraged to manage an individual’s financial affairs; management would provide information for a person to contact an advocate if this was required. People who were spoken to confirmed that they were encouraged and supported to make their own decisions and choices wherever possible. There are no restrictions for going out and coming back to the home; although residents said that out of politeness they usually tell a member of staff where they were going and roughly what time they would be back, as well as using the in and out board (continues to work well). People are able to access their care records through the Care Manager or the RN in charge if requested and there are policies and procedures in place for adult protection, the safe keeping of money and valuables and for guardianship orders. STANDARD 15: MEALS AND MEALTIMES + DEMENTIA STANDARD 1.6 OUTCOME: Service users receive a wholesome, appealing, balanced diet in pleasing surroundings at times convenient to them. Key findings/Evidence: The menus are varied, seasonal and are planned on a 4-week rotation. Three meals are offered a day with the main meal at lunchtime. Generally the home has a set menu with several choices for each course; however, alternative choices are always offered (confirmed by residents). Cultural and religious needs are met as well as other dietary requirements e.g. diabetic, vegetarian, gluten free, low fat and for allergies and food intolerances etc. Residents that were spoken to said the quality of the food and the choices on offer continue to be good. Residents said that if they write their preference on their daily menu card, what they ask for is provided wherever this is possible. The Chef has a meeting with all new admissions to discuss the person’s dietary preferences, likes and dislikes. He also helps to serve breakfast so that he gets to know residents more thoroughly. If a person requests a visit from the Chef to discuss their dietary requirements at any time when they are living in the home, he is more than happy to do this. Residents said that the portion sizes were more than adequate and the food is served hot and is always well presented. A member of the staff visits each resident every day to discuss the choices for their meal for the following day. A copy of each resident’s choice is then kept in the dining room for the person to view. The dining room is bright and airy and is always beautifully laid up to that of restaurant standards, with co-ordinated linen tablecloths, crockery, cutlery, and fresh flowers. Having a table pleasantly laid
contributes to the ambience, making mealtimes into “an event,” something for the residents to look forward to during their day. The recent re-decoration of the dining room includes ‘hard’ flooring to aid infection control and to modernise the room and the lighting is brighter. Shutters have been fitted to decorate the windows and this gives a Mediterranean feel to the room. Residents are encouraged to have their meals in the dining room for the social aspect, however, for people who are unwell or who do not wish to go to the dining room; meals are served to people in their own room (confirmed by residents and observed). There is a hot trolley to ensure the food remains hot during delivery to the various rooms in the home and this continues to be effective. Nutritional screening is undertaken on admission and this is reviewed on a monthly basis. People are also weighed each month so that concerns with weight gain/loss can be managed effectively. Referral to the Dietician from within HSC or to the resident’s GP are then forwarded if necessary. Training is offered by the Community Nurses for nutritional support if a resident has a percutaneous endoscopic gastrostomy (PEG) to ensure adequate nutritional intake (1 resident has – Dietician providing guidance for the ongoing management). Residents are provided with assistance from the staff at meal times with any difficulties they may have e.g. cut up food, or who require assistance to enable a person to eat their meal etc. There is access to hot and cold drinks for people to help themselves to in the lounge, if safe to do so and there are several tea rounds during the day when residents are offered a hot drink. On level 2 in the self-service drinks area and in Treetops, there is chilled water available. If a person requests a snack in between meals or during the night, they are offered biscuits and cheese, sandwiches, toast, soup, cereal, yoghurt or fruit etc. Residents that were spoken to said they had never had to ask for a snack in between meals or at night, as there was always plenty to eat at meal times and there are cakes and biscuits offered on tea and coffee rounds. However, they had no doubt that they would be able to have a snack or a drink at any time if they were to ask for one. Some people said they had small stocks of their favorite foods in their room e.g. biscuits or chocolates, which have been brought in by friends and relatives as gifts. An Environmental Health Officer undertook a food hygiene inspection in October 2018 and the home retained their 5 star rating, which is excellent. STANDARD 16: COMPLAINTS OUTCOME: Service users and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Key findings/Evidence: There is a written policy, which discusses the procedure for making a complaint. There is a timescale for investigating and replying to the complainant and the title of the person who will have responsibility for managing the complaint. The policy is displayed on the notice board in reception and is also included in the residents’ handbook. Leaflets are also available in reception for residents, relatives and visitors to the home to complete if they would like to give feedback (to make comments
or to raise concerns), however these are rarely completed and returned. A review of the care and services at Blanchelande Park can also be written independently on www.Carehome.co.uk (reviews are very positive). The Care Manager retains records of the feedback/suggestions, or for a complaint made and action is taken with the relevant person/s to resolve any concerns. There is also information displayed in the resident’s sitting area for referring a complaint to the Registration & Inspection Officer from within HSC if the Care Manager or the providers of the home cannot resolve the complaint. The Care Manager speaks to residents and relatives daily on an informal basis when she is walking around the home. Relatives and residents are also able to book a more formal, private meeting with her if they wish. A formal residents’ meeting is held with the Care Manager every other month and these are well-supported by residents and visiting relatives. There is a structured agenda to raise concerns or to give feedback in relation to the quality of care and services and the minutes of the meetings are recorded. There is also a suggestion box in the entrance to