CARE HOMES FOR OLDER PEOPLE
Aughton Grange Care Home 26 Granville Park Aughton Ormskirk Lancashire L39 5DU Lead Inspector
Vivienne Morris Unannounced Inspection 09:30 2 November 2007
nd
02/11/07 09:30
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 Aughton Grange Care Home DS0000062646.V347004.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. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Aughton Grange Care Home Address 26 Granville Park Aughton Ormskirk Lancashire L39 5DU 01695 423564 01695 423564 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) Aughton Grange (EMI) Care Home Limited George Gilmore Care Home 27 Category(ies) of Dementia (27), Mental disorder, excluding registration, with number learning disability or dementia (3), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (13) Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code CRH(N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 1. Dementia - Code DE (maximum number of people 27) 2. Mental Disorder, excluding learning disability or dementia - Code MD(E) (maximum number of people 13) 3. Mental Disorder, excluding learning disability or dementia, aged 59 years to 65 years - Code MD (maximum number of people 3) 4. The maximum number of service users who can be accommodated is 27 Date of last inspection 21st November 2006 Brief Description of the Service: Aughton Grange Nursing Home is situated in the picturesque village of Aughton and is close to all local amenities. The home provides 24 hour nursing and personal care for up to 27 elderly people who have mental health needs or a dementia related illness. Accommodation is provided mainly in single bedrooms; although two twin rooms are available for married couples, friends or people who prefer to share. Some single rooms have en-suite facilities. Toilets and bathrooms are located at intervals throughout the home. A separate spacious lounge and dining room are available. However, residents are able to dine within the privacy of their own accommodation, if they prefer. A large conservatory is constructed at the rear of the premises overlooking the pleasant garden and patio area. The service users’ guide, which contains relevant information about the service, including the most recent inspection report, is given to people who are thinking about living at the home, so that they are able to make an informed choice about where to live. The scale of charges as at 2nd November 2007 ranged from £411 - £522 per week. Additional charges were being incurred for hairdressing, newspapers and magazines.
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of the key inspection, was conducted over one day in November 2007. During the course of the visit to this service, discussions took place with relatives of people who lived at the home as well as staff and where possible residents themselves. Relevant records were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from seven people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. Some of this information forms part of this inspection report. The site visit involved spending a significant period of time sitting in the lounge, observing care being given to a small group of people living at the home. The time spent observing what life was like at Aughton Grange found staff to be patient, spending quality time talking with residents and in the main, taking time to ask people questions rather than making decisions for the residents. It was noted that people living at the home were encouraged to be as active as they chose, but could also sit quietly if they wished. Comments from relatives of those living at the home included, “The staff are marvelous. They really are very caring and look after the residents with genuine affection and I think this place is wonderful. I have recommended it to other people. We had received one complaint about this service since the last inspection, which was referred back to the provider to investigate using the home’s complaints procedure and one allegation of abuse was taken through the safeguarding adults procedure and was found to be not upheld. What the service does well:
Enough information had been gathered about people before they were admitted to the home to ensure that the staff team could adequately meet their needs. When asked on the comment card, what the service does well, relatives provided the following comments, ”Most things. However, my husband gets bored. I would like him to be taken out more often, but due to staff shortages
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 6 at times, and expense I know it is not possible otherwise I’m very pleased with Aughton Grange”, “The staff are very loving and caring towards my mother, who can be difficult at times. It is important to me to know she is safe and well cared for, as I can’t visit regularly. It is reassuring to know that I can trust the staff with the care of my mother”, “They are a very dedicated staff team” and “I am very impressed by the care and genuine affection shown by the staff towards those in their care”. When the registered manager was asked what the service does well, he wrote, “ We maintain individual care plans, which show any changes in circumstances and the overall care required and also any visits conducted by external services, such as GP’s, opticians, chiropodists and dentists. The care plans are written in a clear and concise manner and they include privacy and dignity”. The plans of care were very well written documents, showing that the personal and health care needs of people living at the home, including the management of medications were fully met and that the privacy and dignity of service users was maintained. These records provided clear, detailed guidance for staff as to how the assessed needs of people could be adequately met. Visitors were made welcome to the home and were able to see their relatives in private or in the communal areas of the home. The sitting rooms provided people with friendly, relaxed environments in which to spend their time. One relative commented, “My wife has always been very happy here” and another said, “We took my relative out recently, but we had to bring him back to the home because he became agitated and after 5 minutes at Aughton Grange he had settled and was once again quite content. That shows how happy he is here”. Sufficient information was given to people and was available within the home about the use of advocacy services, should they wish an independent person to act on their behalf. The home provided well-balanced, nutritious meals in accordance with residents’ requirements and choices and which were served in relaxed and pleasant surroundings. Complaints were, in general, well managed and appropriate investigations had been conducted when necessary so that people were assured that complaints were taken seriously and so that any shortfalls may be identified and rectified. The policies and procedures of the home adequately safeguarded the people living there. The home was found to be warm and comfortable, providing a clean, friendly and homely environment for people to live in. Policies and procedures were in place to ensure adequate control of infection. A lot of training was being provided for staff, including mandatory courses, a detailed induction process and training specific to the client group living at the
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 7 home, which demonstrated that the staff group were competent to look after the people at the home. The manager was resident focused and led and supported the staff team who had been appropriately recruited, so that those living at the home were adequately protected. Systems were in place at the home to ensure that residents’ finances were adequately protected so that the possibility of any mishandling was minimal. Robust recruitment procedures were adopted by the home. During this site visit four staff files were examined, which were found to contain all the relevant information and checks on staff to ensure that those living at the home were adequately protected. The home was found to be free from hazards so that people were not at risk when moving around the home. What has improved since the last inspection?
