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Inspection on 09/02/09 for Aston House Care Home

Also see our care home review for Aston House Care Home for more information

This is the latest available inspection report for this service, carried out on 9th February 2009.

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.

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

CARE HOMES FOR OLDER PEOPLE Aston House Care Home Angel Lane Hayes Middlesex UB3 2QX Lead Inspector Clare Henderson-Roe Unannounced Inspection 9th February 2009 10:00 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 Aston House Care Home DS0000010924.V373785.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. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston House Care Home Address Angel Lane Hayes Middlesex UB3 2QX 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) 020 8569 1499 020 8569 1488 www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Acting Manager Care Home 48 Category(ies) of Dementia - over 65 years of age (0), Learning registration, with number disability over 65 years of age (0), Mental of places disorder, excluding learning disability or dementia (1) Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To Comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. As agreed on 26th July 2006, one named service user under the age of 65 years, with a mental disorder, can be accommodated. The CSCI must be informed if this service user no longer resides at the home. Date of last inspection Brief Description of the Service: Aston House is a purpose built establishment situated in a residential area of Hayes. It is registered for 48 service users who are accommodated on the ground and first floors of a three-storey building. Thirty-two of the bedrooms are single and 8 are double and most have en suite facilities. There are two communal rooms on both the ground and first floors, with an additional quiet room with snoozelen equipment on the first floor. An activities room has been moved to the ground floor conservatory area. There is an enclosed garden to the rear of the home with garden furniture and room for those in wheelchairs to sit out. The home is easily accessible by public transport and is close to Uxbridge and Hayes town. The current fees paid range from £578 - £813 per week. Aston House Care Home DS0000010924.V373785.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 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection carried out as part of the regulatory process. A total of 19 hours was spent on the inspection process, and was carried out by 2 Inspectors plus an Expert by Experience. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors on each floor were spoken with as part of the inspection process. The Annual Quality Assurance Assessment (AQAA) document completed by the home has also been used to inform this report. We sent out a selection of surveys for residents, staff and healthcare professionals, and the home confirmed that these were distributed. We only received 1 response and the information was fed back to the manager in general terms. The home is being managed by a Project Manager who is to apply for registration and is referred to as ‘the Manager’ in this report. Since the last Key Unannounced Inspection 4 Random Inspections have been carried out. A Statutory Notice was issued for medication management shortfalls and 3 Immediate Requirements in respect of staffing, equipment and staff training shortfalls. 2 of the random inspections were compliance visits and the home was found to have taken appropriate action to address the shortfalls. What the service does well: Prospective residents are fully assessed prior to admission to ensure that the home is appropriate for and able to meet their needs. There is evidence of input from healthcare professionals and where a healthcare issue is identified residents are referred for healthcare input. Representatives spoken with said that they are kept up to date with any changes in their loved ones condition. Staff care for residents in a gentle, professional and respectful manner, and there is a good atmosphere throughout. Information regarding the wishes of residents and their families in respect of end of life care is ascertained and recorded, so that their wishes can be respected. The home has an open visiting policy and visiting is encouraged. Visitors said that they are made welcome and are offered refreshments. The home has information available in respect of advocacy services, thus respecting the residents’ right to independent representation. The home has clear procedures in place for the management of complaints and safeguarding adults, and these are followed, thus protecting residents. The home is being maintained to a good standard, with the exception of lighting and personalising issues with some bedrooms, and overall provides a homely environment for residents to live in. Infection control procedures are in place and are being adhered to. Work has taken place on the Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 6 recruitment of more staff in several areas of the home in order to ensure the home is appropriately staffed at all times. Induction training is in place for new staff and the manager is following up on this to ensure all staff have completed a full induction programme. NVQ training in care is also ongoing, plus training in dementia care and other topics relevant to the diagnoses and needs of the residents, so that staff are provided with the skills and knowledge to care for the residents effectively. The home has clear recruitment procedures and these are followed to safeguard residents. The home has a new manager in post who has the qualifications, experience and approach to manage the home effectively, and staff commented that she is approachable and supportive. The home has a quality assurance system in place that has been appropriately implemented, and has led to improvements being made in several areas of the home. The manager is fully aware of the importance of maintaining these improvements. There are robust procedures in place for the management of residents monies and clear records are kept. Overall health and safety is being well managed at the home, thus protecting residents, staff and visitors. What has improved since the last inspection? What they could do better: Some discrepancies in weight results were noted, and following a re-weighing of the residents involved it was identified that this could have been caused by a change in the weighing scales. Where significant weight changes are noted action must be taken without delay to identify the cause and take appropriate action. Although the food provision at the home is good, residents were not being offered a choice of menu, plus the menu did not accurately reflect the food being provided. These areas need to be addressed. We also recommended that the mealtime routines and timings be reviewed to more effectively meet residents needs and preferences, plus the displayed menu be reviewed to provide one that residents can view and read. The lighting and personalising of the bedrooms needs to be reviewed in line with resident needs and preferences, as in some instances the lighting is dim and rooms are not personalised. