REGISTRATION AND INSPECTION OF PRIVATE NURSING AND RESIDENTIAL HOMES BLANCHELANDE PARK NURSING HOME

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 purpose HEALTH & 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 Officer The 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 RECOMMENDED PRACTICE DEVELOPMENTS Refer to 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 met STANDARD 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 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 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 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 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 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 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 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 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 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: