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

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 Rosalin

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 inspectprivate nursing and residential homes within the Bailiwick of Guernsey at least twice per year TheRegistration and Inspection Officer undertakes a minimum of one announced and one unannouncedinspection per year

The inspections are undertaken in order to establish whether the care home is meeting the legalrequirements i.e The Nursing and Residential Homes (Guernsey) Law 1976 and it’s associatedOrdinances, 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 inthe home

 Feedback will have been given orally to the senior person on duty at the time of thevisit

 Both the Inspector and the Registered Home Owner/Care Manager of the home towhich it refers will agree the report as an accurate report

 The report will show the compliance with the Regulations and Standards and therequired 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 againstthese that form the basis of the inspection and its findings The report follows the format of theGuernsey 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

staffing level against dependency and the challenges the building presents (5 levels)

Ensure training programmes are on-going to include refresher training and for the

development of new skills to ensure the needs of all people in your care are able to be met

27, 31,38

30, 38

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 theresidents who live/have lived in the home There is a website, www.blanchelandepark.com, which isvery informative and includes the philosophy of care, facilities and services the home has to offer; aswell as pictures of both the inside and the outside of the home This adds to the package ofinformation that is available to assist residents to make an informed decision about whetherBlanchelande Park is the right home for them A leaflet is also available, which explains the processfor long term care, which is helpful

There is a resident’s handbook, which provides much of this information and each resident isprovided with a copy of the handbook, which they can keep in their room The handbook is indexedand is published in large print to facilitate easy reading for a person with visual impairment Thehandbook includes the following; Blanchelande Park’s philosophy of care, the aims and objectives ofthe 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 additionalcharges where relevant, e.g purchases from the shop trolley, visits by the hairdresser, telephonecharges and newspapers and periodicals etc There is also information for visiting times, the policy forsmoking, alcohol and for pets in the home, personal possessions (valuables policy), communalfacilities and for gratuities etc It is also acknowledged that whenever possible, residents will beoffered a choice in the gender of the person who will be assisting him/her with personal care (a maleCarer may not be available on every shift)

There is information regarding the procedure for making a complaint and this includes a timescaleand 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 obtainedfrom the information display board in reception Information for contacting the Registration andInspection 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 isprovided for obtaining a copy of the inspection report if a resident or a visitor to the home would likeaccess to a copy to read; a copy is also displayed on the resident’s notice board in reception and isalso 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 areable 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 theyrequired to enable them to make an informed decision for choosing Blanchelande Park The printedinformation provided, enabled these people to ask additional questions to meet their needs and theyare very happy with their final decision and have settled in to the home very well

The contract identifies the room the resident will occupy, care and services provided, financialarrangements; including deposit required, trial period, terms and conditions of occupancy, period ofnotice, 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 inrelation to the General Data Protection Regulation (GDPR) has been included This is due to theintroduction of the new law in May 2018, for the sharing of information with other healthcareprofessionals who are involved with the person’s care and also for the information the home holds inrelation to an individual

The resident and/or their NOK or their representative and the company Administrator sign thecontract, 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 AssessmentPanel (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 assistswith the planning of the person’s care package The certificate is for either nursing care or residentialcare 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 byplacement 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 eachprospective resident prior to a resident moving in to the home, or to add the person’s name to theirwaiting list This is to ensure that the care team are able to meet the person’s individual care needsand the person’s expectations of the home, and/or the expectations of their NOK Also that the carehome has, or can access, any specialist equipment a person may require, prior to admission Aresident or their representative sign a consent form to enable the Care Manager or the nurse incharge 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 isundertaken using the Roper et al model - The Activities of Daily Living Risk assessments areundertaken for nutrition, tissue viability, moving and transferring and for a risk of falls, the use of bedrails (where required) and for mental cognition Additionally, physiological measurements such asblood pressure, pulse, weight and urinalysis are recorded on admission, which provides a baselinereading These measurements are repeated each month (except urinalysis - seen), which providesvaluable information for the GP if a person was to become unwell Blood sugar levels are alsorecorded 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 areasked to complete a profile for the resident titled ‘This is Me’ This enables the team to develop aclearer understanding of the person’s care needs and their likes and dislikes if the person is notalways able to communicate their wishes clearly themselves This can then be used in the future withthese people for reminiscence therapy

