Inspection on 11/05/07 for Aadams Residential Care Home

This inspection was carried out on 11th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aadams Residential Care Home 01/10/08

Aadams Residential Care Home 20/11/07

Aadams Residential Care Home 09/05/06

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

CARE HOMES FOR OLDER PEOPLE Aadams Residential Care Home Peel Hall Street Deepdale Preston PR1 6QN Lead Inspector Ms Susan Dale Key Unannounced Inspection 11th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aadams Residential Care Home DS0000044266.V334740.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. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aadams Residential Care Home Address Peel Hall Street Deepdale Preston PR1 6QN 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) 01772 258977 Mr Salim Adam vacant post Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability (2) of places Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2006 Brief Description of the Service: Aadams Residential Care Home was first registered in November 2005. Formally a Local Authority Residential Home, the building is purpose built on 2 levels and is located close to the city centre of Preston. The building has been considerably improved and adapted in order to meet the environmental standards necessary for registration. All the bedrooms have en-suite bathrooms and there are several lounges including a smoking room, dining room and bathrooms. The owner/responsible individual has ensured that the décor, furniture and fittings are of a high standard and ensures oversight of the home on a daily basis. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and the report is compiled from evidence sent prior to the inspection including a pre-inspection questionnaire and comments from service users their friends and relatives. During the site visit the inspector spoke to the registered provider, staff, service users and visitors to the home. Various records were examined including care plans and staff files. All the findings were discussed with the registered provider. What the service does well: What has improved since the last inspection? The care records have been considerably improved and expanded upon with an assessment that takes into account physical, emotional, cultural and religious needs. The details include a photograph and the signatures of service users. Previously care staff had to cook and clean as well as provide care; the home now employs a cook and domestic, The number of qualified care staff has risen with 10 care staff out of a total of 17 care staff achieving a National Vocational Qualification. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 6 A training programme has been devised and staff are gradually receiving the training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 7 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 Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. An assessment is carried out that ensures the needs of any new service user can be met by the services provided by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an improvement in the assessment process for new service users with an expansion on the recorded details. The assessment process included the history and family background, physical and physiological health, social networks, interests and hobbies, religious and cultural needs. The details also recorded the reasons for being admitted to the care home and how the individual concerned felt about having to be admitted. Risk assessments had been also carried out including the risk of falls and pressure sores. A judgement was made as to whether one or two carers were required for personal care and the need for any special equipment. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 9 A relative spoken with confirmed that they had been involved in the process of assessment and service users spoken with confirmed that they had been able to visit the home before making a decision whether to live there on a permanent basis. One service user was staying at the home on a temporary basis and stated that she would be quite happy to return to the home if necessary in the future. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. The care plans record individual health, personal and social care needs and staff show respect and understand the importance of privacy. There is a need for improvement with regard to the recording of medication, storage and staff understanding of the process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans seen were comprehensive, up to date and included a signature from the service users or their representative and a photograph. Staff were observed to treat the service users with respect and understood the importance of privacy. Service users had signed disclaimers with regard to being checked at night. A record had been kept of baths/showers and weight. The procedures within the home are relaxed and service users can get up and go to bed assisted by staff at any time they wish. Visitors to the home are welcome at any time. A relative made the following comment: “They are always checking to see if my mum is ok and keep me up to date.” Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 11 “Management discussed their concerns when mum had a period of time being depressed.” Personal details of individual service users had been recorded on a white board located in the office and also in a communication book. A recommendation was made that personal details should not be recorded where other persons can see them and that the details should be recorded on individual service user files. It was not clear that a service users ability to self medicate was recognised and assessed. The assessment process needs to judge whether the service user can self medicate and any potential risk that could arise if they do so. There was evidence that staff liaised with health professionals over the care of service users with a recording made of visits by general practitioners and district nurses and visits to hospital. The medication procedures and storage were examined. The medication trolley was observed to be unattended and unlocked close to service users for a considerable length of time. This presents a risk to vulnerable service users some of whom have various levels of confusion. The medication records had missing gaps and the medication returns book had not been completed since 2006. Controlled drugs had not been recorded appropriately and there were unused controlled drugs that had not been returned to the pharmacy. The storage of controlled drugs is kept within a dedicated locked room however the box they are kept in is bolted to a towel holder that could easily be removed from the wall and is therefore insecure. There was no evidence that oversight or an audit was being carried out by a qualified, responsible person over the provision of medication. There were certificates on the wall showing several staff that have been provided with medication training by a local pharmacist. A senior staff member spoken with confirmed that the training had been provided but appears to have of very short duration lasting a maximum of a couple of hours. Because of concern over the medication procedures a referral has been made for a random inspection by a pharmacist inspector. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. Service users are cared for appropriately and are able to exercise control over their lives and maintain contact with friends and relatives. Meals should be given a higher priority by an increase in dedicated cook hours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the service users spoken with expressed their pleasure over the care and attention they received. Visitors can come and go as they please and those spoken with also expressed their satisfaction over standards within the home. Activities include bingo, dominoes, live entertainment, crafts, spring and summer fairs, outings to town and organised trips. A hairdresser attends the home and the ladies have their nails done. Various clergy visit the home on a regular basis. Bingo was taking place during the inspectors visit and a relative who was visiting the home was organising the event. Visitors made the following comments: Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 13 “The staff are always attentive and you are made to feel welcome when you visit.” “ We feel fortunate that we obtained accommodation at Aadams Care Home. On the frequent visits we make to see her she is always content with her accommodation, meals and attention received from the staff.” “The food seems enjoyable and plentiful.” When asked how the home could be improved there was a comment that there could be more games such as card and board games. Another comment said that some of the service users found it difficult to use the phone and that there should be more effort to stimulate service users and move away from just watching TV. There have been a few changes with regard to staff employed to cook. In some cases, staff have been employed on flexible contracts to either cook, care or domestic duties. Currently there is a dedicated cook who is employed to work over seven days; staff usually covers tea times. This is not satisfactory as it means that the cook does not get two days off a week and staff are pulled off caring duties to provide teatime cover. There are no dedicated kitchen assistants to assist the cook who, has to provide lunch and prepare tea in a very short space of time. Staff assisting with tea do not have an appropriate qualification such as Food Hygiene and Food Safety. These issues were discussed with the Registered Responsible Person/Owner of the home who has stated he will recruit an additional cook to ensure that a dedicated and appropriately qualified staff member provides all meals. Service users spoken with expressed their satisfaction with the meals provided and that they offered choice. The cook stated that she was aware of special diets and was gradually getting to know the wishes of individual service users. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Adequate. Policies and procedures are in place to protect the rights of service users but there are no systems in place to record the details of any concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure that is on display within the home. Service users and relatives confirmed that they had no complaints about the home but some were unsure of the procedure to follow in the event of a complaint. A record of complaints has not been kept by the registered responsible person/owner of the home or the previous manager despite the fact that there have been several complaints made to the Commission for Social Care Inspection (CSCI). The complaints have been investigated by the home and improvements made where necessary. There is a need to keep a record and date any concerns including minor concerns and detail the investigation and the outcome. The record can then be used for monitoring the quality of care within the home and taken into account as part of forward planning. Staff were aware of Adult Protection issues and all staff are to receive training on Adult Abuse in June 2007. There have been no incidents of abuse within the home and no referrals of staff to the Protection of Vulnerable Adults (POVA) Register. All prospective staff are checked to ensure that they are not on the Protection of Vulnerable Adults Register (POVA) before commencement. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. Service users live in a safe, very comfortable clean environment that meets their physical needs in a homely way and provides quality secure accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas of the home were clean and comfortable and a great deal of trouble has been taken to ensure that the surroundings are stylish and at the same time meet the needs of the service users. There are ample assisted bathing and toileting facilities; each service user’s bedroom has a toilet and hand basin. Specialist equipment is provided as required including a portable hoist and handrails etc. The home has ample communal rooms including a smoking room that can only be used by service users. The home employs domestic help who is also a care assistant his hours vary according to the requirements on the staffing rota. All staff have certain Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 16 responsibility to carry out cleaning and have to complete a record to show that tasks have been done and the amount of time they have been able to spend with service users. There were some cleaning materials that had been left out around the home and in the bathrooms where they could be a danger to certain service users. A record of routine maintenance is now being maintained. The training records show that only 2 staff have received training in Health and Safety and none of the staff have received training in Infection Control. A recommendation was made that the training should be provided to all staff as soon as possible. One of the relatives spoken with had some issues about the cleanliness of her mother’s room, which was examined and found to be acceptably clean and tidy. Relatives made the following comments: “ Sometimes the bedroom could be cleaned better but in the main a good standard is maintained.” “The care home provides a safe clean environment.” Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. Staff are provided in sufficient numbers and have the skills to provide suitable care for the needs of the current service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been issues raised about low staffing at previous inspections. According to the registered provider/owner the staffing rota has been improved and additional staff have been recruited. There were sufficient staff on duty at the time of the site visit. One of the problems has been that staff have been recruited on flexible contracts for example Care/Domestic and Care/Cook. When there is a shortage of care staff the staff member employed for domestic duties or cooking is instead allocated care duties and all staff are then expected to do the cleaning or cooking. A dedicated cook has recently been employed and this has eased the situation. As previously referred to the cook is employed 7 days a week but only covers breakfast and tea and there is no dedicated relief cook. Staff confirmed that they sometimes had to work additional hours to cover for staff absence and some staff had been asked to come in on their days off. Staff spoken with confirmed that they had received an induction prior to commencement and training had included, First Aid and Manual Handling. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 18 A training matrix was provided and the programme includes Basic First Aid, Fire Safety Awareness, Manual Handling, Medication, Adult Abuse Health and Safety, Food Hygiene and National Vocational Qualifications (NVQ). There is a need to improve the number of staff with Health and Safety training and Food Hygiene and training should be provided on Infection Control. Additional training such as Dementia Care would also be helpful to staff. There are 17 care staff and 10 have an NVQ qualification at level 2 or above. There is a suitable recruitment procedure and the staff records showed that staff have been recruited appropriately with references and checks undertaken with the Criminal Records Bureau and the Protection of Vulnerable Adults Register. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 & 38 Quality in this outcome area is adequate. The service users and staff would benefit from an experienced manager who encourages effective teamwork and establishes some long-term goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without a registered manager soon after it was first registered and there have been three further managers since none of whom applied for registration with the Commission for Social Care Inspection. Currently the registered responsible provider/owner is acting as manager with the help of several senior staff. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 20 The registered provider has been undertaking qualifications and is currently awaiting confirmation for the registered managers award and NVQ level 4 in Care and Management. There was no evidence that one to one supervision of staff was taking place although there was evidence of staff appraisals. Staff meetings have taken place on a regular basis. There needs to be more opportunity for staff to voice any concerns they may have and to feel that they are able to contribute in any future planning. Service users and there friends/relatives should also be encouraged to contribute in the running of the home. Staff confirmed that the registered provider was supportive and that they enjoyed working at the home. Relatives made the following comments when asked what the care home does well: “Taking a personal interest in the residents including those who receive few visitors.” “The service is of a very high standard.” “Management always willing to talk about mum’s welfare.” Financial records are kept and the home has secure facilities for the safekeeping of any valuable belonging to service users. All the records seen were up to date and kept under review. Risk assessments are carried out with regard to the health and safety of service users and staff although as previously referred to, there is a need for all staff to have Health and Safety and Infection Control training. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard OP9 OP9 Regulation 13 13 Requirement The medical trolley must be kept secure at all times. The recording on the MAR sheets and Controlled drugs record must be checked and audited on a regular basis for any discrepancies. The recording of returned medicines must be kept up to date. Service users must be allowed to self medicate where possible and following an assessment of any risk. There must be sufficient staff on duty including a cook and domestic to meet the number and needs of the service users. A manager must be recruited and registered with the Commission for Social Care Inspection. The registered provider must give notice to the Commission of the occurrence of any death, serious illness or other events that could effect the well being of service users. Timescale for action 31/05/07 31/05/07 3 4 OP9 OP9 13 13 31/05/07 31/05/07 5 OP27 18 31/05/07 6 OP31 18 31/05/07 7 OP38 37 31/05/07 Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP10 OP16 OP18 OP26 OP15 OP32 Good Practice Recommendations Any personal details about individual service user should be recorded on their personal file. A record should be kept of all complaints and concerns and any subsequent investigation. All staff should be provided with training on Adult Abuse and Whistle Blowing. All staff should be provided with training in Health and Safety, Infection Control and Food Hygiene. Any staff that assist or provide meals should have a Food Hygiene Certificate. Any new manager must communicate a clear sense of direction and provide opportunities to involve the staff and service users in the process. Aadams Residential Care Home DS0000044266.V334740.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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