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Inspection on 03/03/10 for Allington Court

Also see our care home review for Allington Court for more information

This is the latest available inspection report for this service, carried out on 3rd March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff we spoke with praised the new manager and said they found her approachable and thorough in dealing with any issues which arose. The staff said that standards were continuing to improve at the home. We spoke with the manager and the new deputy and found that they had already identified the issues of concern we noted during the visit and had planned a variety of actions to respond to these issues. The two managers clearly work as a team and have also restructured the whole staff team in order to ensure all members of staff receive adequate support and supervision. The home now has senior and junior nurses in place as well as senior care workers. A new domestic worker had been appointed so that hygiene standards can be maintained in the home and there are now three activity co-ordinators working in the home. We spoke with one co-ordinator and saw the wide range of activities they have planned which cover each day of the week. The home also has very large wipe clean boards which clearly set out the activities offered for that week. A wide range of equipment has been provided for the benefit of the residents so that appropriate activities can take place and so that residents can receive appropriate stimulation. Some changes have also been made to the environment and there are more pictures on the walls of communal areas and memory boxes have been positioned outside bedrooms to enable residents to find their own rooms and remain as independent as possible. The television in one lounge has also been repositioned so that more residents are able to see and hear the programmes they are interested in. We checked the complaints records and saw that the only complaint recorded since the last inspection had been appropriately and thoroughly dealt with.

What the care home could do better:

We checked the records of participation at activities for the previous week and saw that there were regularly only five or six people taking part in the organised events. This means that most of the residents remain in the communal lounges, or their bedrooms, and as there are usually only two co-ordinators on duty at any one time, care staff shouldinevitably be involved with providing stimulation for the remaining residents. The activity co-ordinator has discussed residents` preferences and choices with their relatives and has produced individual files so that staff can be aware of the things people enjoy and might want to take part in. There is a lot of equipment around for staff to use with residents but we were told that, as yet, care staff are not using this equipment or engaging with residents in a meaningful way. We saw care workers and some nurses walk through lounges where residents were sitting and make no eye contact or acknowledge the people there. Two visitors told us that their residents are sometimes left alone in lounges for long periods and we saw residents left alone in lounges during the inspection. The manager is aware of these issues and has planned a rolling training programme for staff to address these working practices. We tracked a selection of care plans and found that although most appropriate information was recorded, the plans were quite confusing and information took some time to find. However, we saw evidence that the manager has already started to edit the planning and said she will be introducing a new format for care planning. Some reviews of care needs however had not been kept up to date and the planning for people with additional mental health and learning difficulty needs also required more detail to ensure staff are aware of how to meet individual needs. Some records showing people`s weight loss did not show how this concern was being monitored in practice. At the previous inspection the manager at that time had introduced care plan summaries or "information sheets" detailing the daily needs of each resident. These sheets are positioned behind bedroom doors so that all staff are aware of individual care needs. However one member of staff said they were not aware of this information and we saw that one resident was brought to the lounge by a care worker without their glasses and zimmer frame despite this equipment being noted as essential on the information sheet. The manager has introduced a new staffing structure in order to address the staff care practice and two of the nurses and a senior care worker were attending a care planning course on the afternoon of the inspection. The manager said that they would then begin to cascade this training to staff through the home. Two of the visitors we spoke with also commented that they often find their relatives still in bed at 11am, despite being ready to get up. The visitors felt that staff were not assisting these people to get up when the wanted, and as they were going to bed quite early, they were going for long periods without food or drink. The manager said this concern would be addressed. Current guidelines for elderly people are clear that people should not go for longer than 12 hours without food and drink for the benefit of their health. Currently there are areas of the home is in need of some redecoration and refurbishment. The chairs in communal lounges are generally very worn and some have torn covers. These need replacing soon and the manager said this upgrade was due to happen soon. The sink in the laundry is old and broken and has not yet been replaced but the manager said this was due to happen the following week. The home has no treatment room and the clinical room is in urgent need of refurbishment to ensure that staff can continue to provide appropriate care services in a safe and hygienic environment. As already noted, the issues of concern raised at this inspection, have already been identified by the manager and are currently being addressed. The area manager alsomakes regular visits to the home and is involved with the changes being made.