Following the assessment a person-centred care plan is developed A copy of a person’s daily caresupport plan is available in the individual person’s room for example - the level of assistance a personrequires with their personal care, level of observation required, or equipment required for movingand handling and for mobility etc When a person moves in to the home it is established with theperson 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 whorequire residential or nursing care and who have varying levels of physical dependency andpsychological 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 advanceddementia who like to wander, as they do not have a locked door policy However, there is a wanderguard system in place to minimise the risk of a person wandering out of the home independently, ifthe person is not safe to do so The person wears a ‘bracelet’, which is linked up to an alarm If theperson walks near to the door an alarm is sounded to alert the staff who can then assist the person byproviding distraction techniques, or by providing supervision for a person to go outside (currently 5people are using this equipment)

A person is cared for in the home for as long as possible, with support from the CommunityPsychiatric Nurse, Social Worker and from the person’s GP If a person is looking to wander awayfrom the home continuously, or there is deterioration in the person’s behaviour, which is affectingother 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 carehome, 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 aperson will need to transfer to a more appropriate facility to support them, this is discussed with theperson’s NOK prior to a final decision being made The care team undertake regular refresher trainingfor dementia care The most recent refresher training was a 2-day course in September 2018, whichwas 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 thisclient 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 informaltraining 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 ofbelonging to an established link nurse system with the specialist nurses from within HSC Thisincludes; tissue viability and wound management, the management of incontinence, infectioncontrol, diabetes and speech and language therapy (for swallowing assessments) Support is alsosought 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 ofOlder People and there is access to the internet for research The Care Manager also invites variousvisiting speakers including the specialist nurses to provide refresher sessions to ensure continued bestpractice 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 ‘lockedin’ to the contract The person and their NOK are encouraged to visit the home before making a finaldecision to take up residency in the home (Administrator provides information for the person to takeaway and read at their own leisure) This enables the person to have a look around and to talk tosome of the residents and staff who already live or work at Blanchelande Park If this were notpossible, the Care Manager visits a person in hospital, at their home, or other place of residence ifnecessary (other care home)

If a person is apprehensive about moving in to the home; the Care Manager suggests a gradualintroduction to the home, for example, visit the home for coffee or to stay for the day, followed byspending a weekend in the home, or to move in to the home for a period of respite while arelative/carer has a holiday etc This is excellent and demonstrates that the management understandthe difficulties and mixed emotions that some people may feel with making adjustments to theirlifestyle and family contact

An emergency admission is accepted in to the home if there is a vacant room at the time of need If aperson transfers into the home as an emergency admission, assessments and care plans aredeveloped as for all long term care residents

All residents who were asked, said that he/she/NOK/ representative had visited the home to have alook around prior to making their final decision All of these residents said that they are satisfied withtheir 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 stillavailable if there is a vacant room at the time of need Specialised services, if not already available inthe 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’slevel of independence and mobility to ensure that as much independence is maintained as theperson’s health and well-being allows, to enable the person to return home The RNs also providetraining, 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 meetthe requirements for data protection, staff have an individual password to log in to the part of theelectronic program that he/she has authority to access GP medical notes are also held securely onthis 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 copiesfor the Carer’s to refer to, which are in each resident’s room, are also kept updated so that theymirror the information, which is held electronically

Risk assessments are undertaken for moving and handling and the risk of falls, nutrition, tissueviability (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 fallsclinic 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 anindividual is also included There is a wander guard system available (if needed) for a person who isnot safe to wander outside of the home independently When the wander guard is required, a riskassessment is undertaken and discussion takes place with the person’s NOK, GP and with the person’sSocial Worker Agreement is made between all parties concerned and is recorded prior to the wanderguard being activated

The Care Manager conducts a regular health and safety walk-through with the Estate Manager tomonitor environmental hazards The outcome is then recorded and is addressed with the relevantdepartment 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 goodpractice

All care plans are generally reviewed monthly or at least within the 3-monthly recommendedtimescale, if no changes are required before this time If a person’s care needs or treatment changesbefore this time, the plan of care is reviewed and is updated immediately (new system flags up whenreviews are due)

