Inspection on 29/01/10 for The Albany Nursing Home

This is the latest available inspection report for this service, carried out on 29th January 2010.

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

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

Other inspections for this house

The Albany Nursing Home 21/02/08

The Albany Nursing Home 20/04/06

The Albany Nursing Home 15/02/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: The Albany Nursing Home 7 London Road Headington Oxford OX3 7SN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Marie Carvell     Date: 0 1 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Albany Nursing Home 7 London Road Headington Oxford OX3 7SN 01865744444 01865744485 thealbany@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trinity Care (Crown) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Albany Nursing Home is a purpose built home that is registered to care for 48 older people. It is situated in the Headington area of Oxford, close to shops and amenities. The Albany is part of Trinity Care (Crown) Limited (part of the Southern Cross Healthcare Group), which has a number of similar homes in Oxfordshire. The home is not registered to admit service users with a primary diagnosis of dementia or mental health care needs. Accommodation is on two floors, accessed by a lift or Care Homes for Older People Page 4 of 30 Over 65 48 0 2 4 0 2 2 0 0 9 Brief description of the care home stairs, and all the bedrooms overlook the attractive gardens. There is a spacious conservatory that opens onto the gardens and a safe walkway through the garden for service users. The range of fees for this home is 552:00 per week to 1051:86 per week. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers and toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was completed in February 2009. This inspection was an unannounced key inspection, carried out by two inspectors over two days. We ( the commission) arrived at the service at 10:00 and were in the service until 16:45 on the first day and we returned for a second day, with one inspector spending four hours in the home and the lead inspector in the service from 10:00 until 17:45. It was a thorough look at how well the service is doing. It took into account detailed information provided by the regional lead nurse in December 2009 and any other information we have received about the service since the last inspection. We sent out surveys to service users and received seven responses. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent with the deputy manager, currently managing the home, the area manager, the Care Homes for Older People Page 6 of 30 regional lead nurse, the prospective manager of the service, staff on duty, service users and visitors to the home. We looked at communal areas of the home, a sample of service user bedrooms, communal bathrooms, laundry and sluice facilities. Time was spent talking to service users, visitors and staff on duty in private and communal areas of the home, we observed meal times and spent time in communal areas observing interactions between service users and members of staff. In addition we examined a sample of records required to be kept in the home, including service user and staff record. Feedback was given to senior staff during and at the end of the second day of the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with enough information to help them decide if the home was the right place for them, before moving in. Service users are not always encouraged to move into the home for a trial period or reviewed with the service user, as decisions to stay permanently are largely made by relatives. Service users are assessed prior to being to admission, to ensure that their care needs can be met by the care home. Evidence: Prospective service users are provided with information about the home, including a copy of the service user guide and welcome pack. Five of the seven surveys completed by service users stated that they had received enough information to help them decide Care Homes for Older People Page 10 of 30 Evidence: if the home was the right place for them, before moving in. Two surveys stated that the service user had not received sufficient information to help them decide if the home was the right place for them before moving in. Service users and their representatives are invited to visit the home to look at the accommodation, facilities and to meet other service users and members of staff. However, this is not always documented in the admission records. A detailed pre- admission assessment is carried out by the deputy manager or senior member of staff, this may include input from health and social care professionals and relatives as well as the service user. This is well documented in service user files. Following the pre- admission assessment the deputy manager or senior member of staff writes to the service user to confirm that the home is able to meet their assessed needs. Since the last inspection the home no longer provides intermediate care. Senior staff are aware that the home is not registered to admit service users with a primary diagnosis of dementia or mental health care needs. From information recorded in service user files it was not evidenced that service users are admitted to the home for a trial period, before deciding if to stay permanently or if a review meeting takes place. The Annual Quality Assurance Assessment ( AQAA) completed by the regional lead nurse in December 2009 stated that the home could do better by encouraging trial stays and reviewing this with the service user themselves as currently decisions are largely made by relatives. This is part of the plan for improvement in the next twelve months. Service users are provided with a contract/ terms and conditions. Three surveys completed by service users confirmed that they had received a contract/terms and conditions. Two service users stated that they had not received a contract/terms and conditions and three service users stated that they didnt know . Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning documentation needs to be developed with the service users involvement, and need to contain sufficient detail to ensure that the nursing/care staff are familiar with the needs of the individual, when care is to be provided and how. It was not evidenced that nursing staff are monitoring care provided by care staff to service users on a daily basis. The healthcare needs of service users are fully met. Medication administration records need to accurately reflect medication given. Service users do not always feel that their dignity and privacy is respected. Evidence: Care plans are drawn up from information recorded on the pre-admission assessment documentation. However, from examination of a sample of care plans it was not Care Homes for Older People Page 12 of 30 Evidence: always evidenced that the service user/representative is involved in the care planning process. Care plans were not in sufficient detail to ensure that nursing/care staff are familiar with the care needs of the individual, when care is to be provided or how. Care plans showed several discrepancies e.g photograph showed service user wearing dentures, but care plan stated due to lack of dentures, service user needed liquidised meals and to discuss with GP the use of supplements. The same care plan stated that the service user was able to feed herself independently, but staff confirmed that this was not the case, other discrepancies identified included likes to have a bed bath, but the care plan stated offer shower daily. Care plans made no reference to cross gender care preferences of the service user, continence care, communication issues, or how mental health needs are identified or met. Entries made in daily contact sheets did not consistently reflect information recorded in care plans. This was discussed with senior staff present during the inspection. Nursing staff complete all entries in the service users daily records, however, care staff complete daily record sheets kept in the service users bedrooms regarding personal care provided. These records are not consistently filled in. It was not evidenced how the nursing staff are monitoring care provided by care staff on a daily basis. No consistent evaluation of care or interventions was documented in the sample of records seen. Reviews of care plans frequently consist of a date with care plan ongoing written. Service user reviews frequently exclude the service user and the reasons why are not recorded. One service user has a custom built wheelchair, with a high back and lap belt, it wasnt evidenced that the wheelchair was specifically for this service user. No reference was recorded to the service users safety if using the wheelchair or for the use of the seat belts. Comments made on one survey included Hoisting could be more comfortable, the sling used is too small. This was discussed with the nursing staff on duty. Many service user being nursed in bed have bed rails fitted. Risk assessments are in place. However, these are not necessarily reviewed monthly as is company policy. Service users were observed being transported in wheelchairs, without their feet being properly supported on the footplates. In discussion with service users and relatives, most expressed their satisfaction of the care provided. Seven surveys were completed by service users, two service users stated that they always received the care and support needed, three service users Care Homes for Older People Page 13 of 30 Evidence: stated that they usually received the care and support they needed and two service users stated that they sometimes received the care and support needed. Comments made on surveys included Back in August my X became ill. The home and staff pulled X through. Now X seems happier and stronger than Ive seen her for some time, As far as Im concerned, I am very well looked after, physically and mentally. I am washed and dressed and cared for by capable staff. The healthcare needs of service users are provided by several GP practices, currently four service users have retained their own GP when moving into the home. The GP practice for the majority of service users visits the home weekly and as necessary. The deputy manager described the GP as very accessible and approachable to requests to visit including week ends and bank holidays. A range of healthcare professionals visit the home including community psychiatric nurses (CPN), physiotherapists, falls specialists, tissue viability nurse and occupational therapists. Four surveys completed by service users stated that the home always made sure that they received the medical care they needed, three surveys stated that the service user usually received the medical care they needed and three surveys stated that the service user sometimes received the medical care they needed. Comments made on surveys included My medical needs are well cared for, hospital, doctor, dentist and optician. Medication administration is undertaken by the registered nurse (RN) on each floor during the day and the one RN does all medication administration at night, starting at about 8pm. A sample of medication administration records for four service users were examined with the RN on duty and deputy manager. The RN confirmed that there is sufficient time between medication rounds to allow adequate spacing between doses. The home uses a monitored dosage system and has two medication trolleys. It was noted that there was three omissions for RN signature for five doses of a medication given to two service users on one day. The RN said it was difficult to take action for medication not