Inspection on 25/01/07 for Aabletone

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Aabletone 14/11/08

Aabletone 09/11/05

Aabletone 05/05/05

Aabletone 05/01/05

Aabletone 28/07/04

Aabletone 29/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Aabletone Waltham House Stoke Park Road Stoke Bishop Bristol BS9 1JF Lead Inspector Kathy Marshalsea Key Announced Inspection 09:45 25 & 26th January 2007 th 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 Aabletone DS0000020261.V305565.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. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aabletone Address Waltham House Stoke Park Road Stoke Bishop Bristol BS9 1JF 0117 9682097 0117 9626283 mimal@cedarcarehomes.com 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) Cedar Care Homes Limited Mrs Mary Nyakandi Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate 42 Persons over 50 years of age requiring nursing care. May accommodate up to 3 persons receiving personal care aged 65 years and over Manager must be a RN on Parts 1 or 12 of the NMC register. Staffing notice dated 18/10/2000 applies Date of last inspection 9th November 2005 Brief Description of the Service: Aabletone is a care home registered with the CSCI, and owned by the Cedar Care Hones Ltd, for 42 people over the age of 51 years who require nursing care and may accommodate 3 persons aged 65 and over who require personal care only. It is a period building with bedrooms on two floors served by a lift. There is a spacious lounge leading onto a patio area and a separate dining room. Most of the bedrooms are for single occupancy, but there are double rooms for those who wish to share. The home employs a Physiotherapist who is able to continue rehabilitation work, and also is involved in the provision of activities. There is also a lounge assistant employed who ensures the safety and welfare of the residents who choose to spend their day in the lounge. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s key inspection, was announced and conducted over two days. To complement the information gathered by the inspector during the inspection survey forms were sent to the home for GP’s, health care professionals and residents and/or their relatives to complete. These gave information about what the home does well and any areas which were of concern or could be improved. The manager also completed a pre-inspection questionnaire. There were 35 service users (residents) residing at the home during the inpsection. The manager, Mary Nykandi, assisted the inspector with information gathering during the two days. Other staff were also friendly and helpful. The inspection was very positive and the staff team should be proud of what they have achieved as a whole. What the service does well: Some positive comments on the various survey forms included: “ The home is very nice and clean and I’m well looked after.” “ I have made a lot of friends since I have been here. And the staff are always happy and helpful.” “ I am very happy here.” “ It’s a lovely home and I consider myself lucky to be here. There is nothing to add, everything is 100 .” The 10 GP and 10 health care professional forms were unanimous in their positive responses to their satisfaction with every aspect pertaining to their experience of the home. There was a large majority yes to whether the staff listen and act on what the resident says, one resident commented that the staff are always available if they needed to ask about anything. The relatives survey forms were also very positive-for example one said that their relative had improved since coming to the home and put this down to being cared for by staff who put the resident first. Another said “ the staff are always friendly and share information openly. We have been pleased with the atmosphere and culture of the home”. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 6 The home has a competent and skilled manager who is diligent and professional. She sets high standards and communicates this to staff effectively. This ensures that the residents benefit from care delivery which is of a good standard, is based upon best practice and is individualised. There is a skilled and competent staff team who are recruited selectively and then trained to fulfil their role. The addition of the lounge assistant and Physiotherapist enhances this team so that once the residents have got up their social and physical stimulation can continue. There is a thoughtful attitude towards new admissions with the home recognising the huge impact moving into care can have. New residents can be assured that this process is eased by them having their own nurse to help them settle in. This nurse will continue to be their named nurse. Health care needs are met by the home themselves or by involving other primary care professionals. Frail residents receive domiciliary visits. Staff are trained and competent in health care matters. Medication policies and procedures are adhered to and protect the residents from any medication errors. Enriched diets are provided for those residents who may be at risk from loosing weight and not eating well. There is regular monitoring of their weight and referrals made to the dietician where necessary. The need to respect residents’ privacy and dignity is a key principle of the home’s aims and objectives. Staff are aware that it applies to all areas of the residents’ lives. Residents are consulted about their preferred routine and can make gender choices about care delivery. The opportunity for rehabilitation continues with the Physiotherapist still being in post. It was evident that the emphasis is on keeping residents moving and if they are in a wheelchair keeping their upper body flexible and active. Activities are organised and include some trips out and seasonal themes for arts and crafts. The lounge assistant is also a key team member for providing some activities and these tend to be on a one to one basis. Residents who choose to be in their room see staff frequently as regular checks are done for their safety. Residents are consulted about life in the home via meetings and quality assurance questionnaires. This should mean that the home is being run in the best interest of the people who live there. Complaints are taken seriously and responded to according to the homes own complaints procedure. The manager welcomes complaints as a way of improving the service. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 7 Heath & Safety is taken seriously so that staff and residents can be assured that their safety is of importance to the organisation. What has improved since the last inspection? 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. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 1,2,3 The information given to prospective residents is sufficient for them to make an informed choice about moving into the home. Admissions are managed to make them personal and effective with an understanding of the impact this decision has upon individuals. Pre-admission assessments are comprehensive so that the prospective resident can be assured that their needs have been assessed. Contracts need clarity about the possibility of a refund in the event of a death. EVIDENCE: 1. The Statement of Purpose is being revised to include the details of the staff’s experience and qualifications. There are also plans to make the document more accessible to more residents such as putting it on to an Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 10 audiotape. Although the latest inspection report is not attached to the document it is on display in the home. 2. Contracts were discussed as 2 relatives had queries mentioned in the survey forms. One was regarding any refund in the event of death as the fees are payable a month in advance. The contract was checked and indeed this is not mentioned so needs to be added. 3. The manager completes a comprehensive pre-admission assessment after a referral is received. The prospective resident is visited wherever they are and the family are also included for information gathering. The assessment covers all the areas set down in Regualtion.Other documents to inform the manager are used, such as the Social Services care plans and assessments, so that as much information as possible is gained before a decision is made about the person’s suitability to live at the home. The manager was clear about the admission criteria and gave two examples of one person who she did not agree to admit and one who was deemed to be unsuitable during the trial period. On the second day of the inspection a new admission was expected. It was noted that time and effort was being made to make this a smooth process. A named nurse was working specifically to deal with the admission-over and above the expected numbers of staff on duty- and was reading the relevant paperwork. The room was prepared and the home had bought fresh flowers and left a “Welcome” card for the new resident. The family had also brought in some personal items to make the room more homely. The inspector looked at the paperwork for this admission. It was clear that there were some safety issues which needed to be considered, assessed and communicated to staff. The named nurse stated that they would be completing some of the care plan and assessments after admission. They also stated that information would be passed on to the staff at handover. The Personal Preferences document had been partially completed at the assessment process by the Manger, helping staff to be aware of the likes/dislikes for meals and drinks, but also preferred rising and retiring times. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 7,8,9,10 Care plans are holistic and are enhanced by supporting information such as the “My Care Plan” in the bedrooms which is very individualised. Health care needs are fully met by staff and other health care professionals. After care following accidents/falls needs to improve so that any new risk is assessed. Residents are protected by medication systems based upon best practice and professional guidelines. The principles of privacy and dignity underpin the way the home is run. EVIDENCE: Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 12 7. All residents have a care plan. Four care plans were checked to see if they meet the required standard. Two contained an excellent level of detail of these residents’ preferences. This is commended. All of them detailed the resident’s abilities, had been reviewed regualty, showed the involvement of the resident/relative and included an end of life plan. There was also more emphasis on the plan being holistic and social and emotional needs were present. Care staff confirmed that they are included in the reviewing of the plan. To complement this a plan is written by the named carer which is kept in the resident’s room. This is called My Care Plan and is written in the first person giving an individual and very personal account of how needs should be met.however, this did not include any manual handling needs or any other sisk management. 8.There are health care assessments in place to trigger any changes to a resident’s condition. One example was a recognised Nutrional tool which prompted staff to seek a dietician referral for advice about weight loss. The risk of the development of a pressure sore is also carefully monitored and staff spoken with were very aware of this subject, and their responsibilities in preventing them from developing. Residents have the support of the staff to access health and remedial services in the home and community. Evidence was seen in files of medical, optical, dental, sight and chiropody appointments. Frail residents are visited in the home. Any wounds are checked regularly and there is sufficient written detail enabling the next person to assess any progress or deterioration of that wound. There is also literature in the folder promoting best practice for wound care and keeping staff up to date. Advice is also sought for psychological health; this was evidenced by a referral to a Psychiatrist leading to an evaluation. From this came a request from the manager that staff receive a training session about how to deal with the difficulties of caring for one resident who often resists due to their Dementia.Unfortunately this had been postponed by the trainer. Care staff spoken with found this situation difficult and struggled to understand the best way of helping this resident. This was discussed with the Manger and Clinical manager. There is an emphasis on residents walking and moving enabled by the Physiotherpaist.The inspector witnessed lots of assistance with walking and one resident was effusive win their praise of the Physiotherapist in helping them keep their ability to walk. Accident records were checked. Two residents had suffered falls in January 2007.The accident form prompts the staff to implement safety measures to Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 13 reduce any fiuher risk. One of those is hourly checks by the staff, this was only found in one room of the two residents mentioned. Neither residents had their care plan or risk assessment for falls reviewed and care staff were not clear about measures needed to reduce any recent risk. 9.Medication policies and procedures but also the Nursing, Midwifery Councils standards underpin medication systems. Medication records were up to date and are audited by the Manger periodically. One medicine needed to include the parameters for when this medicine should/shouldn’t be given. 