Handovers consist of a combination of both written and verbal information as a print out of thecommunication log for all of the residents is used for the handover This is to ensure that importantinformation 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 Eachresident has a key Nurse who is responsible for organising their resident’s care, treatment andappointments etc with the person or their NOK (as relevant) and also for updating their resident’scare plan It is important that the Nurse establishes on admission the level of input a person’s NOKwishes to have (with person’s consent) so that they can be included in regular reviews and updateswith their relative’s key Nurse e.g care plan reviews Each resident also has a key Carer who isresponsible for ensuring that their resident has sufficient clothing and toiletries and liaises with theperson’s NOK to purchase the additional items as needed The key Carers are also involved in theperson’s social care (if appropriate) and are responsible for undertaking the person’s monthlyobservations and for reporting the findings to the person’s key Nurse (NVQ/VQ level 3 qualified Carersundertake) This demonstrates a team approach and enables the Senior Carers to maintain the skillsthat they have learnt as part of the NVQ/VQ training program and it also facilitates continuity ofholistic care The name of the person’s key Nurse and key Carer is displayed in each person’s room soboth 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-relievingequipment is available in the home for a person whose pressure areas are at risk A person’s skinstatus 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 skindamage occurs The RNs also consult with the Tissue Viability Specialist Nurse, or with the CommunityNurses from within HSC, for additional guidance when required There is also a selection of hoists andmoving 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 Theysaid that the staff are kind and friendly and always provide assistance where needed in anencouraging and patient manner

stored securely in a locked treatment room.

Residents, who self medicate, have a locked drawer/cupboard within their room in which to storetheir medication Each person has a risk assessment completed to demonstrate that the person issafe to self-medicate and the person signs the form to acknowledge their responsibility Theseresidents are re-assessed daily as the RNs discuss this when giving out medications A person’s NOKmay also raise a concern with the Care Manager or RN in charge if he/she has concerns that theirrelative is having difficulty with managing their medications The Care Manager or RN in charge thendiscusses their concerns with the resident and/or their NOK (where relevant) and organises to takeover the administration of their medication if necessary This may be just while the person is unwelland is unable to manage their medication at that current time, or on a more permanent basis iffurther problems are evident This is good practice as it demonstrates safe practice; yet promotesindependence and autonomy for the resident

There is an up-to-date British National Formulary (BNF) for the RNs and visiting healthcareprofessionals to refer to as needed The Deputy Chief Pharmacist from within HSC undertook amedication inspection in April 2018 where the medication system was found to be in good order Arecommendation was made for the RNs to undertake formal training for the management of a personreceiving oxygen therapy and this has been completed

All medication including controlled drugs, are stored and are recorded in compliance with regulationsand codes of practice There is a signature list at the front of the medication record files with thesignatures of all of the RNs in the home who administer medication to the residents There is aMedication 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 furthernecessary information, for example if the resident is diabetic There is also a photograph of eachresident 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 undertakenmore 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 whichhave been returned to pharmacy

All residents in the home are offered an annual flu vaccination, which is also discussed in theresident’s handbook Staff are also offered the flu vaccination, which is good practice for infectioncontrol 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 amarried couple or for siblings; currently 2 of these rooms are single occupancy and 1 room is doubleoccupancy 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 canprovide their own telephone if they prefer Some of the residents have installed portable telephonesand others have a personal mobile telephone, or have brought in a laptop/ipad Residents also haveaccess 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 laundryservice; 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 forthe majority of them is by their Christian name or the person’s chosen ‘nickname’ and staff alwaysknock on a person’s bedroom door and wait for a reply before entering (observed during day ofinspection) This demonstrates that staff understand the need to preserve a person’s privacy anddignity, 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 isexpecting 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 ownaffairs