signed for if the RN was an agency or bank RN and did not work at the home regularly. The home undertakes a monthly audit of medication administration and the last audit dated December 2009 was seen. It was observed that pots of sudocrem and E45 cream in service users bedrooms, were not labelled with the service users name or the label had been removed, this is particularly concerning, as some pots were in shared bedrooms. Staff were observed interacting with service users, mostly in a respectful and appropriate manner. One service user rang his/her call bell for staff attention, the member of staff arrived saying What do you want, Im going off duty. It was noted during the inspection that on occasions service users dignity was not maintained, we Care Homes for Older People Page 14 of 30 Evidence: observed one service user with an indwelling catheter, the bag was on a bag holder without a cover and was visible from the corridor, another service user sat in the lounge with a sheet over her legs, but exposed left leg and thigh. Several service users commented that staff take a long time to answer call bells or call bells being left out of reach. Several service users were observed not to be wearing stockings or foot wear, this was documented in one service users records. One service user told us that she only had one pair of knickers, this was confirmed by the laundress, who said that she would find some unlabelled underwear for the service user. Two service users stated that staff always listened to them and acted on what was said, four service users stated that staff usually listened to them and acted on what was said and one service user stated that staff sometimes listened to them and acted on what was said. Comments made on surveys included The home could do better at communication. Get to know service users more, so staff can understand different backgrounds, Staff need to respond to the panic buttons more quickly, Sometimes the staffing levels are low. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with service users and staff on duty we consider that the home may be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, this needs to be considered as part of the pre admission assessment. There are indications that service users and relatives sometimes find that some staff cannot communicate effectively because English is not their first language. Following the inspection we received a detailed action plan from the area manager advising us of action to be taken with timescales with regard to care planning and associated documents this will include the updating of all documents, RNs to complete self directed learning on documentation, dignity in care training to be provided to all staff, nursing/care staff to receive supervision sessions regarding dignity, RNs and the person managing the home to monitor all charting completed by care assistants daily, training for all staff in communication and care delivery and all personal care plans to include the preference of the service user to the gender of the staff member providing personal care. This will be completed by the end of February 2010. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of suitable social and recreational opportunities for service users needs to be developed further. The routines in the home need to be person centred and not task orientated. The dining experience of service users needs to be further developed. Evidence: An activities organiser has been in post since late December 2009 and is employed for thirty hours per week over four days. Activities undertaken by individual service users are recorded on a weekly activities sheet. One service user is unable communicate with staff as English is not his/her first language, and is unable to speak or understand English. It was queried how this individual was able to enjoy story telling, likes being read to, enjoyed the group discussion or watching TV. Following the inspection we received an action plan from the area manager advising us that the senior staff in the home have been asked to discuss with the service users family, ways of improving communication, possibly by the use of pictorial cards with supporting text in the service users own language and to investigate possible Care Homes for Older People Page 16 of 30 Evidence: attendance at a Oxford centre for older people with similar cultural needs. One the first day of inspection there was a film show in the main lounge, several service users were gathered, it was not clear whether the service users had chosen the particular film to watch, most service users appeared to either not be interested in the film or could not see the screen. One service user was doing a word game and was requesting the attention of the activities coordinator. One care assistant was supervising the service users during the film show, the care assistant was standing away for the group and was not interacting with service users, this may have been due to the care assistants poor understanding of English. One survey completed stated that the home always arranged activities that the service user could take part in, two surveys stated that the home usually arranged activities that the service users could take part in and four surveys stated that the home sometimes arranged activities that service users could take part in. The AQAA stated that the home could do better by ensuring that care plans show individual assessment of social care needs and desires, so this can be taken into account when planning activities and to further expand the activities programme to make this more accessible for people who prefer to stay in their own rooms. This is part of the plan for improvement in the next twelve months. Service user and relative meetings take place, the last ones were held in November 2009, it was not possible to see minutes