Blind Veterans UK

Updated 17 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the home, and to provide a rating for the home under the Care Act 2014.

The first day of inspection took place on 13 November 2017 and was unannounced. The inspection team consisted of two inspectors and two experts-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this case the experts-by-experience had experience of older peoples’ services as well as experience of services for people with physical disabilities. The second day of inspection took place on 14 November 2017 and was announced. The inspection team consisted of two inspectors and an expert-by-experience.

The home was last inspected on 6 October 2015 and received a rating of ‘Good’. Prior to this inspection we looked at information we held, as well as feedback we had received about the home. We also looked at notifications that the provider had submitted. A notification is information about important events which the provider is required to tell us about by law. Prior to the inspection we asked the provider to complete a Provider Information Return (PIR), this is a form that asks the provider to give some key information about the home, what the home does well and any improvements they plan to make. We used all of this information to decide which areas to focus on during our inspection.

During our inspection we spoke with 14 people, one relative, two visiting healthcare professionals, six members of staff and four members of the management team, one of whom was going to apply to become registered manager. Prior to the inspection we contacted two external healthcare professionals for their feedback. We reviewed a range of records about peoples’ care and how the service was managed. These included the individual care records for eight people, medicine administration records (MAR), four staff records, quality assurance audits, incident reports and records relating to the management of the home. We observed care and support in the communal lounges and in peoples’ own bedrooms. We also spent time observing the lunchtime experience people had, the administration of medicines and various activities that were taking place throughout the two days of inspection.

Updated 17 March 2018

The inspection took place on 13 and 14 November 2017. The first day of the inspection was unannounced, however the second day of the inspection was announced and the management team, staff and people knew to expect us.

Blind Veterans UK is a charity that was founded in 1915 to support men and women who have served in the armed forces or who have completed National service. It provides practical and emotional support to enable people who have impaired vision or who have lost their sight in battle or through accident, illness or older age, to lead enriched and fulfilling lives. The provider is forward-thinking and their aims and vision are that no person who has served on behalf of the Country should face blindness alone. There are two centres that provide residential and respite care, as well as day facilities and holidays. Blind Veterans UK – Brighton is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates 77 people across three different floors, each of which have separate adapted facilities. One of the floors specialises in providing nursing care. On the days of our inspection there were 36 people at the home who were in receipt of the regulated activity of personal care. All people had a sensory loss. In addition, some people had other conditions such as physical disabilities, diabetes, multiple sclerosis and Parkinson’s disease.

There was a large management structure within the home. The management team had recently been restructured to aid efficiency and consisted of a centre manager, a care manager, facilities manager, operations manager, rehabilitation services manager and a residential manager. This management team ensured that the service that was delivered met people's needs. The home did not have a registered manager. A registered manager is a ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run. The previous registered manager had left three months prior to the inspection. The provider had been proactive in the recruitment of a new manager and one had been recruited and was in the process of applying to become registered manager.

People were asked their consent before being supported. Staff had an understanding of the legislation and guidance that related to assessing people's capacity and making decisions in people's best interests. However, this had not always been implemented in practice. There was a lack of documentation to demonstrate that people, who had conditions that might affect their capacity, had their capacity assessed and that relevant people had been involved in the decision making process. At the end of the inspection, when our findings were fed back to the management team, they took immediate action to ensure that the relevant assessments and documentation were in place. However, this needs to be further embedded in practice.

Without exception, people, a relative and healthcare professionals told us that staff were consistently kind, caring and compassionate and our observations confirmed this. Comments from people were overwhelmingly positive. They included, “I’ve never felt so well looked after, everyone is so kind and helpful. Nothing is ever any trouble”, “Oh nothing is too much trouble for them, they like to know you’re happy and comfortable”, “You only have to hear the tone of their voice and you can tell they really care about you” and “The care is exemplary, you really feel it here”. Further comments included, “It’s a magnificent place”, “The care, efficiency and service is really out of this world” and “This is the best place in the country”. A visiting health care professional echoed these positive comments, they told us, “In my experience this place is the gold standard. I’d come here”.