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 7 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. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 8 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 Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that prospective residents are fully assessed prior to admission, thus the home ensures they are able to meet each persons needs. EVIDENCE: There have been no new admissions to the home in the past few months. The home has a comprehensive pre-admission assessment document that provides a good picture of the resident and their needs. This is completed for all prospective residents in order to ascertain if the home is able to fully meet their needs. We were informed that the home also obtains a copy of the assessment undertaken by Social Services and/or the Primary Care Trust. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 10 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, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user plan documentation is well completed and provides staff with the information to meet each resident’s needs. Medications are being well managed at the home, thus safeguarding residents. Staff care for residents in a gentle, sympathetic and professional manner, respecting their privacy and dignity and promoting well-being. The home provides good end of life care, thus ensuring that residents and their families have their wishes and needs discussed, recorded and met. EVIDENCE: We sampled service user plans on each floor. Overall these were comprehensive and identified the needs of the resident. Progress had been made to personalise the care plans since the last inspection. There was evidence of input from resident’s representatives. This was also confirmed by relatives spoken with at the inspection. We noted that in some cases the input of the relatives was not always fully recorded, and the Manager said that further work would be done in this area. There was evidence of monthly reviews and updates to the care plan when the needs of the resident had Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 11 changed. Risk assessments for falls were in place and these had been reviewed and updated following a fall. At the time of the inspection there were no wounds at the home. Pressure sore risk assessments had been completed for each resident and where required a skin integrity care plan was also in place. Moving and handling assessments had been completed with details of the equipment and techniques to be used for the individual resident. Continence assessments had been undertaken with details of toileting regimes and continence aids to be used. Nutritional assessments had been completed with evidence of weekly weight monitoring for all residents at the home. Care plans were also in place for nutritional needs with details of specific needs being clearly identified. Where there is significant weight loss referrals are made to the GP and dietician, plus there was evidence of nutritional supplements being prescribed and administered to the residents. We noted some discrepancy in weights, and action was taken at the time of inspection to re-weigh the residents concerned. It was thought that a change in the weighing scales could have caused the problem, however the importance of ensuring any significant changes in weight are checked and the reason for the change identified was discussed. There was evidence of input from healthcare professionals to include GP, dietician, optician, chiropodist and palliative care team. We viewed the medication management on each floor. The home uses the monitored dosage system (MDS) for medication management. A list of staff signatures was available. Liquid medications, eye drops, insulin pens and boxed medication had been dated when opened. Receipts, administration and disposal of medications had been recorded. Where medications had been carried forward from the previous cycle these were clearly recorded. The correct code had been used for medications that had been refused or omitted with a clear explanation on the reverse of the Medication Administration Record (MAR). There was evidence of daily medication audits and stock balance checks at every shift change. Minimum, maximum and actual fridge temperatures plus clinic room temperatures were being recorded daily and were within safe range. Controlled drugs were being appropriately stored and recorded. Stocks were checked for three medications and found to be accurate. Policies and procedures on the administration of medication where available. Where residents required their medication to be crushed the consent of the GP had been sought and clearly recorded. Correct lancing devices were in use for blood glucose monitoring. Medications are being well managed at the home. Staff were observed caring for residents in a calm, professional, caring and gentle manner. Care plans on residents privacy and dignity were viewed. The home has 2 people who are ‘dignity champions’ within the staff team. Residents looked well cared for and there was a calm and homely atmosphere throughout. Residents clothing was appropriately labelled and residents were dressed to reflect individuality. It was also noted that residents’ spectacles are Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 12 discreetly labelled for ease of identification. The chef confirmed that at the present time there are no residents with cultural dietary needs. The Expert by Experience made the following observations: The Staff were welcoming and cheerful and the atmosphere was warm and friendly. The Staff were careful with their charges and dealt with them sensitively, with care, dignity & sympathy. I spoke to two sets of relatives – both were happy with the care delivered. I spoke to five of the residents who were articulate and able to comment that they were happy with their care. Since the last inspection the home has introduced the Gold Standards Framework for end of life care. The wishes of residents and their representatives had been clearly recorded to include resuscitation status. Staff had also received training in end of life care and further training had been planned. We were informed that the Macmillan nurse visits the home weekly to provide support and advice to the care team. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 13 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities provision is good and training is being undertaken to identify individual interests, so to meet individual needs and wishes. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents’ right to independent representation is respected. The food provision in the home is good, offering variety and choice, however more work is to be done to ensure residents personal choice is ascertained and respected. EVIDENCE: Residents were observed taking part in activities throughout the day. Since the last inspection the activities room has been relocated to the ground floor conservatory area. The Expert by Experience spoke with the activities coordinator and viewed the activities records, and made the following observations: The activities co-ordinator has plenty of ideas based on the ‘Yesterday, Today and Tomorrow’ (YTT) Alzheimer’s Society training and individually tailored activity planning but he has yet to complete the assessment of all the residents Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 14 before this programme is fully on stream. The Activities Room has been moved from its rather inaccessible second floor room to the ground floor, which should help more residents to get involved. Group activities are planned for each day. On the day I visited there was a PAT dog, whose visit was much appreciated by the residents. Last year, a small farm came to the residents, housed in the garden. It is hoped that this would be repeated this year. For those that did not wish to partake in activities, the activities co-ordinator tries to visit them all in their rooms to provide one-to-one stimulus. There is a log of each person’s daily activity and also an action plan to develop the tailored activities. The activities co-ordinator has asked relatives to provide him with ideas for outside visits to match the resident’s interests. Gardening was encouraged with some of the plants in raised beds. Arts & Crafts were encouraged. A collage on various subjects is an activity that has been planned but has not yet got going. Lists of the activities for the week were placed in the notice board. There is a snooze room for those who would like a peaceful time with various sensory stimuli. It is a bit stark at present as needs to be fully populated but not until all the assessments are complete. Several of the residents enjoy reading a paper, and the activities co-ordinator encourages them to do so and ensures that they have the correct glasses. The staff is fairly supportive but would appreciate a YTT course to understand what the activities co-ordinator intends for the residents. It was good to see that the TVs in the lounges were switched off during the time of my visit. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made very welcome at the home and refreshments are offered. Visitors commented that staff are friendly and deal with any queries that they have. Residents can choose to receive visitors in their own bedrooms or in one of the communal rooms, as they so wish. Information in respect of advocacy services was available and displayed at the home. This included Age Concern, The Alzheimer’s Society and financial advocacy service information. The home had attained a three star rating for the ‘Scores on Doors’ scheme run by the Food Safety Agency. The Chef has been in post since December 2008. We viewed the kitchen and it was clean and tidy, however the area is quite small and cramped. The chef said that he is looking at ways of utilising the space available better and has been carrying out a ‘deep clean’ of the kitchen, which will be carried out on an ongoing basis. There is a 4 week menu, which has been developed in line with the Southern Cross Healthcare ‘NUTMEG’ nutritional programme. The chef said that he has already identified some meals that are difficult for residents to manage, and although he uses the meat choice for the day, he will on occasion adjust the recipe to better suit the residents needs. The actual menu on display is in small print and this needs to be reviewed to ensure residents can read the menu if they so wish. Also, currently residents are not being offered a choice of meal options prior to each meal, and this must be re-introduced and recorded, to include the Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 15 recording of any specialist dietary requirements so these are clearly identified for the kitchen staff to follow. The Expert by Experience viewed the mealtimes and observed that because those needing assistance with meals are served first, and those who are able to feed themselves therefore sit waiting for their meals, and some became distracted and left the dining room. Also, it took a long time to serve all the residents, and this could lead to meals being tepid or cold. Portion sizes are generous and in some instances appeared to be too much for residents to cope with. This was discussed with the chef who was clear that his preference would be for staff to give smaller portions and then offer second helpings, so this practice is to be reviewed. We spoke with the chef and although the food provision in the home is good, the actual timings of and mealtime routines need to be reviewed to ensure that meals are appropriately spread out throughout the day. Snacks and drinks are available throughout the 24 hour period. We sampled the meat and vegetarian options for the lunchtime meal and the food was well presented and tasty. The chef has a good knowledge of food provision and the importance of nutritional values, and is enthusiastic in his work. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 16 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by residents and their visitors. There is a clear system in place for safeguarding adults and this is followed, thus protecting residents. EVIDENCE: The home has a clear complaints procedure and this is on display throughout the home. The Manager has confirmed that there have been 12 complaints in the last 12 months, and all concerns raised are being recorded and addressed under the homes complaints procedure. Complaints records were sampled, and documentation was available to evidence that complaints had been appropriately investigated and responded to. The Responsible Individual has records of all complaints and the investigations and responses, and confirmed that she would ensure that a copy of all the complaint documentation was available in the home. The home has safeguarding adult policies and procedures in place that dovetail with the Hillingdon Safeguarding Adults documentation. Any incidents or issues that may involve safeguarding adults are reported to the Hillingdon Safeguarding Adults team as well as to CSCI. The Manager confirmed that there have been 5 safeguarding referrals in the last 12 months. Staff spoken with said that they had received safeguarding adults training and were clear to Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 17 report any concerns. Since coming into post the Manager had reviewed any recent events and had ensured these had been reported appropriately. We were informed that Southern Cross is working in partnership with Action on Elder Abuse throughout all there care homes and that residents and relatives will have a specific telephone contact number to report any concerns. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 18 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, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being well maintained, thus providing a clean, homely and safe environment for residents to live in. Individual bedrooms need reviewing to ensure the lighting and personalised environment meet each residents needs. Procedures are in place for infection control and these are practiced, thus minimising the risk of infection. EVIDENCE: We carried out a tour of the home. The environment is being well maintained and there is evidence of ongoing redecoration and refurbishment taking place. We were informed that several new profiling beds have been purchased and that by the end of the next financial year the great majority of beds within the home will be profiling beds. The lounges and corridors are bright and airy and look homely. Throughout the corridors sensory pictures are in place on the walls. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 19 The Manager said that although the home has 8 double rooms, however these are mainly single occupancy as residents sharing would have to have made a positive choice to share. We viewed some of the bedrooms, and several of those viewed were quite dimly lit and somewhat stark in appearance, with few if any personal items available. The need to review the lighting in the bedrooms in line with residents personal preferences and needs, and also to encourage more personalising of the bedrooms, were both discussed. We viewed the laundry and this was clean and tidy. There are 2 industrial washing machines with programmes for infection control, plus 2 tumble dryers. Good practice notices and laundering guidelines were on display. Protective clothing to include gloves and aprons was available throughout the home. Infection control procedures are in place and were being followed. Staff spoken with confirmed that they had received training in infection control, and further training was being advertised. The home was clean and fresh throughout. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 20 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of the residents are met. Systems for vetting and recruitment practices are in place and protect residents. There is an ongoing training programme, providing staff with the knowledge and skills to meet the needs of the residents. EVIDENCE: At the time of inspection the home was being appropriately staffed to meet the needs of the residents. The home has registered nurses with general and mental health qualifications and staff have also undertaken dementia care training, plus new staff are currently undertaking this training. We were informed that there had been some issues with staff shortages, however action had been taken to address this. We viewed staff meeting minutes and the topic of staffing and the importance of reporting for duty to ensure the home is consistently staffed had clearly been discussed with the staff. In addition to nursing and care staff, ancillary staff were available in such numbers to meet the needs of the home. The home was clean and smelled fresh throughout. The staffing in the kitchen has improved, with a full time chef employed in December 2008 plus another cook who has recently been employed. In addition, one of the kitchen assistants is currently undertaking a catering course and will also be able to provide cover for the chef. Issues regarding the food provision when the chef is absent have arisen and the importance of Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 21 ensuring that the kitchen staff on duty have the skills and knowledge to prepare and serve appropriate, nutritional meals was discussed. The AQAA was updated following the inspection and evidenced that 11 of the 29 care staff are qualified to NVQ level 2 or 3 in care. The Manager is looking to enrol more staff for NVQ training and is aware of the importance of care staff undertaking this training. We viewed 3 sets of staff employment records and these contained the information required under Schedule 2 of the Care Home Regulations 2001. Southern Cross Healthcare has an induction programme that meets the Skills for Care common induction standards. Staff spoken to confirmed that they had undertaken induction training, and the Manager said that she would follow up to ensure that all staff have undertaken such training, and provide any additional training and support for those who had not yet fully completed it. Staff do receive training in topics relevant to the needs and diagnoses of the residents and staff spoken to said that they do receive training to provide them with the skills and knowledge to care for residents effectively. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 22 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the skills and experience to manage the home effectively and has an open and supportive approach to staff, residents and visitors. The need for consistent management within the home has been clearly recognised and action is being taken to address this effectively. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Resident’s monies are well managed and securely stored. Systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. EVIDENCE: The Project Manager who is currently managing the home will be applying to CSCI for registration as the home Manager. She is a first level registered nurse Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 23 with a post graduate qualification in District Nursing. She also has a Diploma in Management Studies, has completed the Registered Managers Award 1 & 2, and has experience in complex care needs and dementia. She has 11 years management experience and has been a Project Manager for 3 years. Staff spoken with said that the Manager was very approachable and supportive. Aston House has had a succession of managers over the past few years, and none have actually become the Registered Manager for the home. This has been very unsettling for residents, staff and visitors and the Responsible Individual is very aware of the need for consistency of management in the home to provide stability and effective leadership for the staff team. It was clear from speaking with staff that they appreciate the fact this has been openly recognised and that they will now have someone in post to provide continuity of management within the home. Southern Cross has a system in place for quality assurance. This includes a series of audits of all aspects of the home, from which action plans are then drawn up to address any shortfalls identified in a timely manner. We viewed the most recent managers home audit and the action plan to address shortfalls was comprehensive and there was evidence of it being implemented. Medication audits take place each week, however the registered nurses carry out an audit following each medication round. The standard of medications has improved significantly as a result of diligent auditing and action to address previous shortfalls identified. The auditing process has also led to an improvement in the completion of service user plan documentation. Meetings take place for representatives and staff and minutes are taken. Regulation 26 unannounced visits are carried out monthly and a report is completed, and copies were available to view. Computerised records are maintained for all monies being held on behalf of residents. A sample of residents records were viewed and these were up to date and recorded all income and expenditure. Receipts for all income and expenditure are kept and the Area Administrator had recently set up a system for storing the 2009 receipts. 2008 receipts were available in the individual resident files. Interest is allocated to each residents account on a monthly basis. Maintenance and servicing records were sampled and those viewed were up to date. Checks for fire safety aspects and water testing were complete and up to date. The Fire risk assessment was last completed in May 2008 and no issues had been identified. Fire drills are carried out on a regular basis for both day and night staff. Risk assessments for some equipment and safe working practices were available and the Manager said that she would ensure that copies of all the most recent risk assessments are obtained and available in the home. The training records show that staff receive training and updates in health & safety topics to include moving & handling, fire safety, food hygiene, infection control, safeguarding adults and First Aid. Several more training Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 24 sessions in health & safety were advertised throughout the home. In the minutes of the last staff meeting it had been made clear that if staff do not attend mandatory training and updates within the required timescales, then they will not be rostered for shifts until the training has been done. No safety issues were noted during the tour of the home and health & safety is being well managed at the home. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 25 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 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 X X 3 Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 17 Requirement Where a resident is found to have a significant alteration in their weight, this must be checked to ensure the weight recorded is accurate, and appropriate action taken without delay to address the finding. There must be a system in place to offer and record residents’ choices for each meal. The record must accurately reflect the meals being eaten by each resident, to include those with specific dietary requirements, to evidence that these are being met. The menu must be updated to accurately reflect the meal options available for every meal. The meal provision must thereafter accurately reflect the menu advertised. The lighting and personalisation of bedrooms must be reviewed to ensure they meet the needs and wishes of the residents. Timescale for action 01/03/09 2. OP15 17 01/04/09 3. OP15 17 01/03/09 4. OP24 23 01/04/09 Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP15 OP15 OP15 Good Practice Recommendations The routine and serving at mealtimes should be reviewed to ensure all residents receive appropriate amounts of food to meet their wishes and in a timely manner. The meal provision in the home should be reviewed in respect of the timings of meals to ensure residents receive meals at appropriate intervals throughout the day. The menu should be displayed in a manner that is easy for residents to view and read. Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Aston House Care Home DS0000010924.V373785.R01.S.doc Version 5.2 Page 29 - 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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