Blair Park Residential Care Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Staff generally showed kindness towards people, however we observed some un-dignified and poor practices from staff whilst people were eating their lunch which did not demonstrate and caring and respectful approach towards people. We also heard staff speaking to people in a manner that was not always appropriate and we saw people being hugged and kissed without considering whether they had the capacity to consent to this. We raised these observations with the registered manager at the time of our assessment visit and following our inspection, the registered manager took action to address some of these concerns.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards. People told us, “I’m as happy as I can be here, other than being at home”, “I’ve been to a few and this is a good place. Very good staff here and they are all very nice. I like the activity lady. She takes me into town to do my shopping.” A relative told said, “It’s fantastic. The staff are wonderful” and, “All the staff are very friendly.”

Staff said they showed kindness by listening to people. They gave us example of how they would do this. However, whilst staff described some examples of kindness and compassion, the registered manager had not ensured staff understood that some of their interactions did not uphold people's dignity. The registered manager had not always ensured a culture of respect, and how this may impact on people.

We saw and heard staff generally being kind to people. One staff member accompanied a person back to their room and as they walked the staff member chatted to the person and then sat with them for a while in their room. However, we also witnessed some undignified practices by staff. For example, we saw people being interrupted during their lunch to take their medicines or have topical cream applied (medicine in cream format). Much of the interaction between staff and people was task orientated. Following our inspection, the registered manager sent us evidence that the lunchtime medicines routine had been changed so the application of creams, etc., could be done in a more dignified way and not whilst someone was eating their meal. We carried out a short observational framework for inspection (SOFI). This is used to directly observe and report on the quality of care experienced by people who may not be able to describe this themselves. We found during the morning that interactions between staff and the people we observed were neutral and although there was a lot of activity in the communal room some people were disengaged with what was going on.’

While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards. A relative told us, “She is treated with dignity, even the agency staff are very good. They are respectful of her. She now has small portions for her meals which suits her much better.”

The registered manager told us they considered people’s different needs. They said, “We ensure care plans include religious needs and all staff have equality and diversity training, so they have an understanding of each other’s cultures.” Despite these comments, the registered manager had not identified that staff were not always treating a person as an individual through their interactions as often these were task orientated and not centred around the person. A professional told us they often saw people who needed to sit on a pressure cushion not doing so and that was because people had moved, but staff had not considered the person's particular needs and as such had not ensured they had their cushion with them.

People were not always treated as individuals as we saw at lunch time, staff walk past people and calling out their names to let the chef know how much of their lunch they had eaten. This was done in front of other people eating. This meant people may feel overlooked, ignored or not being given an opportunity to speak for themselves. Following our inspection, the registered manager told us they had changed the lunchtime regime and people were served their lunch from a trolley, rather than being given plated-up meals. Staff then completed a form with details on how much each person had consumed of their meal without having to consult with other staff. Although staff acknowledged people from time to time when they were in the lounge, they did not always take the time to sit and have a meaningful conversation with them. We raised our observations with the registered manager on the day.

People’s care plans contained information specific to them. For example, what type of diet they required, if there were any foods they disliked and how they liked to spend their time. This information helped staff get to know people. The information was generally detailed and people were involved in providing the information during their pre-assessment meeting and when their care plan was first being developed. This helped ensure that they could include information that was important to them or information that they specifically wanted staff to know about them.

While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards. People were able to choose what they wished to eat from a menu that staff shared with people. To aid understand, staff had pictorial prompts to show people. One person felt they were supported with their independence. They told us, “I am independent in here. I make the bed and make sure my room is all tidied up.” Relatives felt people could make their own choices. A relative told us, “If she (family member) decides she wants to get out of bed at four o’clock, staff will wash and dress her and allow her to do that. She can choose when she wants to get up too.”

Staff said they encouraged people with their independence. A staff member said, “I have just taken round the menu for tomorrow and people can choose what they want.” A second staff member told us, “[Person’s name] will say ‘can you help me wash my face’. I say, ‘you can do it, do it for me today’. I encourage people to do what they can.” Despite this, staff and leaders lacked understanding about how their actions sometimes meant that people did not have choices or control over what they experienced. This was particularly evident where staff kissed and hugged people without considering whether this was something they were happy with.

During the day there were activities taking place and we heard staff ask people if they wished to participate. Staff respected people’s decision when they declined to take part. There was information in people’s care plans around what they could do for themselves. Such as one person who was described as liking to eat independently with a teaspoon if staff held their plate or bowl. We saw this happen at lunchtime. We did, however see some staff kissing people on their face, but it was not always clear that these people had capacity to consent to being kissed. We also heard staff using elderspeak (a form of endearment in an overly dramatic or condescending manner) such as calling people, ‘honey’ or ‘sweetie’. We heard one staff member, as they supported a person to sit, tell the person “[Person’s name] is a good girl. You are always a good girl. Well done.”

People had information in their care plan outlining what people could do for themselves. For example, if they could wash some parts of their body, or brush their teeth independently. Although this was available for staff, there was no evidence that people had had any input into their care plan and as such included information about what they would like to do for themselves. We saw in the large lounge/communal area that all seats were next to each other, set against the outside wall and facing in. This did not give people the choice of being able to have a table between them and the next person or to be able to sit in a group with friends or visitors. People also had no choice in the noise in the area. Those sitting in seats in the middle of the room had loud music playing on one side of them and a television and the activities taking place at the other. This meant there was a chance of over stimulation for people. One staff member said, "It can be very loud in here at times. We’ll calm it down as it does have an effect on people."

While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards. People told us that on the whole staff responded quickly to their calls. One person told us, “Generally I don’t have to wait too long, but it depends whether they are busy or not.” Another person told us, "I would like to get up earlier, but you have to wait your turn."

Staff were able to explain how they adapted to people’s changing needs. A staff member told us, “{Person’s name} care plan has just changed. She used to be able to support herself to the toilet but now we have to use the hoist. So the care plan has been changed.” Although care plans and the way people were cared for changed, staff were not always alert to people's needs. We observed this when we carried out our Short Observational Framework for Inspection (SOFI).

Our observations varied in relation to meeting people’s needs. Throughout the assessment visit we saw staff attending to people. They provided drinks, support and encouragement. However, there were occasions when staff were busy with tasks and did not always respond to people. For example, during our SOFI, we saw one person on several occasions attempt to engage with staff, but they were paid no attention and staff walked past. One person wished to go the toilet. After being ignored by the first staff member they alerted a second staff member. However, instead of this member of staff supporting the person, they held up their hand to them and said, "Two seconds" and walked away. Staff engaged with people when something needed doing, for example to give them their medicines, their meal a drink. Despite this, we rarely saw staff spend time sitting next to a person in spontaneous conversation. Some people sat all day in the same seats with limited interaction from anyone. However, we did see other people being responded to by staff.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.