Inspection on 30/07/06 for Aaron Court

This inspection was carried out on 30th July 2006.

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

Aaron Court 01/11/07

Aaron Court 06/12/05

Aaron Court 13/07/05

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 Aaron Court 328 Pinhoe Road Pinhoe Exeter Devon EX4 8AS Lead Inspector Louise Delacroix Key Unannounced Inspection 30th July 2006 9:10 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 Aaron Court DS0000062304.V293713.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. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aaron Court Address Aaron Court 328 Pinhoe Road Pinhoe Exeter Devon EX4 8AS 01392 279710 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) Salisbury Care Limited Manager post vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Aaron Court is registered for 24 residents of retirement age. Mr Jay Patel is the Responsible Individual for the Home, having taken it over earlier this year. Currently, a maximum of 21 residents live at the home as bedrooms registered for shared occupancy are used on a single occupancy basis only. The home is built in a residential area of Exeter, close to local shops and a hotel. There are patio areas to the rear of the home and car parking at the front. There are two lounge/dining areas, and a covered area for people who wish to smoke. Stairs or the stair lift access the first floor. All bedrooms have en suite toilet facilities. Because of some environmental aspects i.e. lack of shaft lift and a steep slope in one corridor, admission of someone with restricted mobility has to be carefully considered. The weekly cost ranges from £400 - £450 per week, with additional charges made for hairdressing, chiropody, toiletries and newspapers/magazines. The statement of purpose is on display in the hall. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over ten hours and half hours and was unannounced. Ten residents contributed to the inspection, as did the manager and staff members. Prior to the inspection, surveys were sent to residents, staff members, visitors/relatives, and health and social care professionals, which have been incorporated into this report. As part of the inspection, three people were case tracked; this means that three residents were asked about their experience of living at the home, their rooms were visited and the records linked to their care and stay inspected. During the inspection, a tour of the building took place and records including fire, care plans, staff recruitment, training and medication were looked at. Time was spent talking to residents individually and in a small group and a period of time was spent observing the experience of residents sitting in one of the lounges. What the service does well: The manager encourages prospective residents and their representatives to visit the home before they move in. Residents complimented the staff on the care they received and felt that their medical needs were well met, which was echoed by visiting professionals. Medication is generally well managed. The manager had put good systems in place to promote the well being of the residents during the hot weather. The home has good communication systems in place that respect confidentiality and are kept in a professional manner. Generally, residents feel listened to by staff and treated with respect with their dignity maintained. Some residents were positive about the activities on offer at the home, while other people said they preferred to stay in their rooms and occupy themselves. Visitors are made welcome and events take place within the home that encourages the participation of friends and relatives, such as a summer barbeque. In most areas choice is offered and residents spoke about creating their own routines within the home. Staff are aware of their responsibilities and how to respond to reports or observation of poor practice. The home is well maintained, clean and odour free with residents’ rooms personalised. Residents were positive about the availability of staff to meet their needs, and appreciated the stable staff group. The level of training to NVQ level 2 in care or above is good, and the acting manager promotes staff training. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 6 The acting manager has responded promptly to issues raised at the inspection and actively seeks the opinions of staff and residents about the running of the home. A number of staff said they felt well supported by the manager, which included supervision and staff meetings. Safety checks are generally well maintained. 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. Aaron Court DS0000062304.V293713.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 Aaron Court DS0000062304.V293713.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good admission and assessment process, which ensures that the home is able to meet residents’ needs. EVIDENCE: A resident was met who explained that they were unable to visit the home because they lived too far away but they had given permission for their family to make the choice on their behalf. Another resident said they had been too unwell to visit but had entrusted the choice to their family. Another person said they had been able to visit with their care manager. The home’s statement of purpose promotes people visiting the home before they move in and the completion of an initial admission assessment. Assessments were seen on file and the manager confirmed that assessments from Social Services were also requested and provided. The home does not provide intermediate care. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans need further improvement to ensure that all aspects of health and personal care are recorded and in a way that residents are involved in. Medication and health care needs are generally well managed. The residents generally benefit from staff who treat them with dignity and respect, although a few staff need to develop this skill further. EVIDENCE: As part of the inspection, three people were met and where possible conversation took place about their thoughts on the service. Their care plans were then looked at and discussed with the acting manager. The home is in the process of reformatting the care plans. Daily records were detailed and appropriately worded, and reflected discussions with residents about their care needs. However, not all of the care plans have been signed by the resident or their representative, which would be good practice. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 10 Minor improvements to residents’ care plans would make them more effective working documents, and help reflect the practice within the home. For example, one person’s care needs had changed but their care plan did not reflect this. Key information was held in daily notes rather than the care plan, although these showed recognition of their mental health needs, and that staff were following guidance. For another person, key information about their health needs and how this was managed had not been included. The resident raised concerns about how their health needs were being met, and the acting manager plans to reassure them on this subject. Monthly reviews of residents’ care needs are recorded but these would be improved by a holistic approach to include all aspects of care to provide an overview, which details how the identified goals for their care had been met. Moving and handling assessments for two people did not contain all the information needed. The acting manager has worked hard to promote the importance of good communication amongst the staff team regarding the needs of residents, including regular handovers, plus an information board and a communication book, both of which are kept in an area that maintains confidentiality. A staff member was positive about the level of communication within the home, and the teamwork that took place, which she felt benefited the residents. Many of the residents who contributed to the inspection were complimentary about the staff and the care they received. Two people said they were very happy at the home, and this was echoed by a third person in a written survey. A visitor said they were happy with the care at the home. Surveys completed by residents stated that seven residents said they always received the medical support they needed and two said usually. Two GPs and a social care professional wrote that the home worked in partnership with them and demonstrated a clear understanding of the care needs of service users. Residents described having access to a chiropodist and the acting manager said that they liaised with the continence advisor. A recent report sent in by the home, showed that the acting manager had been proactive in ensuring that a resident obtained the care they needed by challenging a health assessment. At the time of the inspection, the weather was very hot. Signs throughout the home gave action points to help prevent residents becoming unwell as a result of the hot weather. All residents who were met during the inspection had accessible drinks, and confirmed that they were being encouraged to drink. A number of people had fans in their rooms, although this had not been offered to everyone, which some residents thought was unfortunate. However, a member of staff said they would check if others were available. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 11 There is a good medication system in place that is well organised, including photos of residents kept with the administration records. Improvements have been made regarding the management of controlled drugs with appropriate storage now in place. The amounts recorded, and double signed for by staff, tallied with the amounts kept. Staff records show recent training in the handling and administration of medication. Medication administration sheets were appropriately completed and the drugs trolley stored appropriately. A GP and a social care professional felt that residents’ medication is appropriately managed. However, during the inspection medication was given to two people and signed as being taken when this was not witnessed, which is unsafe practice. Two residents were met said they were called by their chosen names. Generally residents spoke positively about the attitude of care staff who they described as kind, although one person was seen to challenge an inappropriate endearment used by a staff member. Wording is professional in the seniors’ communication book and in daily records. A visitor commented that staff ‘chat in a kind and loving way to residents even when they don’t know who is listening’. Two people, however, gave the example of a small number of staff bringing in a drink but not greeting them. In written surveys, eight people said that they felt the staff listened and acted on what they said, but one person felt this was not the case. During the inspection, it was observed that some staff did not always give the time for residents to express themselves and their style of communication was not always appropriate. The acting manager said she has provided training in listening skills and communication, and was able to demonstrate a good understanding in this area of care. She said she would be revisiting this skill with staff. Visiting professionals said that they could see residents in private and residents were seen entertaining their guests in their rooms. One person said that they were happy with the way that personal care was provided in a manner which did not make them feel embarrassed. Aaron Court DS0000062304.V293713.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an adequate range of activities for some residents, which developed further will meet the holistic needs of all residents. There is good consultation with residents about their meals. However, further improvement is needed to ensure that residents are satisfied with the provision. Residents are encouraged to maintain contact with their friends and families, and in most aspects of life choice is promoted. EVIDENCE: Ten residents were asked about how they spent their time during the day. Three people were happy spending time in their rooms watching television, and were not interested in the activities arranged at the home. However, one of these people commented that they wished staff could spend more time with them. Three other people said that they were not always aware of what was happening in the lounges and one person suggested in their survey that better information could be provided in this area. One person commented that they could feel quite isolated and that it was difficult to get to know other residents, Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 13 while one person appreciated the care that staff took to involve them in activities despite their disability. Four people said they wished that there could be a greater variety of activities, such as more singers or exercise, although a number of people were positive about