There are policies and procedures for the protection of vulnerable adults, privacy and dignity and forconfidentiality, 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 PalliativeCare Specialist Nurses as required This is to ensure that the person’s changing needs are met forcomfort and pain relief and for nutrition Blanchelande has a syringe driver and the RNs undertakerefresher 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 andsupervision 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 ofthe relatives as much as is possible and offer refreshments, comfort and support The RNs also makeprovision for a relative to stay with their relative if they want to do so (able to use a vacant room ifavailable 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 residentshave 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 isincreased 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 toprovide 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 hasbeen 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 isencouraged to pursue individual hobbies as well as group activities It is particularly important forthose people who choose not to, or who are not able to socialise much during the day, that they areencouraged to pursue some leisure activity The Activity Assistants also record whether a personenjoyed participating or not This then enables the Activity Assistants to plan more suitable activitiesfor individuals The Care Manager has a document titled “This is me”, (a social profile for people withdementia) 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 offsocial event is taking place e.g tea party within the community) This is residents’ choice due to thenumber of visitors at the weekend (confirmed by residents) A copy of the activity program isdelivered to each room to inform residents of the activities for the following week This is so thatprovision 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 theyaim 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 Residentssaid 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 ownactivities She does go down to the communal lounge if there is something in particular going on thatshe enjoys, such as music and singing sessions, or an exercise class Another person said that she isunable 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 residentswho wish to join in There is a weekly bus trip On a Monday morning a shopping trip is offered totown 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 sothe smaller vehicle (Blanche) is used to take out 1-4 people out at a time (if they want to go) Visitsare also encouraged from outside organisations and entertainers e.g dog training group and theHealing Music Trust, which is excellent and promotes the home as a place in the community forsocialising and also helps people to maintain their social networks

There are several outdoor activities for residents to enjoy within the home’s grounds; there ispetanque, pitch and putt, croquet and a bowling green Relatives are also able to use these areas withtheir relative There is a sunken garden behind Treetops and there is a seating area to the front of thehome, 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 awalking 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 theresidents in the home

The home enjoys entertaining the residents and often holds celebratory or themed days e.g Eastercelebrations, Liberation Day etc The music room can also be used if a resident wants to hold a privatecelebration with family and friends When it is a person’s birthday he/she is also able to choose themeal for that day and have one suggestion for an activity they would like to do e.g a visit to CandieGardens or to a garden centre etc

The Activity Assistant said she recently attended a meeting, which was set up for Activity Assistants incare homes She found this very useful to discuss with other Activity Assistants how their activityprogramme worked and to share ideas and information She said this was an excellent supportnetwork, which provided motivation through the introduction of new ideas and she hoped the groupsupport 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 aboutthe garden or tending to the vases of flowers in the communal areas etc Some residents still like tomake their own beds, one person likes to help to collect the cups after morning coffee or afternoontea 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 tocome 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 theCentre for the Blind Several other people go out to lunch frequently with family and friends andsome 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 inthe dining room as a mark of respect to the other residents in the home; unless they are assistingtheir relative with their meal The doors to the home are locked at 20.00 hours; therefore peoplereturning later in the evening are required to ring the doorbell There is a visitor’s book in theentrance 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 theentrance to the home and there are signs to indicate this More recently the button to press to exitthe home has been relocated for additional security for people who are not safe to leave the homeindependently

There is opportunity for residents to receive visitors in their own room, or in any of the communalareas as they wish Relatives and residents are encouraged to make themselves a cup of tea in thedining area if they are safe to do so This is excellent and contributes to normal practice of invitingsomeone into your home and offering them a cup of tea Relatives and friends are also able to makearrangements to have a meal with their friend/relative if they wish (for a small cost) and severalrelatives and friends make use of this service As previously discussed in this report the music roomcan 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 aresident did not wish to see, the RNs would respect this and measures would be put in place toensure 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 Eachresident has access to a secure lockable drawer for personal items such as medication anddocuments, 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 anindividual’s financial affairs; management would provide information for a person to contact anadvocate if this was required People who were spoken to confirmed that they were encouraged andsupported to make their own decisions and choices wherever possible There are no restrictions forgoing out and coming back to the home; although residents said that out of politeness they usuallytell a member of staff where they were going and roughly what time they would be back, as well asusing 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 ifrequested and there are policies and procedures in place for adult protection, the safe keeping ofmoney 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 daywith the main meal at lunchtime Generally the home has a set menu with several choices for eachcourse; however, alternative choices are always offered (confirmed by residents) Cultural andreligious 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 ofthe food and the choices on offer continue to be good Residents said that if they write theirpreference 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 anddislikes He also helps to serve breakfast so that he gets to know residents more thoroughly If aperson requests a visit from the Chef to discuss their dietary requirements at any time when they areliving 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 isalways well presented A member of the staff visits each resident every day to discuss the choices fortheir meal for the following day A copy of each resident’s choice is then kept in the dining room forthe 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 laidcontributes to the ambience, making mealtimes into “an event,” something for the residents to lookforward to during their day The recent re-decoration of the dining room includes ‘hard’ flooring toaid 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