Inspection on 29/07/08 for Alfreton Residential Home

This is the latest available inspection report for this service, carried out on 29th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alfreton Residential Home 13/03/06

Alfreton Residential Home 07/06/05

Alfreton Residential Home 17/01/05

Alfreton Residential Home 02/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Alfreton Residential Home 6 Reservoir Road Prenton Birkenhead Wirral CH42 8LJ Lead Inspector Peter Cresswell Key Unannounced Inspection 29 July 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alfreton Residential Home Address 6 Reservoir Road Prenton Birkenhead Wirral CH42 8LJ 0151 608 6863 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.weatherstoneshouse.co.uk Weatherstones House Care Limited Sandra Elizabeth Phillips Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Alfreton is a detached three-storey house with a large and attractive back garden. The home is in a quiet and leafy residential area of Birkenhead just off a main road and within a mile of local shops. There is a five minute drive to the Mersey Tunnel. Alfreton is part of a family owned business that operates a small group of care homes and a domiciliary care agency. The home has a registered manager and the owners and their family play an active part in the week to week running of Alfreton, which was their first care home. Alfreton is registered to accommodate 16 elderly persons who are accommodated in three shared and ten single bedrooms, four of which have en suite toilets. Two of the rooms were shared when we made the site visit for this inspection. People who make Alfreton their home have the use of a TV lounge, dining room, a ‘music’/quiet lounge and a conservatory that overlooks the back garden. There is no separate visitors room, but the range of communal spaces means that residents can see visitors in private if they want to, even if they share a room. The home has a spa bath, an assisted Apollo bath and a shower room. All floors can be reached by a passenger lift. Fees range from £375 to £421 a week. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit. The manager was on leave so the senior care assistant was in charge and dealt with our visit. We also spoke to a number of staff, several residents, a visiting relative and a member of the owners’ family. We toured the home, visiting about half of the bedrooms, and examined care plans, medication, fire safety records, training records, recruitment files and the menu. Some of our survey forms were distributed to residents before the visit and six were returned to us. The owner had completed a CSCI Annual Quality Assurance Assessment (AQAA) before the site visit. What the service does well: What has improved since the last inspection? What they could do better: Staffing needs to be reviewed to ensure that care cover is not reduced when there is no cook on duty. A training matrix would help to make sure that all training is up to date. People should only share a bedroom if they have made a positive choice to do so. Extra attention needs to be paid to the recording of medication that is not included in the monitored dosage system. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home’s pre-admission assessment procedures ensure that residents are appropriately placed and therefore receive care that meets their needs. EVIDENCE: People are assessed by the manager before being admitted and the assessments for those most recently admitted were on file. Assessments from external professionals such as social workers are also obtained as part of the admission process. In a survey form one resident said ‘I was given the opportunity to come in for the afternoon and have coffee with the other clients and give myself a chance to look around.’ Alfreton does not provide intermediate care so Standard 6 does not apply. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Care planning is good and the manager’s regular informal reviews ensure that staff are aware of residents’ current needs. The system for organising medication is generally sound, protecting the welfare of the residents, though some changes need to be made to make sure all medicines are given as prescribed. EVIDENCE: Detailed care plans set out how people’s needs are to be met. The plans are based on recorded assessments made by the manager and care staff, including an ‘Activities of daily living’ assessment and a pressure sore prevention template. There is a form to record clothing and possessions brought into the home but these were not completed in all of the cases we looked at – this was possibly significant as one resident could not find all of the things she assumed had been brought in. Each element of the care plan is regularly reviewed by the manager or the senior care assistant, though not much detail is recorded either in the reviews or the daily reports. The daily reports are made on loose Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 10 leaf sheets which can be transferred to individual files. Staff also use a hard backed ‘daily report book’ which is in effect a handover or staff communications book. Some of the entries refer to confidential matters such as toileting of named individuals and are therefore inappropriate. This sort of information must be recorded on the individual sheets for each resident. People who live at Alfreton have access to the full range of community and, if necessary, specialist health care services and this is recorded on the files. Alfreton uses a monitored dosage system for medication, with most medication delivered by the dispensing pharmacist in blister packs. Medication that needs to be refrigerated is kept in a dedicated fridge which is not lockable but is kept in a secure environment. Its temperature is checked and recorded daily. Medication is generally well organised and accurately recorded. However, the records for medication not included in the monitored dosage system were not comprehensive and in one of the cases we examined it was not possible to say if the correct number of tablets had been administered. The manager should introduce a system for recording the amount of medication received and when it starts to be used. If medication is to be taken ‘as required’ (PRN) there should be a written protocol or guidance for staff, setting out the circumstances in which it is to be used. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home arranges a wide range of activities to enhance the lives of its residents. The menu provides choices and meets the dietary needs of the residents. EVIDENCE: There is a full programme of activities for the people who live at Alfreton. A part time activities organiser has been appointed and works twelve hours a week. A timetable is on display for each month and lists at least one activity of some sort every day. These include bingo, chair exercises, board games, music activities, cooking, gardening and some trips out. The most recent trip had been on a canal boat. One resident told us in a survey form that she loved ‘singing, dancing and playing cards’. Another said ‘I like the social evenings as my family all come and make it a good get-together’. However, during the inspection some people did tell us that they were often bored. There is always scope to introduce extra activities and tailor them to the interests of residents as recorded in their care plans. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 12 There is an individual record of all of the activity that each resident has joined in, which provides a lot of information for the planning of successful activities in the future. This file also includes a pen picture for each resident – in one case it refers to the fact that the person in question ‘loves theatre, ballet and drama’. There were photographs on display of some of the social events and a garden party was being planned for late August. A ‘Dignity in Care’ grant has been used to buy a ‘multi sensory machine’ that plays soothing music and a light display. The owner has also bought a computer which residents use to contact relatives and friends using a webcam. Care staff help residents to use the computer and the senior carer said that residents have enjoyed using both of these facilities. The main meal is served at lunchtime but whilst the evening meal (‘supper’) is lighter it includes substantial cooked options. The cook and the manager put a great deal of emphasis on using fresh ingredients. Most of the residents who spoke to us said that they enjoyed their meals and one said that although she was a ‘fussy eater’ the cook was always happy to prepare something that she liked. Of the survey forms returned four people said that they always liked the meals, whilst the other two said they ‘usually’ liked them. Nobody expressed any negative views. The cook is very experienced and works three hours a day, four days a week, with the other meals prepared by the manager or other staff. This has staffing implications which are dealt with elsewhere in the report. Salads and sandwiches are always available as options and other choices are available at each mealtime. Tea and cakes are served in mid afternoon. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Procedures for complaints and safeguarding are in place, providing protection for residents. EVIDENCE: The home has appropriate policies in respect of complaints and the safeguarding of the people who live there. One complaint has been received since the last inspection and that was resolved satisfactorily. All staff have recently attended training on Safeguarding Adults, run by Wirral Borough Council. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Residents enjoy a comfortable and clean environment though not all people sharing a room have made a positive decision to do so. EVIDENCE: Alfreton was clean, well maintained and free of offensive odours when we visited. One or two minor cosmetic repairs were needed, such as some cracks in the plaster of the upstairs corridors and some small holes in the first floor bathroom. These matters are dealt with by the handyman who works one day a week. We inspected a sample of the bedrooms and they were well furnished and personalised. Two bedrooms are shared at the moment. One resident had been moved downstairs to a shared room. Apparently neither she nor her family had raised an objection to this but there was no evidence that she had Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 15 made a ‘positive decision’ to share, as described in the National Minimum Standards. The home has a main TV lounge, a ‘quiet’ room (known as the ‘music room’) and a conservatory that overlooks the garden. The conservatory is used more in warmer weather and was the main focus of activity when we visited on a warm day. There are still two large chest freezers in the conservatory which does not contribute to a homely atmosphere, in contrast to the rest of the home. In defence of this arrangement the owner has pointed out that there is a range of other communal spaces for people to use. Some repainting is needed to the outside and this will be addressed in the cyclical maintenance programme. Over the past two years new carpets have been bought for most of the communal areas and several bedrooms. The garden is large and well maintained. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Sufficient staff are generally employed to meet the needs of the residents but care staff levels need to be maintained when the cook is not on duty. The home’s recruitment procedures protect the residents against the employment of unsuitable people. EVIDENCE: Ten care staff have NVQ2 in care or above and four others are working towards their NVQ2 so Alfreton has achieved the standard of 50 of care staff with at least NVQ2. Staff have recently attended training on safeguarding adults, medication handling and moving and handling. Staff are also due to attend further training on Safeguarding Adults and Equality and Diversity. It was difficult to verify exactly what training had been provided as no central record or matrix was maintained. The manager might find it useful to complete a training matrix so that it is immediately apparent what training has been received and what is due. Two new members of staff have been taken on this year and all of the relevant checks had been carried out. They had completed appropriate induction training and this was recorded. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 17 As reported in an earlier section, the home employs a cook for three hours a day on four days a week and at other times the care staff or the manager do the cooking. This is not the best or most appropriate use of the manager’s skills and time. When the cook is not working extra staff need to be deployed to make sure that staffing levels are maintained. The rota provides for at least two carers to be on duty at all times. At night there is one waking member of staff and one sleeping in. There are no dedicated cleaning staff and all cleaning is done by care staff which underlines the need to maintain staffing levels. In the Annual Quality Assurance Assessment (AQAA) the owner states that ‘the staff work as a team so that all can be “support workers” and there is little “That’s not my job” ’. All of the residents who responded to our survey felt that there were always enough staff available to care for them. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is efficiently managed and staff morale is good, helping to promote a homely and welcoming atmosphere. EVIDENCE: The manager has many years of experience at Alfreton and has achieved her Registered Managers’ Award. Staff are enthusiastic and several have worked for the company for some years. The home has the Investors in People Award, which requires it to maintain a quality assurance system. The award is due to be reviewed in 2009. Alfreton’s internal QA includes written questionnaires to residents but there was no evidence of this being done recently. The owners and their family visit the home frequently and are closely involved in the home’s management; one of them came to see us during the site visit. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 19 Fire safety records were up to date. Accidents are reported appropriately to the Commission for Social Care Inspection and recorded in accordance with the Data Protection Act. Staff receive one to one supervision six times a year and the manager keeps a record of this though the records were not inspected on this occasion. The manager looks after the personal allowances of several of the residents and keeps small amounts of money for them. A record is kept of what is spent and receipts are kept. The owner may wish to review the question of one resident’s savings, as discussed with the senior care assistant. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Accurate records must be kept of any medication that is not provided in the monitored dosage system, including stocks received and administered. This is to make sure that people have been given this medication as prescribed and that all medication can be accounted for. Timescale for action 01/09/08 Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP10 OP23 OP27 Good Practice Recommendations Where medication is to be administered ‘as required’ (PRN) details should be on file as to the circumstances in which the medication is to be used. Daily reports containing confidential or sensitive information should be made on the individual’s file, not in a communications book. Residents should only share a bedroom if they have made a positive choice to do so. The staffing rota should be reviewed to ensure that appropriate levels are maintained when there is no cook on duty. Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Region Unit 1, Level 3 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alfreton Residential Home DS0000018857.V369165.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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