Inspection on 13/07/05 for Aaron Court

This inspection was carried out on 13th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Aaron Court 01/11/07

Aaron Court 30/07/06

Aaron Court 06/12/05

Aaron Court 17/03/05

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 Aaron Court 328 Pinhoe Road Pinhoe Exeter EX4 8AS Lead Inspector Rachel Fleet Unannounced 13 July 2005 10:00hrs 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 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. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Aaron Court Address 328 Pinhoe Road Pinhoe Exeter Devon EX4 8AS 01392 279710 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Salisbury Care Limited Care Home 24 Category(ies) of OP Old age (24) registration, with number of places Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The Responsible Individual must obtain NVQ2 in Care by 2006 Date of last inspection 17 March 2005 Brief Description of the Service: Aaron Court is registered to accommodate 24 residents of retirement age. Mr Jay Patel is the Responsible Individual for the Home, having taken it over earlier this year. Currently, only a maximum of 21 residents are accommodated, as bedrooms registered for shared occupancy are used on a single occupancy basis only. The Homes staff do not provide nursing care. It is situated in a residential area of Exeter, close to local shops and a hotel. There are well kept grounds, with patio areas to the rear of the Home, and car parking at the front. There are two lounge/dining areas, and a garden room that people who wish to smoke may use. The first floor is accessed by stairs or the stair lift. All bedrooms have en suite toilet facilities. Because of some environmental aspects, admission of someone with restricted mobility has to be carefully considered. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 19 residents at the Home on the day of the inspection, with two away elsewhere. The inspector spent six hours speaking with nine residents around the Home, two care staff and the chef, as well as looking at documentation, before sharing her findings with the Acting Manager, Sally Ozols, and Mr Patel. As the new Responsible Individual for the Home, Mr Patel was concerned to ensure that residents were well cared for (in a practical way) during the initial period following the change of ownership, and this appears to have been achieved. He has prioritised other matters (such as documentation, etc.), to address them within the first year of the new ownership. Since the last inspection there has been one complaint, part of which was not upheld and part of which is still being investigated by Mr Patel. What the service does well: What has improved since the last inspection? What they could do better: Whilst aspects of medication systems and Health and Safety management are satisfactory, immediate attention was required to ensure appropriate records are kept of medication received into the Home, and that fire safety checks are Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 6 carried out and recorded at recommended intervals. Other aspects of medication management should also be made more robust. Individualised plans of care are written for each resident, as required. These could inform staff better if all needs are identified (for residents developing dementia, for example), and if plans include how health needs of residents are to be met - including any input from district nurses, etc. Cross-infection risks to staff handling soiled laundry can be reduced. And washing machines with the ability to disinfect heavily contaminated laundry should be obtained in the event of such a risk developing at the Home. Safety risks to residents could be better identified if all staff are aware of appropriate checks to be carried out on bedrails. The Acting Manager has experience of managing a care home. However, they have not yet been registered with CSCI. This would confirm their fitness to manage this particular care setting. 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. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Prospective residents have good information to help them make an informed choice about whether the Home would suit them or not. EVIDENCE: The Service User Guide has been amended since the last inspection to include information about fees. Information for prospective residents is comprehensive. One relatively new resident said she found things much as they had been described to her prior to admission, and felt very settled. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 & 9 There is a good care planning system in place to inform staff of residents’ needs generally, and residents benefit from good multi-disciplinary working to meet their health needs. However, less detail in assessment and recording of needs of some residents means that some needs may not be met, and there may be inconsistencies in standards of care regarding health needs. Medication systems have been improved, but are not yet sufficiently robust to ensure safe management of residents’ medications. EVIDENCE: Care plans were detailed and personalised, reflecting individuals’ needs and preferences. There was evidence that some residents had been involved in planning their care. Some needs had not been recorded in some plans. Regarding needs related to dementia, for example. Physical health needs are well attended to, as confirmed by residents, and with staff able to explain care given. But this was not reflected in care plans – to show how health needs were to be met (relating to two residents with diabetes and one on warfarin, for example), when district nurses were involved, etc. – which could lead to inconsistencies in standards of care. Residents’ weights are regularly monitored. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 10 Improved storage facilities have been obtained for general medications, and for items needing cold storage. Making storage more secure was discussed. Stocks of controlled drugs were not being accurately recorded - an issue noted at the last inspection, so a requirement was made that this now be addressed within 28 days. Mr Patel explained how he would remedy this problem. It was not clear what dose had been given to one resident, when the medication prescribed had a variable dose. Handwritten entries were not signed to show two people had checked the instruction was accurate. A risk assessment is carried out when residents wish to be self-medicating, which is good practice. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 11 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 standard(s) 12 & 15 Residents’ lives are enhanced by the social, recreational and faith-related opportunities offered. The meals in the home are good, with regard to having choice and variety. Dietary intake needs careful monitoring to ensure all individuals’ preferences are discussed and met as much as possible. EVIDENCE: Residents said they had enough to do during the day and did not get bored, several being able to occupy themselves in some way. One who preferred to stay in their room said they were still informed of any organised events. One said she felt free to use the lounge whenever she wanted to. Some felt there was a limited activities programme at present, but were also aware of the Home’s plans to organise more activities. One enjoyed the trip to Powderham Castle the previous week; one enjoyed the monthly musical entertainment and quizzes. Ministers of different denominations visited residents who wanted to see them, the Home helping to organise this when needed. The majority were positive about the food provided. One said the chef was open to suggestions, and food had improved since his employment. Two said there was a good variety. Others said they were told in advance what the meal was to be and given the chance to ask for an alternative. A cake was made for each resident’s birthday. One suggested that it would be nice to have salad Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 12 daily but was otherwise happy with the food provided; one felt teatime portions were too small. These points were discussed with Mr Patel who said he would speak with the chef, residents and staff, particularly to ensure all residents had enough to eat in the evenings, and that everyone knew high tea was available 4.30-5pm and supper 6-9pm. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 13 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 standard(s) 16 & 18 There is a satisfactory complaints procedure, with systems for obtaining residents’ views and hearing their concerns or complaints. Residents are protected by the Home’s polices and procedures for the protection of vulnerable adults. EVIDENCE: Residents said they had no reason to complain, but felt able to speak to at least one staff member if they had a complaint in future. The Complaints procedure is displayed at the entrance to the Home, as well as being included in information given to each resident on admission. Mr Patel speaks with each resident almost every day. There has been one complaint by a third party since the last inspection, relating to concerns about a resident’s condition on admission to hospital. One aspect of the complaint is not upheld, and Mr Patel is currently investigating two other aspects. A letter (-received from relatives of the resident concerned, since the complaint was made) was seen at the inspection, containing positive comments about care given by the home. The Acting Manager had undertaken training that enables her to train other staff on protection of vulnerable adults. Staff said they had had some training and discussion on matters related to protection of vulnerable adults, and described what action they should take if they suspected abuse was occurring. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 24 & 26 The standard of the Home’s environment, both internally and externally, is good - providing residents with a well maintained, safe, clean and homely place to live. Laundry facilities need monitoring to ensure action is taken as necessary to avoid unnecessary risks to residents’ health from cross-infection. EVIDENCE: Residents said they were satisfied with their own accommodation, and staff felt there were no problems for any of the current residents regarding their facilities. Bedrooms were personalised, reflecting residents’ personalities and lives. Aids were seen in toilets and bathrooms to maintain independence. Inventories were kept of personal effects. Lockable storage facilities are provided in each bedroom, should residents wish to lock valuables away, or want to be self-medicating. Several residents enjoyed sitting out in the paved garden area, able to sit in shade if they wished. Residents were happy with the cleanliness of the Home, which was of a high standard in all areas (including the kitchen) on the day of this unannounced inspection. One said the cleaner had pulled moved all the furniture in their room on the previous day, to clean behind it all. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 15 Laundry facilities are still being monitored; machines do not have recommended programmes, but related risks are relatively low. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 There are sufficient staff able to meet residents’ current needs. Residents would benefit in the long term if staff had updating with regard to residents’ needs so that any changing needs are also met. EVIDENCE: Residents’ comments included ‘Everyone’s very nice’, ‘You’ve only got to ring the bell and they’re there’, and ‘They’re mixed – as you’d find everywhere’. Staff were described as patient, and respectful. Residents felt staff knew what help they wanted, when they came to assist them. Two with mobility problems said staff did not rush them. There is more ancillary support for care staff, since the employment of the chef and a domestic. Staff confirmed they had had training on topics related to safe working practices. They had good knowledge of fire procedures, for example, the training having been carried out by an appropriately qualified trainer. Staff had had less training on care more specifically related to residents (diabetes, bereavement, etc.). They felt supported by senior staff and colleagues, with opportunity to express their views at staff meetings and on a one-to-one basis. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 38 Whilst there is no Registered Person in charge with a care-related qualification, etc., there is potential for reduced standards of care for residents. Systems for consulting residents are good, with a variety of evidence that their views are sought and acted upon. Some aspects of health and safety are not sufficient at present: attention to fire safety checks, cross-infection risks from soiled laundry, and safety checks on bedrails would ensure safety and health of both residents and staff are better promoted. EVIDENCE: The Acting Manager has been in post for three months approximately. She has been a CSCI-registered Manager at another care setting offering a different category of care. An application is yet to be made to register her as manager of this Home. Mr Patel intends to gain a care qualification but has not commenced the course yet, because of commitments in managing the care home during the new period of ownership. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 18 Residents spoke about regular conversations with Mr Patel, and requests they’d made for different things, which had been dealt with. There are no residents’ meetings, but their views are sought informally in this way (i.e. on a one-to-one basis) and through surveys. Results of the latest survey have been shared with residents, along with the action to be taken where weaknesses in the service were identified. Mr Patel and the Acting Manager had recently undertaken Health and Safety training. Mr Patel confirmed servicing of equipment was up-to-date, although he was still arranging contracts, as the new owner of the Home. Residents and staff confirmed certain fire safety checks were carried out regularly. However, records had not been kept of such checks, and some had not been carried out as frequently as recommended (fire alarm testing had not been done weekly, for example). Action has since been taken to correct this. The kitchen was well managed, with fridge temperature readings recorded, and leftovers dated when put in the fridge, for example. Staff said they rinsed any soiled laundry items by hand before putting them in the washing machine. This unnecessarily places staff at risk of cross-infection. One staff was not sure about safety checks to be carried out on bedrails. A valid insurance certificate for the Home was displayed. Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 1 x 3 x x x x 1 Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement You must make arrangements for the recording of medicines received into the care home.This is especially regarding controlled drugs received into the home. Previous timescale of 31 03 05 not met. You must ensure, after consultation with the local fire authority, that you make adequate arrangements for testing fire equipment at suitable intervals, keeping records to evidence action taken. You must appoint an individual to manage the care home and who is fit to do so. This requires registration with CSCI. Timescale for action 10 08 05 2. 38 23 (4)(c)(v) 10 08 05 3. 31 8&9 31 10 05 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 8 Good Practice Recommendations You should evidence how health needs are to be met, including access to health care services, or communication with health care staff, to meet assessed needs.This was D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 21 Aaron Court 2. 9 3. 4. 9 9 5. 26 6. 38 especially with regard to care of residents on warfarin, those with diabetes, & other needs usually managed by the district nurses. You should ensure safe storage systems by keeping the drug fridge in a lockable area (unless it is a lockable fridge) & securely affixing the CD storage box within the cupboard. It is recommended that a register be maintained to record the receipt, administration and disposal of Controlled Drugs. You should ensure that it is possible to determine from the administration record what amount of medication has been administered to service users, when the medication is prescribed with a variable dose, and ensure that handwritten entries on medication sheets are signed & dated by relevant staff. You should promote systems for control of infection & ascertain that systems are sufficient to control spread of infection, with regard to 1) the practice of hand-rinsing soiled items, which should cease; 2) the washing machines that do not have recommended programmes.This recommendation is carried forward from the last inspection. However, it has been agreed with the new Responsible Individual that he will monitor cross-infection risks, and purchase washing machines with recommended programmes if cross-infection risks increase, or when existing machines break down. You should ensure that all staff are aware of safety inspections of bed rails, as recommended in guidance from the Medical Devices Agency (July 2001). Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Aaron Court D54 D06_s62304_aaroncourt_v230801 130705 stage 4.doc Version 1.40 Page 23 - 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. 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