The home had improved arrangements for giving people the opportunity to be involved in the assessment of needs and care planning process, so that they had some input into the care received. The provision of activities had improved since the last inspection by the employment of an activities co-ordinator, so that those less able to participate could receive more 1:1 interaction from staff and a wider range of activities could be available for those more able to join in. The care records contained more detailed information about how people could be supported to maintain their leisure interests whilst living at the home. When asked what had improved since the last inspection, the registered manager said that relatives meetings had been introduced and were invaluable in relation to complaints and concerns. Issues were discussed openly and this gave a forum for some relatives who found strength in group settings. The registered manager told us that some improvements had been made to the environment since the last inspection, including new carpets being fitted on the stairs and landing, redecoration of the main lounge and corridor and purchase of some new furniture. On touring the premises it was noted that these improvements provided pleasant surroundings for people to live in. The staffing levels were being calculated in accordance with the dependency levels of the people living at the home, to ensure that their individual needs were being adequately met. The number of care staff holding a recognised qualification had increased significantly since the last inspection so that the staff team, as a whole was
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 8 sufficiently trained to look after the people in their care, which is commendable. Significant improvements had been made since the last inspection and all requirements had been appropriately addressed. Systems within the home had been improved so that the quality of service provided could be effectively monitored. Questionnaires for residents, relatives, staff and stakeholders in the community gave people the opportunity to provide the home with their views on how well the service was meeting goals for those living at Aughton Grange. Clear audit trails, conducted by the home allowed the registered person to identify and to put right any shortfalls in the service. An annual development plan demonstrated that the registered person had considered a structured approach to forward planning so that the service could consistently meet the expectations of people living at the home. The record of accidents was retained in line with data protection in order to protect the confidentiality of people living at the home. What they could do better: 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. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 9 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 Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 10 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. Standard 6 did not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Enough information had been gathered before admission to ensure that the home could meet the individual assessed needs of the people wishing to live at Aughton Grange. EVIDENCE: At the time of the site visit there were 22 people living at Aughton Grange Nursing Home and the care three of these people was ‘tracked’. One comment card received from a resident showed that they had received enough information before they moved into the home and that they had been given a contract. The registered manager told us that he conducted a full comprehensive assessment of needs before people were admitted to the home. This was done with the input from relatives and social services and the results of the assessment was used to develop the initial care plan. At the pre-admission
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 11 stage a statement of purpose was given to relatives, who were also asked to contribute some written information to the care planning process so that people were involved in the arrangement of care and so that staff had a clear picture of people’s individual needs. The care records seen showed that detailed information had been gathered before admission, which involved the resident or their relative, so that the service was certain that the staff team could meet the needs of people admitted to the home. The Pre-inspection questionnaire showed that policies and procedures were in place at the home, so that staff were provided with guidance about the admission process. Records showed that people involved with the care of service users had conducted a periodic review of placements to ensure that the home remained a suitable environment to meet the continuing needs of people living at the home. Staff were appropriately qualified and had also received specific training in relation to dementia care to ensure that they were aware of the needs of people suffering from dementia. The assessed needs of those admitted to the home were consistently recorded within the care plan therefore staff were provided with detailed information as to how service users’ needs were to be met. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of those living at the home were being fully met and their privacy and dignity was consistently maintained. EVIDENCE: A comment card was received from one person who was living at the home, who said that they always received the care and support, including medical attention as was needed. Six relatives, who sent in comment cards, in general agreed with this statement and felt that, on the whole the different needs of people living at Aughton Grange were met. One relative wrote on the comment card, The home always contacts me to tell me what has happened and how my mother is. This is important to me as I live away, and another said, “Excellent staff and they are always there to help”. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 13 The registered manager told us that he had emphasised to all relatives at meetings the importance of their input to the care plans, explaining that it is the resident’s right to have access to the care plans and to make decisions about the care provided. The care of three people was ‘tracked’ at the time of the site visit. The plans of care seen were person centred and very well written documents. They were reviewed at least once every month, showing any changes in circumstances and providing staff with clear, detailed guidance about how people’s assessed needs could be fully met. People living at the home or their relative had been given the opportunity to make decisions about the care provided and the service users’ guide told people about the involvement of residents and their relatives in the care planning process. Records seen showed that a variety of support services and external professionals, such as opticians, chiropodists, community nurses, general practitioners, psychiatrists and audiologists, were involved in the overall care of residents to ensure that all their assessed personal and health care needs were adequately met. One comment made by a relative was, The care my wife receives is second to none” and another said, People are treated with respect as individuals”. A wide range of risk assessments had been conducted, which were found to be detailed, showing what systems had been put in place to reduce the possibility of injury. The registered manager told us that policies and procedures were in place at the home to ensure the safe handling of medications. We found that medications were being well managed so that the health and safety of those living at the home was promoted. However, the management of medications could be further improved by the commencement of a regular recorded audit trail so that the safety of people living at the home would be better. The care records showed that people were treated with respect and that their privacy and dignity was maintained whilst personal and health care was being provided. The registered manager told us that policies were in place in relation to the six principals of care, including privacy and dignity. The statement of purpose told people that the privacy and dignity of those living at the home would be respected and this was supported by our observations. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home usually matched residents’ social and recreational needs. People living at Aughton Grange received a healthy, varied diet according to their assessed requirements and choice. EVIDENCE: The registered manager told us that an activities co-ordinator had been employed since the last inspection and that she had completed a relevant training course to enable her to provide suitable activities for the people living at Aughton Grange. He also said that relatives now completed a ‘getting to know you’ booklet, which covered past and present hobbies and interests, so that the home could, as far as possible tailor the activities provided to the needs of those living at the home, in accordance with people’s levels of awareness and concentration. The registered manager told us that organised activities did take place, but with the client group spontaneous one to one activities were often more beneficial for the people living at the home. Staff were being encouraged to make activities a part of daily life and ongoing for Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 15 most of the day. Relatives were being encouraged to join in and to make suggestions about types of activities, which people may enjoy. Many people were seen to be thoroughly enjoying a comedy film in the lounge area on the wide screen television, which gave a feeling of being at the cinema. It was pleasing to see ices being served during the film and staff were talking to people about the film being shown, so that their concentration was maintained. Relatives were also enjoying taking part in the activity and a jovial atmosphere was evident. Other people were walking freely around the home and staff were assisting those less able. Some staff were interacting with people on a 1:1 basis so that their social needs were also being met. Staff told us that a religious service was conducted at Aughton Grange every month and relatives spoken to confirmed that the religious needs of people living at the home were met. The registered manager told us that plans for improvement included educating all staff to realise the importance of maintaining people’s interests and activities and that he would like all staff to attend a relevant training course. The resident who returned the comment card indicated that there were usually activities arranged that they could take part in. Comment cards received from six relatives indicated that people, in general were supported to live the life they chose. One relative wrote on the comment card, My relative has dementia and has no reasoning to enable her to decide how she now wishes to live the life she would choose. However, the staff ensure that her activities of daily living are met”. One resident who had diverse needs was seen to be provided with the same opportunities as the other people living at the home and records showed that equality and diversity had been taken into consideration before the admission process to ensure that the staff team could meet this person’s individual needs. The care records seen showed that the wishes and feelings of people living at the home had been taken into consideration and that their preferences had been determined to enable them to have some control over their lives. The statement of Purpose included an explanation of the six principals of care, including rights and choices, showing that those living at the home were able to make decisions and informed choices. Detailed social histories had been obtained so that staff knew what residents’ interests were and so that they were able to form close bonds with the people living at the home and their families. Detailed explanations were included
