Archived: Blandford Grange Care Home

We met staff employed by the home and others supplied from an agency. Staff told us they experienced good quality handovers of information between day and night staff. We saw that handover information covered social and physical aspects of people's care needs.

We spoke with a person who regularly visits a relative in Blandford Grange. They told us that since December 2011 they had seen evidence of improved communication within the home, and between the home and themselves. They saw the current management team showing a lead to the home and keeping people informed of developments, both individually and through monthly relatives' meetings. They saw it as important that there should be a registered manager as soon as possible, to sustain the improvements they had seen.

A person with swollen feet complained that staff had failed to help them put their feet on a stool, as was directed in their care plan. They knew how to summon staff to ask to correct this, but not all people in the home would be able to do so. A person with a specialised communication need told us staff, including temporary and agency staff, followed care plan guidance on how to communicate with them.

A visiting relative said there had been benefits as a result of staff changes on the top floor. They saw current staff there as experienced and skilful, displaying 'a clear difference in approach'. They considered some of the previous staff to have been too young or inexperienced in working with people with dementia. A person on the first floor told us they were worried about the consequences of staff leaving who they were familiar with. They thought the reliance on agency staff could mean that staff might not understand their needs. They complained that staff only came into their room when they used the call bell, otherwise staff were too busy to look in. An agency nurse told us they saw people waiting for attention, particularly for personal care and assistance to eat meals, because many tasks required two staff members to be available.

When we visited the home on 13 January 2012, all people in the home were accommodated and cared for on the ground and first floors. Each floor was equipped and staffed to meet a similar range of needs. There was a mix of permanent, agency and seconded staff on both floors. Staff were spending time with people, chatting in lounges and accompanying people to walk in the corridors and garden.

We spoke to seven people that live in the home. All of them said staff were available when they needed them, and that call bells were answered quickly. However, people said they could go long periods without seeing much of the staff. Some people would like staff to have more time to spend with them. One person said afternoons seemed long to them. People said that when staff gave assistance to their personal care, they did not feel hurried and staff worked with them in a pleasant way, making conversation. We saw and heard examples of care interactions which supported this view.

A person told us they were 'definitely satisfied' living in the home. They chose to go to different parts of the home during the day. A person who spent most of their time in bed, owing to a medical condition, described receiving staff assistance to changes of position in bed and other personal care needs, when they requested it. They were fully aware of their care plan for managing risk of pressure damage.

A visitor told us that they had raised issues with the home on behalf of their relative, about room cleanliness and aspects of personal care. They were satisfied that their complaints had been taken seriously and addressed. However, they thought they were matters that the management should have been already aware of through monitoring the quality and supervision of staff.

We found that after incidents such as falls, or deterioration in medical conditions, people had experienced delay in being given access to medical assessment and treatment. People's communication needs were not taken account of in assessing how they were. We served a warning notice on the provider in November 2011 because staff had not recognised when a person required medical treatment, and had not responded in a timely way to meet their needs.

We found that the service had carried out investigations of the actions of some nursing staff in relation to poor care decisions identified through safeguarding investigations. Some staff had been subject of disciplinary measures. The provider showed us that registered nurses were receiving at least monthly clinical supervision, which included ways of monitoring their competence to practice. We also saw evidence of training being arranged for all staff in safeguarding, dementia awareness, communication skills and customer care.

Care records showed that there was now prompt contact with GP surgeries, including making arrangements for doctors' visits. A monitoring record had been set up for a person who had fallen and there was a pain assessment form. There was a protocol for registered nurses to follow if there was any possibility that a person had sustained a head injury. Registered nursing staff were confident about how they were to respond to suspected or actual injuries, and how to document what they observed and decisions they made.

We spoke with people's visitors, both during our visit and by telephone later. They described staff and management as kind and approachable. There was agreement that the home provided a homely and attractive environment. However, people were disappointed that an absence of garden furniture limited opportunities to enjoy the outside spaces.

We joined a group of five people with an activities worker. They had tea and biscuits together and talked about experiences and places that were important to them. They told us they enjoyed this type of activity. During the day we saw the activities worker in different parts of the home, assisting different types of activity, including games and use of music. We also saw that a person was taken out of the home for shopping and a cup of coffee in the town.

We saw that some people in shared lounges appeared bored, with no evident sources of stimulation nearby. Three visitors that we spoke to told us they saw their relatives as under-stimulated, both in terms of exercise and social interaction. Two visitors discovered their relatives were wearing other people's glasses and said this was a common problem in the home. Some visitors considered there were not enough staff to be aware of needs arising in the communal rooms.