The provider ensured that they went the ‘extra mile’ to provide adapted communication to enable people to continue to live independent lives. Staff were made aware of the impact a sensory loss could have on a person’s life. Training, that was updated annually, enabled staff to experience first-hand what a sensory loss could mean for a person. They were provided with blindfolds and different adapted glasses which reflected certain eye disorders and were supported to navigate the home, sometimes being assisted to use a wheelchair in addition. Staff told us that it gave them a firm understanding of the potential difficulties people could experience with day-to-day tasks. One member of staff told us, “The sighted-guiding training is brilliant. You learn about different sight disorders and experience them by using adapted glasses, and get pushed in a wheelchair and have to take a meal while blindfolded. It gets repeated annually and all the staff have shared in that experience”.

People told us how much they liked the staff and how the home created a caring environment where they felt content and comfortable. A memorial event had recently taken place for people, their relatives and staff as well as serving members of the military forces, to commemorate and remember Armistice day and the lives of people who had been lost in Wars. People and staff told us how comforting the service was and that people had been supported to lay wreaths at the on-site memorial within the grounds of the home. One person told us, “We had a wonderful memorial service out there yesterday”.

The provider had a clear set of values that encompassed a person-centred approach, ensuring that people were involved in their care and treated with compassion, dignity, equality and respect. These values were embedded in the culture and the practices of staff. Staff told us that they were proud to work at the home, enjoyed the support that they provided and worked as a team and this was observed in practice. The provider and management team had good quality assurance processes and audits that monitored the practices of staff and the effectiveness of the systems and processes at the home. Action plans were implemented as a result of audits to ensure that any improvements noted were planned for and completed. The provider, management team and staff, worked with external agencies and professionals and continually reflected on their practice and learned from incidents and occurrences to ensure that the service continually improved.

People received a service that was responsive and centred around their needs. The provider employed and funded access to various healthcare practitioners and people had access to annual appointments with ophthalmic consultants to maintain their physical and eye health. Staff were well-trained and had completed training that the provider deemed essential to staff's roles. In addition, staff also undertook training to ensure that they had an understanding of military life to enable them to understanding people's life experiences and aid interaction.

People had access to an extensive and varied range of activities, events and facilities. The home housed an on-site gym, swimming pool, arts and crafts department, a fully stocked bar and a well maintained and accessible garden. People led purposeful, fulfilled and enriched lives. Comments included, “They help you to learn, l have learnt to paint. To get to 97 years old and still learn new things is lovely”, “There is plenty to do here, if you are bored it is your own fault for not joining in” and “I use the Gym but only the treadmills on medical advice but I get one-to-one staffing so I can do this”.

People were involved in the development and on-going review of care plans and were able to voice their wishes and contribute to a plan of care that was specific to their goals and aspirations. People had been supported to develop and regain skills to enable them to pursue their dreams and interests. One person had been supported to access an external physiotherapist, at the provider's expense, to enable them to develop and regain skills that had been impaired by their health condition. The person told us how much they enjoyed an activity and that they had been supported to undertake exercises and work towards pursing this.

People were involved in decisions that affected their lives at the home. Regular meetings, committees and care plan reviews ensured that people were able to express their wishes and preferences. The provider welcomed feedback and had worked in accordance with their policy when they had received complaints and concerns. The home is large and numerous departments worked together to ensure that people received an effective and coordinated approach to their care. People told us that they enjoyed the food, that they were involved in the development of menus and were provided with choice. People's hydration and nutritional needs were met.

People had timely access to external healthcare professionals when required and received good care at the end of their lives that was in accordance with their expressed wishes. People told us that recently a large number of their friends had passed away due to age and related health conditions, however due to the care that they had witnessed their friends receiving, they were no longer afraid of dying as they knew that they would be comfortable and well-cared for. One person told us, “I am so lucky to be able to spend my end of days in a place like this”.

We previously carried out an unannounced comprehensive inspection on 6 October 2015 and the home received a rating of ‘Good’. At this inspection on 13 and 14 November 2017 the home retained its rating of 'Good'. The home had shown continued improvement and development and had demonstrated outstanding practice in two domains, however, one domain was in need of improvement. This meant that the overall rating