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 16 within the plans of care to show how people could be supported to maintain their leisure interests whilst living at the home. The communal rooms provided friendly, relaxed areas for residents to spend their time and we noted that there was a lot of laughter and enjoyment. One relative commented, “The residents have lots of parties. The other night they had a Halloween party. They loved it. They have a party ay Christmas and Easter and for their birthday”, another said, “Perhaps there could be a few more trips out organised. There used to be quite a lot, but they seem to have stopped for some reason” and a third commented, “My relative tends to get a bit bored, but he is able to walk around the home without any restriction”. A visiting policy was in place and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Comment cards received from relatives all indicated that they were made to feel welcome to the home and were able to visit service users in private. The inspector noted that personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of resident’’ belongings had been conducted on admission to protect the safety of individual’s personal possessions. Information was provided in the service users’ guide in relation to the use of advocacy services, so that people had the opportunity to have an independent person acting on their behalf, should they so wish. Leaflets were also readily available within the home so that people were able to contact the local advocacy service them-selves if they preferred. Information submitted by the home before the site visit showed that people were given a choice of menu and that special diets were catered for to ensure that everyone’s dietary needs were met. The four weekly menus showed that a well-balanced diet was offered to ensure that those living at the home received a nutritious dietary intake and the food served appeared appetizing in order to aid nutrition. People were seen being supported with their meals if they needed, whilst independent eating was encouraged where possible. The dining rooms were found to be relaxed areas for people to eat in, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. One relative said, “I came to have my breakfast once with my husband as he had a hospital appointment. I honestly could not believe what they (the residents) could have for breakfast. It was amazing”. One resident said, “The food here is always good”. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and appropriate investigations had been conducted, although the recording system could have been better. The policies, procedures and practices of the home sufficiently safeguarded those using the service. EVIDENCE: The registered manager told us that complaints were recorded and investigated appropriately and that relatives were informed of how to instigate the complaints procedure. Of the six comment cards received from relatives, five said that they would know how to make a complaint and one indicated that they would not know how to complain. The comment card received from a resident indicated that they would know how to make a complaint and would know who to speak to if they were not happy. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 18 A system was in place at the home to ensure that complaints were recorded and investigated in a proper manner and a timely fashion so that people were kept informed of what stage their complaint was at. However, the record of complaints was not retained in a numbered page book, to reduce the possibility of mislaying or removal of loose pages and blank lines were evident, creating the possibility of additional text being added at a later date. Although, complaints were recorded and investigated appropriately, all the information gathered was retained in different places, so that a clear, easy to follow audit trail could not be conducted without searching for the information needed, showing that detailed investigations had been carried out and outcomes had been reached. A policy was in place in relation to concerns and complaints, which was clearly displayed within the home and was issued to each resident or their relative in the statement of purpose, so that people were aware of how they could make a complaint, should they wish to do so. Relatives, spoken with told us that they would know what to do should they wish to make a complaint about the service. The registered manager told us that a policy in relation to the safeguarding of adults was in place at the home, which had not been changed since the last inspection and which was found to be satisfactory at that time. Staff spoken to confirmed that they had received training in relation to safeguarding adults and the training matrix seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lived in a clean, pleasant and safe environment, which was well maintained and free from unpleasant smells. Satisfactory procedures were in place for the control of infection. EVIDENCE: The registered manager said that he now conducted inspections of the building every day so that any repairs or replacements needed could be identified and addressed in a timely fashion. The comment card received from a resident indicated that the home was always fresh and clean. A tour of the building took place at the time of the site visit, when all communal areas and a number of residents’ bedrooms were seen. The home was found to be clean, tidy and well presented, providing a pleasant environment for those living at Aughton Grange.
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 20 The environment was free from any unpleasant smells and the grounds were maintained to a satisfactory standard, providing pleasant surroundings for those living at the home. There had not been any changes to the infection control policies and procedures, which were satisfactory at a previous inspection. Clinical waste was being disposed of appropriately, demonstrating that infection control procedures were being followed in day-to-day practice. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working at the home were trained, skilled and in sufficient numbers to fulfil the aims of the home and to meet changing needs of residents. Robust recruitment procedures were adopted to ensure that the people living at the home were adequately safeguarded. EVIDENCE: The registered manager told us that he was staffing the home in accordance with the dependency levels of the people living at the home, to ensure that their needs were being appropriately met. The comment card received from one resident showed that, in general, staff were usually available when they were needed. There was a clear duty rota in place demonstrating which staff were on duty at any time of the day or night. Records showed that a good skill mix of staff made up the staff team so that residents’ needs were being met. Visitors spoken to felt that their relatives’ needs were being fully met and that the staff were appropriately trained. Figures sent to the Commission by the home showed that fourteen care staff were employed at Aughton Grange, twelve of who held a recognised qualification in care, equivalent of 85 , which is commendable.