the home where residents, visitors and staff can give anonymous feedback if they prefer; however the box is rarely used (none since previous inspection). This suggests that either people are satisfied with the care and services at the home, or feel comfortable to approach the Care Manager direct to discuss any issues on an individual basis if/when an issue arises. STANDARD 17: RIGHTS + DEMENTIA STANDARD 1.6 OUTCOME: Service user’s legal rights are protected. Key findings/Evidence: Residents are able to access local advocate services if required and the Care Manager can provide support with this if needed. Residents are also able to participate in any local political processes. Several of the residents are on the electoral role and want to continue to vote, which is excellent and ensures that all people who wish to take part are included. There are adult protection policies in place and there is a unit in the VQ programme, which includes adult protection, which all Carers complete who are studying for this award. In-house safeguard refresher sessions are also undertaken with staff. When a new member of staff commences employment in the home, the Care Manager or an RN discusses the importance of maintaining confidentiality of residents’ information with the new employee. Once this has been completed, the new employee is required to sign a contract acknowledging that they have understood and will adhere to this practice. The Care Manager is also aware of the data protection law, which was introduced in May 2018 and the management and administration department are working within these guidelines.
STANDARD 18: PROTECTION + DEMENTIA STANDARD 4.3 OUTCOME: Service users are protected from abuse. Key findings/Evidence: The RNs in the home work within the guidelines of recommended practice, which are set out by the Nursing and Midwifery Council (NMC). Policies and procedures are also in place for the following; adult protection, inappropriate restraint, neglect, discrimination, whistle-blowing, receiving gifts, the safe storage of money and valuables and for staff non-involvement in a person’s financial affairs. All policies are reviewed annually, dated and are signed. Allegations of abuse are investigated by the Care Manager and the appropriate action is taken; the Registration & Inspection Officer and the Safeguard Lead from within HSC are also notified. The Care Manager also retains records of the investigation process. If the Care Manager considered a member of staff to be unsuitable to work with vulnerable adults she would also notify the Registration and Inspection Officer. Residents who were spoken to said that they felt safe in the home, no issues were raised when discussing the manner in which staff speak to them or assist them with their daily care activities. STANDARD 19: PREMISES + DEMENTIA STANDARDS 7.1, 7.2, 7.3, 7.5 OUTCOME: Service users live in a safe, well- maintained environment. Key findings/Evidence: Facilities within the home are safely accessible and Blanchelande Park is homely, clean and comfortable. The furniture and furnishings are suitable for the client group and the home retains records for maintenance work and for ongoing re-decoration. Each time a room becomes vacant it is re-decorated and the carpet and furniture are replaced as required. The majority of the nursing rooms have had the carpet replaced with hard flooring. This is to assist residents and staff with improved manoeuvrability with walking aids, wheel chairs and hoist equipment and also for infection control. Communal toilets, bathrooms, reception and rooms on each floor display clear signage and there is a variety of places of interest for a person who has dementia to wander around e.g. Treetops social room, music room, several lounges and reception areas and accessible corridors on all floors. The access to the swimming pool is kept locked at all times and is only accessible using a combination of a keypad and a key lock system for total security. The Care Manager undertakes a weekly Health and Safety walkthrough during which time she specifically looks for hazards and acts upon them (in partnership with the Estate Manager). The Providers also undertake a walk though the home during their regular visits. Works to be undertaken, or replacement required is then prioritised and is actioned accordingly. Fire equipment, electrical safety checks and lifts etc are maintained and inspected in compliance with regulations/standards (dates provided).
A team of Receptionists provide cover for the reception desk during office hours and there is a book for all residents and visitors to sign in and out for additional security and for fire safety, which is good practice. There is good security lighting in the grounds of the home and CCTV covers the entrance to the home and there is a sign in place to indicate this. The insurance certificate is displayed at the entrance to the home and this is in date. STANDARD 20: SHARED FACILITIES OUTCOME. Service users have access to safe and comfortable indoor and outdoor communal facilities. Key findings/Evidence: The Care Manager is aware of the Guernsey smoking legislation; smoking is permitted outside of the home only in a designated smoking area (currently no residents smoke). The communal areas within the home are clean and tidy and are free from any unpleasant odours. They are suitably furnished with adequate lighting, which is flexible for different need/activities at various times of the day or evening. Treetops provides a super recreational area with lovely views from the home and it is light, airy and spacious. Many residents undertake activities there; sit with visitors, read, or just sit quietly enjoying the lovely views. It is a very popular area of the home for both residents and visitors. The outdoor areas of the home are easily accessible and are kept well maintained and are colourful. There are various areas throughout the grounds for people with varying degrees of mobility, including for someone who is wheelchair dependent (e.g. the paved picnic area). STANDARD 21: LAVATORIES AND WASHING FACILITIES OUTCOME: Service users have sufficient and suitable lavatories and washing facilities. Key findings/Evidence: All residents’ rooms are en-suite and contain infection control equipment for the staff. The home has 3 communal walk-in showers and the communal bathrooms include specialised assisted baths (1 recent new bath). Each facility has easy access, adequate heating, lighting and ventilation and is free from any unpleasant odours. There is a lock on the door, a call bell and there are hand wash facilities for the staff. There are 2 toilets close to the dining area and these display clear signs. There are also privacy curtains in these facilities so that a person walking past in the hallway cannot see in when the door is opened, which demonstrates an understanding of maintaining a person’s privacy and dignity.
