CARE HOMES FOR OLDER PEOPLE
Aadams Residential Care Home Peel Hall Street Deepdale Preston PR1 6QN Lead Inspector
Ms Susan Dale Key Unannounced Inspection 20th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aadams Residential Care Home DS0000044266.V351407.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.V351407.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.V351407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th May 2007 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 is currently acting manager. Aadams Residential Care Home DS0000044266.V351407.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 and discussions with staff and service users. Various records were examined including medication, care plans and staff files. A partial tour of the home took place. All the findings were discussed with the registered provider. What the service does well: What has improved since the last inspection? Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 6 Previously, personal details of individual service users had been recorded on a white board located in the office and also in a communication book. Action has been taken to remove any personal details and any recordings are now in the communication book or individual files. There has been an improvement in all areas of medicine administration. Records are well organised and audits take place on a daily basis to ensure that medicines are being administered correctly. There is now evidence that where service users are able to self-administer medication, a risk assessment is carried out and a signature obtained from the service user. Permission has been obtained from General Practitioners over homely medication and whether it was suitable for the individuals concerned. Controlled drugs are now stored in a container that is secure. The training of staff has improved with external comprehensive training delivered to staff. Two cooks are now employed over the 7 days; the more senior cook controls the menus and ordering of food. The teas are now prepared by the cook in advance for the staff to easily provide and 5 staff have a Food Hygiene Certificates. The cook confirmed that she has been provided with any new equipment she has asked for in the kitchen including, boards and cutlery; she has also updated her Food Hygiene Certificate. All staff have received training on Adult Abuse and those spoken with understood how to recognise the different types of abuse. The home has a suitable complaints procedure and there was evidence that complaints are now being investigated and recorded appropriately. There have been issues raised about low staffing at previous inspections. The staffing levels have improved and there were sufficient care staff on duty for the needs and numbers of the current service users. The staff induction-training programme has been expanded and now lasts for 1 week. The acting manager ensures that new staff are able to experience all aspects of care whilst shadowing other staff as part of the induction programme. Staff training has improved, there are 18 care staff and 13 staff have a National Vocational Qualification (NVQ) at level 2 or above and 5 staff are in the process of obtaining the qualification. Since the last inspection all staff have received training in Health and Safety. The acting manager who is also the registered provider has been undertaking qualifications and obtained the Registered Managers Award and NVQ level 4 in Care and Management. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 7 Staff meetings have taken place on a regular basis and there is now more opportunity for staff to voice any concerns and contribute in any future planning. There have also been meetings with service users and friends/relatives to obtain their views about the care provided. Questionnaires have been devised and delivered to service users to determine the quality of services provided by the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aadams Residential Care Home DS0000044266.V351407.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 Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 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: The assessment process included the history and family background, physical and psychological 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. The assessment also took into account any requirements/wishes with regard to cultural/religious needs and the preferred gender of any staff assigned to provide personal care. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 10 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. One of the service users recently admitted into the home had no complaints and felt that the staff at the home had gone out of their way to make him feel comfortable and he was very happy. The home does not provide Intermediate Care. Aadams Residential Care Home DS0000044266.V351407.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. Service users are provided with an appropriate care plan that meets physical and health requirements. Medication policies, procedures and storage have been significantly improved to ensure the health protection of service users. 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. A recommendation was made that the weight of any new service user should be recorded as they enter the home. 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. The records contained a
Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 12 document that listed individual wishes with regard to choice of food and whether the meals would prefer to be taken in the dining room or in their own room. Previously, 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 on individual service user files. Action has been taken and the details are now recorded in either the communication book or individual files. There were serious discrepancies with regard to medication procedures and storage at a previous visit to the home. A Pharmacist Inspector provided advice and action has been taken with improvement in all areas of medicine administration. Records are well organised and timings of medicines in relation to food are now correct. The medication records had been signed and audits take place on a daily basis to ensure that medicines are being administered correctly. There is now evidence that where service users are able to self-administer medication, a risk assessment is carried out and a signature obtained from the service user. The medication administration records (MAR) have been divided into morning, lunchtime and evening with separate records for any medication required before food; a separate record was being kept over ‘over the counter’ homely medication. Staff confirmed that they found the new system very easy to manage and had been a big help to ensure correct medication had been provided. Permission had been obtained from General Practitioners over homely medication and whether it was suitable for the individuals concerned. Controlled drugs are now stored in a container that is secure. The training of staff has improved with external comprehensive training delivered to staff. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome group was good. The home provides activities that meet the expectations and capabilities of the service users and visitors to the home are made to feel welcome at all times. Meals have improved with a varied menu that provides service users with nourishing meals according to their wishes. 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. Some of the service users spoken with confirmed that they had been previously within other homes and were far happier in Aadams. Comments included: “Its grand here”, “I have no complaints at all”. “They have taken me out on trips in my wheelchair and I’ve really enjoyed it.” “The meals are good and plenty of it.”
Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 14 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. Dominoes were taking place during the inspectors visit. There has recently been a trip out to Blackpool Illuminations with a fish and chip supper and a Halloween Party has taken place with photos displayed of recent events. A Christmas Party open day is to be at the home on the 1st December 2007 with an invitation for anyone to attend. Staff encourage service users to dance in the afternoon as they listen to music and there are regular sing-a- longs with a professional entertainer. One of the senior staff is involved with the activities and she has been recording the details of any activity undertaken by service users on an individual daily basis or whether they preferred to not participate. Some advice was given about how the activities could be improved by sending staff on training courses that could help them with ideas and questionnaires that could be provided to service users following any events to monitor their appreciation of different events. There have been concerns previously over the lack of a full time cook and staff having to prepare and provide teas that took them away from care. Staff who prepared meals did not have a Food Hygiene Certificate. This has now improved with 2 cooks employed over the 7 days; the more senior cook controls the menus and ordering of food. The teas are now prepared by the cook in advance for the staff to easily provide and 5 staff have a Food Hygiene Certificate. The cook confirmed that she has been provided with any new equipment she has asked for in the kitchen including, boards and cutlery; she has also updated her Food Hygiene Certificate. Menus are planned over 4 weeks and take into account any preferences or dietary needs. There was evidence of a detailed account of likes and dislikes for a service user who has been refusing to eat and the cook has tried various ways of tempting to her eat by the way the food is displayed etc. The cook also now ensures that service users get fresh vegetable every day and home baking. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 15 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 group was adequate. Policies and procedures in place to ensure that service users are protected from abuse need to be clarified in order to ensure that staff know what to do in the event of any abuse. Complaints and there investigation are now being recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff have received training on Adult Abuse and those spoken with understood how to recognise the different types of abuse. It is important that all staff are made aware of the procedures to be followed in the event of an allegation of abuse and how it could affect staff. The Abuse policy must be expanded to show explicitly, what staff have to do in the event of an allegation of abuse. The policy currently does not include any procedures to follow and although the acting manager is aware of the reporting procedures, senior staff need to know what to do in the absence of the acting manager. The home has a suitable complaints procedure and there was evidence that complaints are now being investigated and recorded appropriately. The complaints are clearly recorded and it was recommended that the outcome of each complaint once the investigation has been concluded should also be recorded. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 16 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 a certain
Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 17 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. A record of routine maintenance is maintained. Since the last inspection all staff have received training in Health and Safety. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 18 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. Evidence must be made available of security checks showing staff have been recruited appropriately. 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. The staffing levels have improved and there were sufficient care staff on duty for the needs and numbers of the current service users. There are now 2 dedicated cooks covering the 7 days and as they prepare teas there is more time for care staff to provide care and quality time with the service users. Staff spoken with confirmed that they have adequate time to carry out care duties. A domestic is employed who also has a separate contract to provide care. Recent staff recruitment was examined and on those seen there were inappropriate references one was ‘To whom it may concern’ and there were no references from the last employer. There was no evidence of checks carried out with the Criminal Records Bureau (CRB) or the Protection of Vulnerable Adults (POVA) Register. The acting manager confirmed that the
Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 19 security checks are carried out by an external company who confirm when the checks have been carried out by phone. It is important that evidence of security checks is provided in writing and that 2 appropriate written references are obtained prior to any new staff commencing. The staff induction-training programme has been expanded and now lasts for 1 week. The acting manager ensures that new staff are able to experience all aspects of care whilst shadowing other staff as part of the induction programme. 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). All staff have now received training in Health and Safety and Infection Control. There are 18 care staff and 13 staff have an NVQ qualification at level 2 or above and 5 staff are in the process of obtaining the qualification. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 20 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, 36 & 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 opened and there have been three further managers since none of whom applied for registration with the Commission for Social Care Inspection. Currently the registered provider is acting as manager with the help of several senior staff and has applied to be registered as manager with the Commission. The acting manager has been undertaking qualifications and obtained the Registered Managers Award and NVQ level 4 in Care and Management.
Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 21 Apart from the senior staff on duty, staff confirmed that they had received one to one supervision; informal support was in place for the senior from the acting manager. The senior staff spoken with confirmed that she provided formal supervision to care staff. Staff meetings have taken place on a regular basis and there is now more opportunity for staff to voice any concerns and contribute in any future planning. Staff are encouraged to comment on the agenda, which is provided in advance. There has also been meetings with service users and friends/relatives; the comments of service users and their relatives were recorded as well as any areas of concern and how the home would address those issues; generally the comments were very positive. Staff confirmed that the registered provider was supportive and that they enjoyed working at the home. Questionnaires have been devised and delivered to service users to determine the quality of services provided by the home. The home has been awarded Investors in People status. 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 and a record is kept of all accidents/incidents. All staff have now received training in Health and Safety and Infection Control. Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 3 Aadams Residential Care Home DS0000044266.V351407.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement Evidence must be provided of security checks and two appropriate written references for new staff to ensure the protection of vulnerable service users. A manager must be registered with the Commission for Social Care Inspection. Timescale for action 01/12/07 2 OP31 18 28/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1. OP8 A record of weight should be recorded as service users enter the home and then regularly maintained to ensure the health of the service users. 2 OP18 A procedure should be recorded and the information provided to staff about the reporting procedures in the event of an allegation of Abuse. 3 OP36 The acting manager should provide senior staff with formal supervision. Aadams Residential Care Home DS0000044266.V351407.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
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