a recent barbeque and the quality of the singer. The manager has encouraged visitors and relatives to be involved in entertainment arranged by the home, such as the barbeque and a Christmas party. One family also joined their relative for Christmas Day and had a meal at the home. The home also celebrated the World Cup. Activities do not take place at weekends as many residents have visitors as shown by the visitors’ book. On Tuesdays, a hairdresser visits the home. On the remaining days, the activities records for July showed that a core group of residents took part in skittles, a quiz, listening to music and looking at magazines. Since the inspection, minutes have been received from a residents’ meeting, which shows that activities have been discussed with agreed changes made to what is available. No surveys were received from visitors or relatives but residents confirmed that visitors were made welcome, and the manager explained how one relative regularly joins one of the residents for a meal, which she has encouraged. A visitor who was spoken to on the day of the inspection expressed their happiness with the home and said they visited regularly when they found staff supportive despite their relative’s increased care needs. One person was very positive about the independence they had, and how staff supported them. A discussion with the manager confirmed this positive attitude. Other residents described making their own routines, including when they got up and went to bed, when they had a bath, and where they ate the meals. However, it was noticed during the inspection that residents were not offered a choice of drink either in the morning or at lunchtimes, with biscuits place on the saucer in the mornings or in one case handed directly to a resident. Residents confirmed this has happened before. Since the inspection, minutes have been received from a staff meeting, which record that this practice must not continue, and details the action has been taken. The manager spent time describing the steps taken to address residents’ past comments about the quality of their main meals. She explained that food was bought locally and was fresh. Evidence was seen in residents’ meetings minutes that showed this area had been discussed several times and the menu book showed that steps had been taken to address these criticisms. However, only three people out of ten spoken with during the inspection were positive about the food. Nine residents responded to the survey question ‘do you like the meals at home?’ with six people saying usually and four people saying sometimes but nobody saying always. One person said, ‘In my opinion, Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 14 menu not always suitable for elderly people who are confined to the home sometimes due to poor cooking and presentation.’ The manager recognises that concerns regarding the food has not yet been solved and again this was raised in a recent residents’ meeting after the inspection with resulting changes made to the menu. Aaron Court DS0000062304.V293713.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Minor changes to the recording of complaints would better evidence the steps taken by the home to address residents’ complaints. Residents are protected from abuse as sound practice and procedures are in place. EVIDENCE: Two GPs and one social care professional said that they had not received any complaints about the service. Some residents said that they would go directly to the manager if they had a concern or complaint; others felt the care staff on duty could address these. Some people felt that they could raise concerns at the residents’ meetings. Since the last inspection, there has been one complaint made to the home, which the acting manager said had been partially substantiated. Information regarding this complaint was seen but there was not a clear record of meetings that took place and the resulting outcome. Discussion took place with a staff member, who was clear about their responsibilities to ‘whistle-blow’ on poor practice and who to contact, both internally and externally. The acting manager confirmed in a telephone call that she has received Protection of Vulnerable Adult training in the last three years but intends to update this. She said that the home has a ‘whistleblowing’ policy but that local information needs to be added to this e.g. social services and the adult protection team. She also confirmed that three senior members of the staff team have received training in this area, and that she planned to discuss POVA awareness in the next staff meeting. Aaron Court DS0000062304.V293713.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good providing the residents with an attractive, clean and homely place to live and suitable equipment to meet their care needs. Residents’ rooms suit their needs. EVIDENCE: The home is well maintained and since the last inspection the acting manager said that one bathroom had been redecorated and both communal bathrooms were now fitted with non-slip lino. She also said that both lounges have been recarpeted, one bedroom recarpeted and that a new carpet was on order for one resident’s room. Seven residents’ rooms were visited during the inspection, and these were all well maintained. The home has an attractive courtyard garden, which contains seating and shaded areas. There are two lounges, both of which contain dining areas. Currently, there are seats for fourteen people leaving seven people unable to eat communally but a Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 17 number of residents said they chose to eat in their rooms and on the last inspection the owner said that extra seating would be provided when needed: for example, at the Christmas meal or if people changed their minds about where they ate their meals. The home has a stair lift to the first floor. Both bathrooms have an assisted seat and residents were seen using pressure-relieving equipment, which they could explain the purpose of. One piece of equipment is currently on loan from the district nursing team and the acting manager said that as yet it had not been agreed how this piece of equipment would be funded when it was recalled. Residents’ rooms that were visited were all personalised and contained lockable storage space. Residents were positive about their rooms. There is the option for residents to lock their doors and this was seen during the inspection. Some residents have had their beds moved to enable care staff to