STANDARD 22: ADAPTATIONS AND EQUIPMENT OUTCOME: Service users have the specialist equipment they require to maximise independence. Key findings/ Evidence: There are ramps and grab/handrails fitted throughout the home and there are 3 passenger lifts. There is a wide range of equipment available for the needs of the residents, demonstrating their commitment to ensuring that resident’s needs are being met and manual handling issues addressed. This includes electric height adjustable beds (one extra long to accommodate a tall person), airwave mattresses and chair cushions, pro-pad cushions, sliding sheets and turning belts, wheelchair scales, sensor mats, adapted cutlery and crockery, variable height chairs, an assortment of hoists, tilt wheelchairs, a tilt and space shower chair, raised toilet seats, syringe drivers, suction equipment and a nebuliser machine etc. Risk assessments are undertaken by an RN prior to the use of bedrails and this is recorded. An equipment audit is also in place. There is an ongoing programme in place to replace the current shower units with wet rooms or larger shower units. This is to improve accessibility (lower step to get into the shower and sliding doors rather than doors that open outwards/inwards), which continues to improve the facilities for wheelchair access and general manoeuvrability for residents, which is excellent. STANDARD 23: INDIVIDUAL ACCOMMODATION - SPACE REQUIREMENTS OUTCOME: Service users own rooms suit their needs. Key findings/Evidence: The majority of the rooms within the home are single occupancy. The double rooms (6) are occupied only by a married couple or siblings. These rooms have access to a portable screen if needed; however, they are all en-suite. All rooms visited have attractive furniture and fittings, which are of a good standard and are non-institutional and are kept well-maintained. The layout of the room is the person’s choice and residents have personalised them with their belongings and various pieces of furniture that they have brought in from their home; demonstrating that individuality is encouraged. STANDARD 24: FURNITURE AND FITTINGS OUTCOME: Service users live in safe, comfortable bedrooms with their own possessions around them. Key findings/Evidence: Residents are able to bring in some of their own pieces of furniture, pictures and ornaments to personalise their room if they wish and are encouraged to do so, as discussed above. All of the
nursing beds are electric height adjustable profile beds and residential beds are currently divans (programme in place to replace divans with ‘to the floor’ profile beds – several have been replaced and this is ongoing). Bed linen and towels are changed at least weekly; or as frequently as necessary if needed before this time. Each person is able to lock the door to their room if they wish and they have access to a lockable drawer or safe within their room in which to store valuables and medication. There is a telephone point, television with access to satellite TV and there is a call bell in every room (most residents use the pendant style call bell which they can wear or keep in their pocket – observed on day of inspection). All rooms inspected appeared well maintained and were clean and free from any unpleasant odours. Residents who were spoken to during inspection are satisfied with the cleanliness of their room and felt that their personal possessions are handled in a respectful manner. STANDARD 25: SERVICES - HEATING AND LIGHTING OUTCOME: Service users live in safe, comfortable surroundings. Key findings/Evidence: There is air conditioning in each room and each unit can be individually controlled to suit the preference of each person (no radiators in the home). The temperature of the towel rails has been set to remain low surface temperature and residents cannot adjust this; the Estate Manager does this for each resident at their request and residents are aware of this. All taps in areas where residents have access have been fitted with a temperature regulator to ensure that the temperature of the water does not exceed 43 ̊C (regular checks documented). The water system within the home is managed in compliance with the standards for the prevention of Legionella. The Estate Manager and the Care Manager have completed training for the prevention of Legionella, by an accredited person from the UK. As a result of the training, a record was set up to record all checks and cleaning schedule and some taps have been changed in the home on the specialist’s advice. The Health & Safety Executive can provide additional guidance as necessary. All rooms have adequate heating, lighting and ventilation and there is emergency lighting throughout the home. There is adequate outdoor lighting in the grounds of the home and car park. STANDARD 26: HYGIENE & CONTROL OF INFECTION OUTCOME: The home is clean, pleasant and hygienic. Key findings/Evidence: The Housekeeping Assistants are managed by a Housekeeping Supervisor and they have cleaning
You can also read