of these meetings. A monthly newletter has recently commenced. The November 2009 was seen and we gained the impression that the newsletter is well received. Many service users have friends and family who are able to visit on a regular basis. Visitors spoken to said that they were always made welcome when visiting the home. Several service users said that the routines were not always as flexible as they would like and this appeared to depend on staff on duty and the dependency of the service user. We observed lunch being served in the main dining room. Many of the service users require assistance with eating their meals. Very little interaction was observed between service users and staff, this may have been due in part to the extremely loud music playing, with made any conversation impossible.We have previously been advised that the home had protected mealtimes, which means that the nurses on duty are available to observe meals being served, assist with feeding service users and monitoring food intake, rather than carrying out tasks such as medication rounds. Care Homes for Older People Page 17 of 30 Evidence: However, on the first day of this inspection one of the RNs on duty was administering medication and appeared unaware of the effect the loud music being played was having on service users. This had been addressed by the second day of the inspection. Concerns about meeting the dietary needs of service users, have been raised with senior staff by service users and relatives. Two surveys stated that the service users always liked the meals in the home, two surveys stated that the service users usually liked the meals in the home and two surveys stated that the service users sometimes liked the meals in the home. Comments made by service users in surveys or during the inspection included Need more staff and more time to feed me, I never get a choice of meals, just brought on a tray to my room. It was noted that one service user who is fed via a percutaneous endoscopic gastronomy tube (PEG) feed and was unable to take any food by mouth was presented with a birthday cake. The AQAA stated that the home could do better by improving the dining experience for all service users. This is a part of the plan for improvement and has already commenced. The home provides its menus using an assessment tool, called NUTMEG to ensure that service users are provided with a wholesome, well balanced and nutritious diet. This was confirmed in discussion with the chef and examination of menus and food choice records. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their relatives are confident that any complaints made would be listened to, taken seriously and acted upon. All staff receive training in safeguarding adults from abuse, this training is ongoing as new staff Evidence: The homes complaints procedure is displayed in a prominent position in the reception area. In the last twelve months the home has received ten complaints either verbally or in writing. The recording of complaints was seen to be clear, detailed and included action taken and outcomes. In discussion with service users and comments made on surveys most stated that there was someone they could speak to informally if they were unhappy. This was usually friends, relatives or staff in the home. Five surveys completed by service users stated that they knew how to make a formal complaint, two surveys stated that the service users did not know how to make a formal complaint. Comments made included Ive never needed to make a complaint. Service users confirmed that they would be confident that any complaints would be listened to, taken seriously and acted upon. Since the last inspection we have not received any information regarding complaints. All staff receive training in safeguarding adults from abuse, including whistle blowing. Care Homes for Older People Page 19 of 30 Evidence: Since the last inspection one safeguarding referral has been made and six safeguarding investigations have taken place. No referrals have been made for the inclusion of staff on the protection of vulnerable adults list ( POVA). The AQAA states that the home could do better by introducing dignity champions and training staff in handling verbal complaints and grumbles. This is part of a plan for improvements in the next twelve months. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its stated purpose. Since the last inspection the home has reduced its number of shared bedrooms and no longer provides a six bedded intermediate care unit. There is an ongoing refurbishment and redecoration programme in place. Bedrooms are personalised and service users are encouraged to bring in their personal effects. Evidence: The home is purpose built and the location and layout of the home are suitable for its stated purpose. Since the last inspection the home has reduced the number of shared bedrooms and no longer provides an intermediate care unit. Since the last inspection there has been an ongoing refurbishment and redecoration programme in place. New furniture is being purchased including privacy screens for use when hoisting service users in the communal rooms. At the time of the inspection there were two housekeeping staff, one for each floor and a laundress on duty. The general cleanliness of the home was adequate in communal areas and bedrooms, but attention to detail lacking for example, curtains Care Homes for Older People Page 21 of 30 Evidence: off the curtain rails, soap stains on walls and failure to make good plaster work where soap dispenser have been installed. In a shared bedroom it was noted that denture pots had not been emptied. On the first day of the inspection there was an unpleasant and pervasive stale smell in the home with a smell of stale urine at the far end of the ground floor corridor. On the second day of the inspection the odours were less apparent and there were more wall mounted air fresheners in place. Carpets in the main lounge and conservatory were stained and in need of replacement. It was observed that there are still Christmas cards up on shelves in the lounge and Christmas tree baubles outside in the water feature. In the dining room it was noted that there were seven sets of spectacles, some broken and a bottom set of dentures on a book shelf. The first floor sluice disinfector was out of order , this had been reported and was waiting for the company to repair. It is unclear who supervised the housekeeping staff on a daily basis this was discussed at a relatives meeting and is currently being addressed. At the last inspection a requirement was made that suitable arrangements to prevent the spread of infection around the home must be put into place. This has been complied with. Since the last inspection two sluice disinfectors have been installed, alcohol hand pump dispensers have been installed outside each bedroom and in the reception area. Housekeeping staff are provided with protective clothing and have undertaken training in COSHH and infection control measures. Regular internal audits completed. Bedrooms are personalised and service users are encouraged to bring in their personal effects. A comment was made that the communal bathrooms are not used very often. The laundry was well organised and the laundress was able to describe good practice. Soiled linen was seen to be place in alginate bags ready for washing. There are separate rooms for dirty laundry and for ironing and storage of clean work. Commercial washing machines are in place and have sluicing facilities. Three surveys completed by service users stated that the home was always fresh and clean, three service users stated that the home was usually fresh and clean and one service user stated that the home is sometimes fresh and clean. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels need to be sufficient at all times to meet the needs of the service users. The homes recruitment procedures need to be robust to protect service users from potential harm. Staff induction, training and personal development needs to be actioned, to ensure that all staff have the necessary skills to meet the needs of service users. Evidence: From discussion with staff on duty, service users, examination of duty rosters and from observation , it is not evidenced that there is consistently sufficient staff on duty to meet the needs of the current thirty four service users. The home employs two full time RNs on day duty and one part time RN is employed on night duty. Five bank RNs are employed on a regular basis and vacant hours are covered by agency staff. Nineteen full time care assistants are permanently employed. The home is currently advertising for full time RNs. In the last twelve months ten care assistants, four RNs and several ancillary members of staff have resigned for a variety of reasons. This was not accurately reflected on the information provided on the AQAA, which stated that only one member have staff had resigned in the previous twelve months.Two service users who completed surveys stated that always staff were available when they were needed, two service users stated that usually staff were available when they were Care Homes for Older People Page 23 of 30 Evidence: needed and three service users stated that sometimes staff were available when they were needed. Comments made by service users included that there needs to be more staff on duty, especially at week ends when there seemed to be less staff on duty and more use of agency staff. We were advised that all care assistants complete a detailed induction programme that meets skills for care standards and that seven of the care assistants have completed national vocational qualification (NVQ) at level II. It was not evidenced how the home is intending to meet the standard of having 50 percent of care assistants with this qualification. From examination of a sample of five staff personnel files, it was not evidenced that recruitment of staff is robust. Application forms were incomplete, with no evidence that gaps in employment history had been explored, references being obtained from colleagues or friends rather than previous employers. POVA first checks are completed before a member of staff starts work in the home, criminal record bureau (CRB ) are carried out, but it is unclear what supervision arrangements are put into place, until the checks are completed. All staff are employed for a three month probationary period and a permanent offer of employment follows if the probationary period is satisfactory. It was not evidenced how the probationary period is monitored or by whom, as one staff file, consisted of a letter to a member of staff detailing why the probationary period was to be extended and the areas of improvement required, these included quality of work, team working and communication. During the period of employment until the end of the three month probationary period, then extended for a second three month period, little evidence was recorded of the monitoring of the staff members performance, two periods of brief supervision meetings were recorded, one stated that X is settling in slowly, the second stated X is still on probation period, little bit of improvement, needs to make more effort. Within six weeks a letter was sent confirming that following a satisfactory you have completed your probationary period. It was not evidenced that two members of staff conduct the formal interview. Brief notes written following the interview of a member of staff , incorrectly stated that the applicant was a qualified health care professional. This was not stated on the application form. Following the inspection we received an action plan from the areas manager advising us of the