provide care from either side of the bed. This has restricted the space available for visitors’ seating, although residents did not raise this as a concern. During the inspection the lounges were visited at different times of the day and are not regularly used so could provide a private meeting area. Residents commented positively on the cleanliness of the home and this was observed on the day of the inspection. It was also odour free. In written surveys, five residents responded that the home was always clean and fresh and four residents said this was usually the case. A visitor commented that the domestic was ‘very thorough and so kind to residents. Always a hug and a word for them’. Staff were seen wearing belts with hand gel attached. This is good practice; particularly as some sinks around the home had liquid soap but only fabric towels, which hinders good hygiene practice. The home has invested in a washing machine with a sluicing facility since the last inspection and the manager confirmed that hand rinsing soiled items no longer takes place and staff minutes remind staff about procedures. There is a good system for managing soiled items with the use of ‘red bags’ that dissolve in the washing machine. Aaron Court DS0000062304.V293713.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have a caring approach and work in a home where training is promoted and residents benefit from a stable staff group. However, staffing levels are at minimal levels in the evening and one staff recruitment file was missing required information, which has the potential to put residents at risk. EVIDENCE: On the day of the inspection, there were a cook, a domestic, a senior and three care staff on duty and the acting manager in the morning. In the afternoon, this changed to a senior, two care staff and the acting manager and in the evening one senior and one member of care staff. The rota shows that there is a waking night staff and a sleeping night staff, who can be called to assist, if necessary. Guidance on staffing levels indicates that staffing levels at currently running below the recommended guideline in the evenings. Two staff members wrote in their written response that they would like more time to spend with residents and one commented that evening shifts were busy. During the inspection, one resident felt staff were extra busy at the weekends when they had to cook the main meal as well as provide care. In their written response, two residents said that staff were always available when they needed then and seven residents said staff were usually available. During the inspection, residents generally felt that staff met their care needs and appreciated the stable staff group but some people expressed a wish for Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 19 staff to be able to spend some more time with them but recognised that they were busy. Some people felt that staff were task orientated e.g. they brought a drink to them in their room but did not talk to them. The acting manager explained that she is trying to promote the role of keyworkers for each resident with the aim that they know they get to know the resident well and supports them with personal tasks. This was seen in staff minutes regarding Christmas cards and an example occurred during the inspection when a keyworker spent time with an individual resident. According to the pre-inspection report, fifty percent of the care staff group have an NV2 in care or above, which is a good achievement. The acting manager advised that three care staff are currently working towards this qualification. Three staff recruitment records were inspected; one has been improved retrospectively in line with a previous recommendation. The second contained appropriate information but the third did not. There was not a clear record of recruitment, including key discussions around the person’s application. The sources of references were poor and although steps have been taken to gain extra information these were not adequate and done retrospectively after the person had started working. This is not safe practice. Since the inspection, the acting manager has been proactive in trying to gather the necessary information and has sent the evidence to CSCI. The pre-inspection questionnaire states that fifty percent of the staff are qualified to NVQ 2 in care or above, which is a good achievement. The acting manager has shown a strong commitment to promoting training within the staff group by providing in-house training within staff meetings, and eight care workers wrote in their surveys that they also had funding for training. The home has achieved a high number of care workers with first aid training, which has been focussed on seniors and night staff. This is also the case for food hygiene training. These have both been external training courses. A record of diabetic training by the district nurse for senior carers was seen. Training records were also looked at for a senior and two care staff members and two staff members spoke of their training opportunities. Aaron Court DS0000062304.V293713.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and residents benefit from a well informed and supported staff team. There is an emphasis of resident involvement in the running of the home and safety checks and training are generally well managed, although one area needs further development to ensure training is based on current practice. EVIDENCE: The home currently does not have a registered manager but has an acting manager in post, whose application to be registered manager has recently been received by CSCI. She has experience in working with older people in both health and social settings. She explained that she is currently studying for her registered manager’s award and has a positive attitude towards training. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 21 The owner has advised CSCI that they are commencing a suitable qualification in social care. Eight members of staff said in their written responses that they felt well supported by the acting manager and several residents said that they felt the acting manager was approachable but some said they would like to see her more often. The acting manager explained that she aims to see residents on an individual basis at least one a week. A social care professional commented in a survey sent to CSCI that the acting manager ‘is always very accommodating in working closely with social services and meeting clients’ individual needs’. A visitor said ‘excellent manager – very aware of needs of elderly’. Another comment on a survey was, ‘Aaron Court has improved dramatically this last year. Staff seem to work well as a team –alwayscheerful…All in all well done’. During the inspection, the acting manager demonstrated good knowledge about the needs of residents and has provided details of prompt action to address the requirements and recommendations made. The acting manager explained that she had carried out one quality audit since working at the home and plans to repeat this exercise again this year to gather views of residents and visitors on the changes that have been made to the running of the home since her appointment. The minutes from residents’ meetings and staff meetings show that they are held regularly and that the acting manager actively seeks staff and residents’ involvement. The acting manager advised that residents’ personal allowances are not managed by the home. Instead, any additional charges are added to the monthly bill. On the last inspection, invoices were seen for chiropody, papers and hairdressing, which are sent to residents’ representatives. Eight staff members wrote in their surveys that they had formal supervision and staff meetings, and that as part of supervision their practice was observed. Induction records were seen for new staff, as well as appraisals for other staff. In their written response, eight staff members said that they were clear about the home’s policy on confidentiality and the disciplinary procedure. Hot water temperatures are recorded regularly and both communal bathrooms have thermometers. The temperature of bathwater poured for a resident was checked and found to be within the recommended guidelines. The acting manager confirmed that all windows were fitted with window restrictors on the first floor, and a spot check in one room confirmed this. Fridge and freezer temperatures are recorded, as is the temperature for cooked meat, which is good practice. Staff involved in food preparation confirmed that they had food hygiene qualifications, and their certificates were seen. However, the acting manager said that one resident is currently using bed rails but records are not kept of safety checks to ensure they are positioned correctly. The acting Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 22 manager has provided a brief moving and handling course but this has not been based on a formal qualification to provide this training responsibility. Seven residents’ rooms were visited and all had covered radiators to promote the safety of residents. The acting manager confirmed that most radiators in communal areas were covered, apart from in the hall, which she said were not used. One radiator in one communal bathroom is uncovered and the acting manager said this would be rectified. Fire records and the pre-inspection questionnaire showed that checks were up to date and that an external fire safety company had serviced equipment. One member of the staff team explained how they train staff in the home’s fire drill and use a video to support this training. Devon Fire and Rescue Service visited the home in the last year. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 23 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13 (2) Timescale for action The registered person shall make 18/08/06 arrangements for the safe administration of medicines received into the home. (The person administering medication must ensure that the medication has been taken before signing the MARs sheet.) 18/08/06 The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person the information and documents specified in paragraphs 1-9 of Schedule 2. (Staff files must contain all the required checks and information to evidence that the staff member is fit to work at the home. Clear records must be kept to evidence each individual staff member’s recruitment i.e. discussions with staff to clarify their recruitment information). It is recognised that the manager has taken prompt action to rectify the above. Requirement 2. OP29 19 Schedule 2 Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 25 3. OP38 13 (5) The registered person shall make 30/09/06 suitable arrangements to provide a safe system for moving and handling service users. (The acting manager must be able to prove that their in-house training is based on best practice to ensure she is qualified to provide training for staff). 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 OP7 Good Practice Recommendations The resident or their representative should sign their care plans. Key information should be in care plans rather than in daily notes e.g. supporting a person with increased mental health needs. Care plans should evidence how a resident’s health needs will be met i.e. diabetes or a urine infection. Monthly reviews of residents’ care needs are recorded but these would be improved detailing how the identified goals for their care have been met. Moving and handling assessments should include equipment used with risk assessments including use of the stair lift. Staff should ensure that all residents’ social needs are met. Whether this is through group activities or on a one to one basis with records kept. Residents should be offered a choice of drink and biscuit. It is recognised that the manager has already begun to address this issue through staff training. 2. 3. OP12 OP14 Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 26 4. OP15 5. 7. 8. OP16 OP27 OP38 Residents’ satisfaction with the quality of the food should continue to be monitored and changes made where necessary, with clear documentation of the action taken. It is recognised that the manager has already begun to address this current issue through a residents’ meeting. Complaints should be recorded in a clearer manner with a final outcome recorded so that they can be audited. Staff levels should be monitored, particularly if residents’ care needs increase and records kept if the levels impact on service users. As recommended in guidance from the Medical Devices Agency (July 2001) bed rails should be checked to ensure they are safely positioned with clear records kept as to when they are checked. Aaron Court DS0000062304.V293713.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Exeter 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 DS0000062304.V293713.R01.S.doc Version 5.2 Page 28 - 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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