Inspection on 02/12/05 for Aaron Court Care Home

This inspection was carried out on 2nd December 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 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 Care Home 29/11/06

Aaron Court Care Home 10/06/05

Aaron Court Care Home 20/01/05

Aaron Court Care Home 08/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Aaron Court Elizabethan Suite Aaron Court Nursing Home 190 Princes Road Ellesmere Port South Wirral CH65 8EU Lead Inspector Helena Dennett Unannounced Inspection 09:00 2 December 2005 nd 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 Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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 Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aaron Court Elizabethan Suite Address Aaron Court Nursing Home 190 Princes Road Ellesmere Port South Wirral CH65 8EU 0151 3571233 0151 3568216 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) Aaroncare Plc Mrs Gloria Ann Gleeson Care Home 34 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (34) of places Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service is registered to provide accommodation to a maximum of 34 service users in the category DE(E) (Dementia over the age of 65 years) Within the maximum numbers accommodated, 3 service users may be accommodated in the category DE (Dementia under the age of 65 years) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The registered manager must satisfactorily complete NVQ level 4 in management by December 2004 10th June 2005 4. Date of last inspection Brief Description of the Service: Aaron Court Elizabethan Suite is registered to accommodate 34 residents over 65 years of age diagnosed with dementia. The facilities in the home comprises of two ground floor units of thirty single bedrooms, five of which have en suite facilities and two double bedrooms, one of which has an en suite facility. The registered facilities are close to the centre of Ellesmere Port with local shopping facilities available to service users. The service is located on a main road and has access to public transport, being on a main bus route to Ellesmere port. The service is located on the ground floor of a two storey building, the first floor being given over to a separately registered service for older people in need of general nursing care. Also located on the ground floor are central facilities such as kitchen, laundry and administration. This service is provided by a private company that operate a number of registered care homes around the country. There are registered nurses on duty at all times. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours. The inspection team consisted of Anthony Cliffe and Helena Dennett Regulatory Inspectors. Residents, relatives and staff were spoken with. Feedback was given to the manager at the conclusion of the visit. What the service does well: What has improved since the last inspection? What they could do better: Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 6 Residents’ care plans ensure their health care needs are identified and met but improvement in the identification of how challenging behaviour and nutritional and fluid intake is monitored, risk assessed and managed needs to be improved. Care plans need to reflect if choices are made by residents or decisions of staff. Although staff are supported in their training thus making sure that they have the knowledge and skills to care for residents, training on challenging behaviour has not been offered to all members of staff so residents may be placed at risk of being managed inappropriately such a conflicting situation arise. 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 Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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 Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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): 1,2 A statement of purpose and service user guide is in place, which provides up to date information for prospective residents so that they know what to expect when they come to live at the home. EVIDENCE: The statement of purpose and service user guide has been reviewed since the last inspection. This now contains more accurate information on the services that Aaron Court Elizabethan Suite provides. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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 and 10 Residents’ care plans ensure their health care needs are identified and met. Improvement is needed in the identification of how challenging behaviour and nutritional and fluid intake is monitored, risk assessed and managed Care plans need to reflect if choices are made by the residents or if they are the decisions of staff. Medicines are well managed at the home to make sure that residents receive their medicines as prescribed. Residents’ rights to privacy and dignity are upheld. EVIDENCE: Care plans showed a range of completed assessment documents, with a care plan to address individual identified needs. Care plans record residents` physical and mental health needs. Each care plan provided a pre admission assessment by staff and an assessment by the social worker or a copy of an assessment in an NHS facility. Generally care plans were detailed and identified residents’ needs. However there were several anomalies regarding the identification of challenging behaviour and how this was risk assessed and Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 10 managed. There were references to challenging behaviour in residents’ care plans. The behaviour management in one resident’s care plan informed staff to ‘intervene’ when the resident was agitated or distressed but did not verify how. Staff were instructed to ‘sit with her away from any triggers that may have caused the agitation’ but did not identify what the triggers were. The pre admission assessment for this resident identified ‘she is agitated during intervention’ but was not clear what the behaviour was. In a resident’s care plan to assist the resident with personal care staff were instructed to approach a resident with ‘reassurance and a calm approach’ but did not explain why. The previous month a care plan had been written regarding the management of the resident’s ‘dementia and confusion’. This detailed that the resident displayed ‘periods of agitation and verbal hostility, non compliance with medication and arguing with other residents’. There were no risk assessments or risk management plans in place regarding the challenging behaviour of these residents. The manager identified a resident as displaying the most challenging behaviour. The resident was seen at during the mid day meal in close proximity to a hot trolley containing food. In discussion about the resident’s behaviour the unit manager said ‘ she is continually active around the unit, wanders into other residents’ bedrooms and takes personal possessions. At meal times she is into everything and takes other residents’ meals, will eat food from the trolley and attempt to take the hot teapot. If other residents go into her bedroom she throws the out or pulls them out. She is resistive with staff, we watch her. There have been episodes of other residents being found on the floor by her bedroom. We cannot prove it’s her. We have to watch her especially at mealtimes’. This behaviour was not recorded in daily records nor was it identified as a need or a risk to the resident or others. There was no risk assessment or risk management plan in place. If the resident required supervision or observation this was not clear. An action plan in a care plan recorded that a resident was only to have a bath once a week. It was not clear if this was a decision of the resident or staff. A resident was identified with a deteriorating health problem and seen by a General Practitioner who diagnosed a chest infection. The care plan for this instructed staff to ‘encourage oral fluids’. It did not confirm if staff were to record fluid intake. Residents were identified with a poor nutrition and high risk of weight loss. The assessment of nutrition did not confirm if food intake should be recorded. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 11 Checks on residents Medicine Administration Record Sheets identified that medicines had been signed as given in accordance with their prescription. The medicine trolley and storage cupboards are kept upstairs in separate registered premises. Although only registered nurses have the keys for this room, it is not ideal and it is recommended that the home try to identify a suitable medicine storage room within its own registered premises. See Requirement 1 and Recommendation 1. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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, 14 and 15 There are activities going on to make sure that residents are kept stimulated and active. Residents are able make choices about their daily lives and routines. The menu has been reviewed to ensure that meals are balanced. EVIDENCE: The manager said that the hours of the activity organiser has been increased so that she can keep residents stimulated and active. A list of activities is available and includes; visiting entertainers, gentle armchair exercise to music, bingo and trips out. Photographs are kept of the activities that take place. The manager said that residents are able to move around the home unrestricted and choose were they spent their day. Residents were offered the choice of where to eat their meals and assistance at meal times. A review of the menus has taken place since the last inspection to make sure that the meals provided at the home are well balanced and nourishing. A separate Christmas menu is also available. Menus were displayed at the entrance to the lounge/dining rooms on the unit. There were two menus displayed, the menu for the week and an alternatives menu. The alternative menu offered a wide variety of choice including a cooked breakfast. The choice of menu at the time of the visit was from the alternatives menu or fish in parsley sauce, mashed potatoes and garden peas. Dessert was fruit and jelly. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 13 Residents were eating independently and staff were available to assist residents. A staff member asked a resident about her choice of meal and said ‘ I have chosen a ham salad you know I don’t like fish’. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Information about the complaints process for the home is available so residents and their relatives know how to make complaints and who to make them to. A policy on adult protection is available in the home so staff know the action to be taken should an incident occur. EVIDENCE: There is a policy in place to ensure that residents and/or relatives know what to do if they have any concerns or complaints. There have been no complaints made to the home since the last inspection. There is a policy on adult protection and prevention of abuse in place. This was last updated in July 2005. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Residents live in a clean and pleasant environment. EVIDENCE: Elizabethan Suite was found to be clean and well maintained. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 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 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 and 30. There were enough staff on duty to meet the needs of the residents. The manager is not provided with additional hours to carry out management tasks and so this could impact on residents care. The recruitment procedures include all the necessary checks of new staff are carried out before they start working at the home to make sure they are suitable to work in care and that residents are protected. Staff are supported in their training thus making sure that they have the knowledge and skills to care for residents. However training on challenging behaviour has not been offered to all members of staff so residents may be placed at risk of being managed inappropriately such a conflicting situation arise. EVIDENCE: There were enough staff on duty to meet the needs of the residents on the day of the inspection. However on examining the duty rota it was evident that the manager of the home is not provided with any supernumerary hours and therefore is counted as one of the staff when on duty. Additional hours should be provided for the manager to carry out her management tasks. Two staff files were looked at on this inspection. All the necessary checks had been carried out before staff started working in the home. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 17 There was evidence that staff are offered training by the home. Courses such as moving and handling, principles of care and adult protection were listed. All members of staff had not attended a course on managing challenging behaviour. Staff on the unit described their understanding of residents’ needs and challenging behaviour. A staff member said ‘on the other side there are residents who wander around a lot more. The most aggressive residents hit out, spit and kick during intervention. We have to distract them. We do not hold their hands; we take them to a quiet place if necessary. The nurse in charge will be the person who usually decides what we do. We have a policy that says we don’t use physical restraint. We sometimes get injured. I have a scratch on my wrist’. Staff said they had an awareness of managing challenging behaviour as part of NVQ training. A staff member said ‘we know our residents and how to approach them individually. We respond to them as we get to know them’. Staff should be aware of the techniques to be used should an incident arise at the home. See recommendation 2 & 3. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 18 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): 31,32,33,35,38. The manager is experienced and qualified so the home is run well for the benefit of the residents. An internal quality assurance system is in place to ensure that the home is run well and in the best interests of residents. A good system to manage resident’s monies is in place so that their financial interests are safeguarded. Staff have had mandatory training to ensure that residents health and safety is maintained. Equipment is serviced regularly so that the safety of residents is maintained. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 19 EVIDENCE: The manager is a qualified Registered Mental Nurse and has recently completed the NVQ` Level 4 in management award. She is registered with the Commission for Social Care Inspection. However as identified earlier in the report she does not have additional hours provided to undertake management duties. An internal quality assurance system has been implemented in the home. The registered person does unannounced visits monthly to make sure that the home is running well and residents are well looked after. Residents and relatives’ views are sought by the distribution of questionnaires. However these are not anonymous and so there may be a risk that relatives may not wish to complete these fully. Staff meetings are held regularly and any issues acted on. Resident/relative meetings are also held regularly and a record of the issues discussed is kept. Audits are carried out regularly. A sample of the accident audits was looked at. The outcome of the audit is recorded with the action to be taken to try and minimise risks. There appears to be a good system for the management of residents’ money. A separate account is kept. Receipts are obtained for any transactions and where possible two signatures are also kept so that residents know their money is handled appropriately. The equipment used by residents and the lifts have been serviced regularly. The administration told the inspector the electrician was due to carry out the portable electrical equipment testing in December 2005. Fire training has been provided for staff. Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 x X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 14 and 15 Requirement The registered person must ensure that records that identify residents’ needs and staff responsibilities in meeting their health and welfare are kept under review, including appropriate risk assessments and risk management strategies for dealing with challenging behaviour and the recording of fluid and nutritional intake. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP30 OP31OP27 Good Practice Recommendations A suitable facility for medicine storage should be provided. Training on the management of challenging behaviour should be provided to all staff. The registered person should ensure that the manager is provided with adequate supernumerary hours per week in which to undertake her management duties. DS0000018708.V262412.R01.S.doc Version 5.0 Page 22 Aaron Court Elizabethan Suite Aaron Court Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Elizabethan Suite DS0000018708.V262412.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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