10.The need to offer respect and dignity to all residents is one of the home’s key principles. It is discussed at new staff’s induction and continues to be emhasisied. The manager has this at the heart of her principles and has made this clear to the staff. The inspector witnessed some good examples of this being observed. Staff knocked on bedroom doors and waited before entering the room, screens are used in the lounge and double rooms. The lounge assistant was observed to reassure one resident, who was very anxious, repeatedly over the course of one day. They also had very good communication skills generally. One example was seen of one care assistant who behaved in a way which did not show respect for two residents and poor Manual Handling. This was passed on to the manager. Residents are able to make choices about the gender of the person delivering their care; this was seen in care plans. Aabletone DS0000020261.V305565.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 12,15 The routines of daily living and activities made available are flexible and varied. Choices are exercised by residents in relation to every aspect of their daily life. Some residents would benefit from one to one time with their named nurse. Residents receive a wholesome and balanced diet with provision being made for those who need an enhanced diet. EVIDENCE: 12. The home continues to employ a Physiotherapist who also provides some structured activities and organises trips. Records how some of these trips, for example: Blaise castle, Tea rooms on the Downs, Ashton Court, the Zoo, and Botannical gardens. There was also a summer fayre and seasonal activities such as a church choir coming in to do a carol service and the girl guides coming in to do leaf pictures. This seasonal theme continued with making Xmas decorations, crackers and hats. Displayed around the home were examples of artwork done by the residents. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 15 There is also a monthly church service; the inspector was told that this was arranged at the instigation of one resident unable to go out to a service. The inspector witnessed a lively armchair aerobics session led by the Physio followed by a competitive skittles session! To complement this role there are also Lounge assisitants. They keep their own records of what they do and were observed spending quality time with residents. The inspector observed one of the assistants looking at one resident’s photo album with them, which was continued when they were called away by the home’s administrator. This is commended. Two survey forms from relatives expressed concern at their relative not getting the attention they would be receiving if they were in the lounge. The inspector checked this. There were several residents who were in their rooms for both days of the inspection. One was very clear that this was their choice and that staff popped in to see them as much as they could. Staff spoken with were aware of this person’s likes and dislikes though this was not in great detail in the care plan. This resident obviously knew the staff well and one of the domestic staff was seen to have a good rapport with them. Staff said that they try and spend time just talking with the residents who are in their room and were aware of the risk of them being isolated. They were conscious that they do not always record in their notes if they have spent time just being with them and chatting. This was confirmed by the notes the inspector read. There are hourly checks for the safety of some residents when they are in their room so staff are often popping in to see them. It was agreed with the manager that their named nurse could spend one to one time with those residents who are in their rooms. 15.There was a relief cook on duty on the second day of the inspection. They had not been at the home for a while but even so could remember the likes/dislikes of may residents. Survey forms had been fairly positive about the meals, there are 2 choices and alternatives to that are also given. One person who has different cultural needs for meals has this met. The menu is varied and rotates over 4 weeks. The dining room is pleasantly laid for meals and classical music played during lunch. Assistance was given discreetly and at the residents’ own pace. There is not sufficient space in the dining room for every resident to eat at the same time. This must be kept under review and discussed at the residents meetings so that the home can be sure they are satisfying all the residents’ preferences. The cook was aware of the advice given by the dietician for the residents at risk of loosing weight. Forified milk was being used for them as well as additional protein. They also received extra snacks such as cakes and biscuits throughout the day. This was seen by the inspector. The lounge assistant also offers fresh fruit to every residents daily. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Complaints are taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: 16. The home has a complaints procedure, which is present in various documents such as the contract and statement of Purpose. Survey forms confirmed that people felt able to make a complaint and would know who to refer to. The inspector spoke with one relative who had made a complaint about a year ago. It was agreed that the inspector would check upon this and what actions the home had taken subsequently. The inspector talked to the Manager about this incident and then looked at the documentation. It was evident that the Manager had taken this incident seriously. Recordings are still taking place for the correct fitting of bed rails for that particular resident but also all the other residents who have bed rails in place. (The investigation had been done by an external agency.) Although the complainant had disagreed with the result of the investigation they felt able to make any future concerns known, and had confidence in the care that their relative received. The complaints log showed a responsive attitude and acknowledged the need to satisfy the complaint as quickly as possible. This had been done for two other complaints. One was regarding a member of staff and will be discussed further in the Section 31-38. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 17 The inspector noted that in the minutes of a residents/relatives meeting held last October the Manager had discussed the complaints procedure so that those who are not able to read it are aware of its content. The home has a file of appreciation containing numerous cards and thank you letters from relatives. 18.The home has a revised abuse policy which is clear, instructive and gives the local procedure for involving other agencies. The Manager stated that there have been no actual allegations of abuse though staff did report a member of staff who was not following the home’s procedures. The home keeps an incident log where injuries may be noted but have been unwitnessed. The manager audits this log and stated that the majority of injuries have been one off’s. She also stated that the staff are very good at reporting any changes in any resident’s condition. All staff attend the training in abuse run by Bristol City Council. This is also covered in the care staff’s induction programme. The only use of restraint used in the home is bed rails and wheelchair straps. Consent is obtained for the use of the bed rails. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Residents benefit from a well maintained home which is in good decorative order. It is kept clean and free from offensive odours. EVIDENCE: 19,26.Aabeltone provides a high standard of accomadation. It is well maintained and most rooms are above the average size. Residents are encouraged to personalise their room and bring in small items of furniture. There is a spacious lounge with level access to the patio and garden. The dining room is attractive and also is used by some residents as a “ quieter” lounge. The house was warm, tidy, and clean and had no malodours during the inspection. Furnishings were appropriate for the building and for the needs of the client group. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 19 On a tour of the building it was seen that 2 bathrooms on the upper floor were being converted to shower rooms. All bedroom doors have automatic closures on them so that the doors can be kept open while complying with Fire regulations. This is commended. Bedrooms are re-decorated when empty and some rooms have wooden flooring for hygiene purposes. There is a pay phone for residents to use and is set on a shelf so that it can be accessed by wheelchair users. It was noted that the home has several lifting hoists and stand aids. Toilets have rails to enable independence. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Residents’ needs are met by the number and skills of the staff team. The team are trained and competent to do their job. EVIDENCE: 27. The home employs arrange of staff to meet the needs of the residents. These include named nurses (trained) named carers, care assistants, Physiotherapist, lounge assistants, domestic staff including a laundry assistant, administrator and catering staff plus maintenance men. The home does not need to use agency staff and if necessary utilises staff in the organisation’s other homes instead. The care is delivered by staff who work in a designated area called Zones. A trained nurse leads this group and is assisted by the named carers. The inspector spoke with three named carers about their role. They recognised the need for them to be accountable for their actions and now had more paperwork to complete. This had led to some frustration as they got used to doing this as well as the physical work. They were knowledgeable about their particular residents. A healthy discussion took place about one resident who had been challenging for care delivery. It was evident that extra training is needed and wanted by the staff to understand the process of dementia. It was noted during the inspection that few call bells rang. Those residents who were able to confirmed that they choose when they go to bed and get up. This Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 21 would indicate that there are sufficient staff on duty to meet the needs of the residents in their preferred way. 28.There is a commitment to NVQ training.6 care staff had their certificate for Level 2 and 5 others were waiting for their certificate. 3 staff have also completed their Level 3. 30.The manager is committed to prioritise training and facilitate staff members to undertake external training courses. If a prospective resident is to be admitted and has specialist needs the staff attend training in the subject and then cascade this to the staff group. The home has a range of DVD’s which staff have to watch at prescribed intervals. These include Dementia, Manual Handling, Abuse, Challenging behaviour, Fire, Food Hygiene, First Aid, Good communication and safe working practices. There have also been internal teaching sessions such as Infection control, manual handling, effective communication and wound management. The manager has compiled a list of courses she would like staff to attend in 2007, which are related to meeting the needs of the residents. She is committed to keeping herself up to date with nursing practice and empowers staff to share their knowledge and skills with their colleagues. She also seeks specialist advice for example from St Peters Hospice about completing end of life plans. There is a Skills for Care induction programme for care staff, this is a recognised programme. The inspector saw two examples of this booklet in use. Recently recruited trained nurses had come from other homes in the organisation. Their induction was based upon the housekeeping of being in a different home. Their skills and competency’s had been assessed as part of their adaptation programme with the company. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good The residents and staff benefit from a manager who is competent and able to meet the home’s aims and objectives. There is an open and inclusive management style. Staff are regularly supervised and feel supported in their role. Goals set to improve practices must be checked for compliance. The health and welfare of the staff and residents are promoted and protected. EVIDENCE: 31,32.The registered manager Mary Nykandi, has the required qualification and is highly competent to run the home and meets its aims and objectives. She is able to demonstrate competency in the care of the elderly and the conditions associated with old age. She demonstrates a clear sense of purpose Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 23 and direction to staff who are made aware of the high standard of care that is expected. She has a comprehensive knowledge of the residents, even knowing who the named nurses were for the residents the inspector wanted to case track from memory. The manager ensures that staff are aware of the home’s policies and procedures and checks that they are implemented. As stated previously she is committed to keeping herself up to date with best practice and communicates this to the staff group. There was evidence that the ethos of the home is open and transparent, with the views of the staff and residents listened to and valued. This was confirmed in the minutes of meetings held and from talking with staff. Staff spoken with were positive about the manager. One felt that the standard of care had improved in the home since she had been manager. They said that the care was good before but she had raised the standard higher still. They all agreed that they are more aware of their own accountability and so have more paperwork to complete. They also said that she “was on the ball” and knew what was going on. They feel able to make suggestions to her and know they will be listened to and that their suggestions would be tried. They also felt that the principles of privacy and dignity were emphasised much more and that the Manager had high standards in this area. 36.Supervision records were checked for three members of staff. Sessions are planned in advance for the whole year. Before any staff become supervisors they are taught by the manager. All three files showed regular sessions have been held. One file which the manager was the supervisor contained clear goals for the supervisee, and then showed improvements to the staff member’s practice. Another example did not do that and it was evident that there had been issues regarding some aspect of this staff members practice since 2005.As the sheets were not in chronological order it would have taken time for someone to check back at previous sessions for continuity. The outcomes for old goals set did not appear to have been evaluated. This was discussed with the manager. Quality assurance monitoring takes place based upon seeking the views of the residents. An example of this in the Statement of Purpose was done in June 2006. 29 evaluation forms were given out. In 2006 2 residents’ meetings were held. These took place on a Saturday enabling relatives who otherwise may have been at work to attend. The minutes showed that the meeting contained information sharing as well as welcoming suggestions or concerns. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 24 The same was so for the minutes of various staff meetings. staff are invited to add to the agenda. At the Zone meetings staff discuss the residents in that area so that all staff are aware of their needs and any difficulties. 38.It was evident from the pre-inspection questionnaire that Heath & safety testing is rigorously completed. The inspector checked the Fire Log which complied with Fire safety recommended timescales. Staff are also trained at the recommended timescales of 3 monthly for night staff and 6 monthly for day staff. Regular drills take place to update staff including the night shift. The manager conducts a 6 monthly Heath & Safety audit of the whole building. The latest one was done in November 2006.It showed that any areas of risk such as a leaking ceiling had been attended to. There are other safety checks such as ensuring the water temperatures are not excessively hot and that legionella controls are in place. Risk assessments for any residents at risk from being scalded in the bath were also present. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 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 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X X 2 3 3 Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4)(c) Requirement The registered person must ensure that after any accident/fall to any resident the risk is assessed and any actions needed to reduce that risk recorded and communicated to the staff group. The registered person must ensure that staff have the skills to care for those residents who suffer from dementia and those who challenge the care giver. Timescale for action 26/01/07 2 OP30 18(1)9c)(i ) 31/03/07 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. Refer to Standard OP2 Good Practice Recommendations There should be clarity in the contracts between the service user and home about any refund payable upon death. Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 27 2. 3. OP9 OP36 Parameters for when not to give medication should be included on the medication administration chart. Supervision sessions should have set agreed goals for areas of improvement for poor practice. This then needs to be checked at subsequent sessions. Enhance the social care by the named nurses spending one to one time with their residents regularly and recording this. Include the Manual Handling assessments in the bedrooms so that staff are kept up to date. 4. OP12 5 OP8 Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aabletone DS0000020261.V305565.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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