action to be put into place, with timescales to ensure that all staff are recruited in line with company policy and the commissions national minimum standards. Compliance will be monitored as part of the companies quality assurance procedures and provider representative visits. The home has a training and development programme in place. All staff are expected to complete mandatory training. The company has its own training staff and the AQAA Care Homes for Older People Page 24 of 30 Evidence: stated that the home could do better by increasing compliance with all mandatory training and to train a member of staff to facilitate in house training. The AQAA states that a plan for improvement in the next twelve months is to meet all mandatory training, ensure that new employees receive full and adequate induction and supervision and to introduce competence assessments for all care staff. Duty rosters did not accurately reflect the actual numbers of staff on duty, due to staff sickness or staff simply not turning up for duty. Following the inspection we received an action plan from the area manager detailing what measures were to be put into place to ensure that all staff are recruited in line with company policy and the commissions national minimum standards. This will be completed by the end of April 2010 and will be checked for compliance as part of the the homes quality assurance systems, internal audits and provider representative visits. In addition the action plan detailed action to be put into place with immediate effect as from February 2010, this includes details of induction training for new staff, skills for care induction to be completed with twelve weeks, the allocation of a named mentor, supervision to include personal development and training needs and the manager to meet with all new staff fortnightly to discuss and support integration into the team. This will be checked for compliance as above. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been without a registered manager for some time, this will be addressed with the registration of a manager. Evidence: The home has been without a registered manager since the previous manager resigned in October 2009 after three months in post. At the end of August 2009 the deputy manager was appointed and since then has been managing the home, with support from the regional lead nurse for four days per week and the area manager for one day per week. The deputy manager is one of the two nurses employed permanently on day duty. She is rostered to provide direct care to service users for five mornings and carries out her management role in the afternoons. The regional lead nurse, area manager and the manager from another home came in to assist with the inspection and were present during the two days. We were advised that the manager would be transferring to the home on a permanent basis as from February 2010. This will require the prospective manager, although already registered for another care home, to submit an application for registration as manager at The Care Homes for Older People Page 26 of 30 Evidence: Albany. Service user, staff on duty and visitors were unclear about who was managing the home. Comments made included Never been told, There seems to be more managers around than staff at time, No one seems to have any authority to make a decision or authorise anything. Comments were also made that the deputy manager and the administrator provides an element of stability, at what is a difficult time. Quality assurance systems are in place, including seeking the views of service users, relatives and stakeholders, internal audits and provider representative visits undertaken monthly. We saw evidence of the results of the November 2009 service users, external professionals and relative satisfaction surveys. However, it was noted that out of thirty seven service user surveys sent out, only four were returned, three of the ten external professionals surveys were returned and of the thirty seven surveys sent to relatives, only sixteen were returned. Procedures are in place for dealing with service users monies held in safekeeping. These are audited on an annual basis. Staff meetings are held on a regular basis and we saw evidence of meetings held in December 2009 and January 2010. The regional lead nurse has been meeting with staff on a regular basis to discuss a variety of topics, group supervision and in-house training. She is to move to another area from the beginning of February 2010, to undertake a different role. Formal supervision arrangements do not meet the company policies or procedures. It is intended that following supervisory training the RNs will be able to undertake this role. It is an expectation and an indicator of good employment practice that all staff have regular, allocated time to discuss their work, role and any training needs. A sample of supervisory records were examined and were of a poor standard. Reports written by a provider representative, following a monthly unannounced visit to the home, were available for examination. A sample of records relating to health, safety, fire welfare were examined and seen to be up to date and well maintained. Following the inspection we received an action plan from the area manager detailing what action would be taken to establish a management structure to provide consistent support and leadership to the home, this will include the professional development plan for the deputy manager. This will be actioned by mid February 2010. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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, Care Homes 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 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 29 of 30 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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