Random inspection report Care homes for older people Name: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN two star good service 01/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Patricia House Date: 0 3 0 3 2 0 1 0 Information about the care home Name of care home: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN 01923894542 01923894544 sylvestj@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (BNH) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 44 Number of places (if applicable): Under 65 Over 65 44 dementia Conditions of registration: Date of last inspection Brief description of the care home 10 0 1 1 0 2 0 0 9 Allington Court is registered to provide accommodation and nursing care to 44 older people with dementia, 10 of whom may be below 65 years of age. It is owned and operated by BUPA Care Homes Limited and is situated in extensive grounds, adjacent to another BUPA care home, in a semi-rural location in the village of Bricket Wood, within easy access of the M25 and M1 motorways. There is ample parking space provided at the front of the building. The home was purpose built for this service user group and is in the form of a hexagon with two internal courtyards, which, together with the attractive and secure grounds Care Homes for Older People Page 2 of 9 Brief description of the care home provide ample additional communal space where service users can walk and exercise, or simply sit and enjoy the gardens and views. All service users are accommodated in single rooms and there are four lounges, an activity room and dining room. There is an information folder/Service Users Guide in the reception area of the home, which includes contact details of the Care Quality Commission, (CQC), and information about charges for the home. The last CQC inspection report and the homes Statement of Purpose are displayed in the homes reception area and copies are also available on request. Current weekly fees start at £995 and are calculated according to need. Additional charges apply for hairdressing, personal toiletries and newspapers and for any chiropody, dentistry and optician services where these are subject to charge. Care Homes for Older People Page 3 of 9 What we found: This random inspection took place on 3rd March 2010 with Patricia House and Sheila Knopp, Regulation Inspectors, in order to assess the progress made in implementing the requirements made in the report of the last inspection visit. A new manager and deputy manager have also been appointed since the last inspection.The inspection took place on one day and the inspectors spoke with staff, visitors and residents, where they were able to make a response. One new domestic worker has been appointed since the last inspection visit but currently the home has vacancies for five full-time equivalent registered nurses. The manager said that despite this shortage, only appropriate candidates would be appointed and that, in the meantime, only agency nurses who have worked at the home previously, would be used. This is so that the residents receive care from staff who know them and know the procedures in the home and can provide continuity of care. What the care home does well: What they could do better: We checked the records of participation at activities for the previous week and saw that there were regularly only five or six people taking part in the organised events. This means that most of the residents remain in the communal lounges, or their bedrooms, and as there are usually only two co-ordinators on duty at any one time, care staff should Care Homes for Older People Page 4 of 9 inevitably be involved with providing stimulation for the remaining residents. The activity co-ordinator has discussed residents preferences and choices with their relatives and has produced individual files so that staff can be aware of the things people enjoy and might want to take part in. There is a lot of equipment around for staff to use with residents but we were told that, as yet, care staff are not using this equipment or engaging with residents in a meaningful way. We saw care workers and some nurses walk through lounges where residents were sitting and make no eye contact or acknowledge the people there. Two visitors told us that their residents are sometimes left alone in lounges for long periods and we saw residents left alone in lounges during the inspection. The manager is aware of these issues and has planned a rolling training programme for staff to address these working practices. We tracked a selection of care plans and found that although most appropriate information was recorded, the plans were quite confusing and information took some time to find. However, we saw evidence that the manager has already started to edit the planning and said she will be introducing a new format for care planning. Some reviews of care needs however had not been kept up to date and the planning for people with additional mental health and learning difficulty needs also required more detail to ensure staff are aware of how to meet individual needs. Some records showing peoples weight loss did not show how this concern was being monitored in practice. At the previous inspection the manager at that time had introduced care plan summaries or information sheets detailing the daily needs of each resident. These sheets are positioned behind bedroom doors so that all staff are aware of individual care needs. However one member of staff said they were not aware of this information and we saw that one resident was brought to the lounge by a care worker without their glasses and zimmer frame despite this equipment being noted as essential on the information sheet. The manager has introduced a new staffing structure in order to address the staff care practice and two of the nurses and a senior care worker were attending a care planning course on the afternoon of the inspection. The manager said that they would then begin to cascade this training to staff through the home. Two of the visitors we spoke with also commented that they often find their relatives still in bed at 11am, despite being ready to get up. The visitors felt that staff were not assisting these people to get up when the wanted, and as they were going to bed quite early, they were going for long periods without food or drink. The manager said this concern would be addressed. Current guidelines for elderly people are clear that people should not go for longer than 12 hours without food and drink for the benefit of their health. Currently there are areas of the home is in need of some redecoration and refurbishment. The chairs in communal lounges are generally very worn and some have torn covers. These need replacing soon and the manager said this upgrade was due to happen soon. The sink in the laundry is old and broken and has not yet been replaced but the manager said this was due to happen the following week. The home has no treatment room and the clinical room is in urgent need of refurbishment to ensure that staff can continue to provide appropriate care services in a safe and hygienic environment. As already noted, the issues of concern raised at this inspection, have already been identified by the manager and are currently being addressed. The area manager also Care Homes for Older People Page 5 of 9 makes regular visits to the home and is involved with the changes being made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 A suitable range of activities and stimulation must be provided for all residents in the home on a daily basis. This requirement has been partially met. A new due date has been made. This requirement has been carried forward as continues to be addressed. An new due date has been made. This is to ensure that adequate stimulation is provided so that all residents are able to enjoy their lives as fully as possible. 01/05/2010 Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The clinical room in the home 01/05/2010 must be refurbished. This is to ensure that staff at the home can provide care and nursing services to residents in a safe and hygienic environment. 2 33 26 Regulation 26 reports must be sent to the Commission. This is to assess the progress being made to address the issues of concern in the home. 01/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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