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 22 The registered manager told us that good recruitment procedures were in place and that once employed staff progressed through an induction period to ensure that they were confident to carry out the duties expected of them. Records showed that a formal induction process had recently been adopted by the home, which involved working through a booklet appropriate to their role. This booklet provided some good information to help staff to understand their role and to enable them to perform the duties expected of them. Three staff files were examined at the time of the site visit. It was found that recruitment procedures were being adequately followed in day-to-day practice and sufficient checks had been undertaken on staff to ensure that those living at the home were adequately protected. The staff application form showed that the service was an equal opportunities employer and this was confirmed by examination of the staff rota, which showed that the staff team was made up of people from different nationalities. The information provided to the Commission before the site visit showed that a wide range of training was provided for staff and that future planning had been arranged, including training specific to the client group living at the home. This showed that people working at the home received adequate training to look after the people in their care. All staff completed mandatory core-training courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people in their care. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 23 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, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect with systems in place to monitor the quality of service provided and to ensure that the safety of people living at the home was consistently maintained. EVIDENCE: The manager of Aughton Grange Nursing Home is a first level registered nurse and he told us that he had commenced an additional recognised qualification, so that his knowledge and skills were being maintained in line with current guidelines. During the time he has been in post Mr Gilmore has worked hard to improve the service and to provide an increased quality of life for residents. At the time
Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 24 of this site visit it was evident that significant improvements had been made so that people living at the home were receiving a good standard of service, which is commendable. An annual development plan had been introduced and the manager of the home was resident focused, leading and supporting the staff team who had been appropriately recruited, so that those living at the home were adequately protected. Comment cards received from service users and their relatives provided very positive feedback about the registered manager. Staff spoken to felt supported by the manager and were happy with the overall management of the service. Discussions took place with several relatives and comments included, “George (the manager) is first class. He is very supportive and deals with any concerns quickly” and “George and the staff are very good. This is a very well run home”. One member of staff told us, “George will sort out any problems”. The registered manager told us that staff meetings and relative’s meetings were held every month and that notes of the meetings were retained. One relative confirmed that minutes of the relatives meetings were circulated to all those concerned and that relatives were asked to fill in questionnaires so that they could give feedback about the service provided. A wide range of completed surveys was seen so that the quality of service provided could be monitored. The results of residents/relatives surveys were published in a graph format so that any interested party could see what life was like at Aughton Grange. The registered manager had put in place a variety of audits and regular checks, within a risk management framework, so that any hazards could be easily identified and so that systems could be implemented to reduce or eliminate the risk factor. The regional manager conducted audits each month, which were recorded and retained on site so that any issues raised could be addressed. Systems were in place at the home to ensure that residents’ finances were adequately protected. Information provided by the home showed that relatives were usually responsible for the management of residents’ money, where residents were unable or did not wish to manage their own affairs. Information provided to the Commission before the site visit showed that systems and equipment had been appropriately checked so that the health, safety and welfare of those living at the home was protected. Records seen supported this information. The environment was seen to be free from any hazards so that people were not at risk when moving around the home. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 25 The registered manager said that a variety of policies and procedures were in place, which provided staff with relevant health and safety guidance in order to safeguard those living at the home. Accidents had been well documented, and records were retained in line with data protection in order to protect the confidentiality of people living at the home. The training matrix showed that staff were provided with a lot of training, including health and safety issues so that they were appropriately trained to protect those in their care. Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 26 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 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP9 OP16 Good Practice Recommendations It is recommended that a recorded audit trail be introduced to further improve the management of medications. The record of complaints should be retained in a numbered page book, to reduce the possibility of mislaying or removal of loose pages. Blank lines should be avoided to reduce the possibility of additional text being added at a later date. Information about complaints should be brought together, so that a clear audit trail can be conducted, showing that detailed investigations have been conducted and outcomes have been reached. The registered manager should achieve a National Vocational Qualification at level 4. 3. OP31 Aughton Grange Care Home DS0000062646.V347004.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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
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