CARE HOMES FOR OLDER PEOPLE
Aaroncrest Nursing Home Aaroncrest Tanhouse Road Skelmersdale Lancashire WN8 6AZ Lead Inspector
Mrs Christine Marshall Unannounced Inspection 5th February 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aaroncrest Nursing Home DS0000025549.V323463.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. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Aaroncrest Nursing Home Address Aaroncrest Tanhouse Road Skelmersdale Lancashire WN8 6AZ 01695 558880 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) aaron.crest@virgin.net Aaroncare Ltd Mrs Mandy Harris Care Home 50 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (29), Physical disability (5) of places Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered to accommodate a maximum of 50 service users to include: up to 29 service users in the category OP (old age not falling within any other category) up to 5 service users over the age of 45 years in the category of PD (Physical disability) up to 21 service users in the category DE (dementia) 16th February 2006 Date of last inspection Brief Description of the Service: Aaroncrest is a purpose built care home with nursing. The home can accommodate up fifty people of over the age of sixty-five years, with a condition for one person with physical disability. The registered manager is Mandy Harris. Carys Jarvis is registered as the responsible individual. Accommodation is on two floors served by a passenger lift. The ground floor accommodates those residents who have Dementia (D). The first floor accommodates residents within the category of Older People (OP) Ramps to the front of the home allow access for wheelchair users and a number of aids and equipment are available to assist residents with mobility problems. The majority of rooms are single, with one companion room, which is available for residents who might wish to share. Some en-suite facilities are provided, and there are sufficient washing, bathing and toilet facilities. The home has four lounges and two dining rooms. At the time of this inspection visit (5/2/07) the fees for the home were from £310.50 to £523 with additional costs for private chiropody, hairdressing and newspapers. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Aaroncrest included a site visit to the home that was done between mid-morning and mid-afternoon; the visit was unannounced, which means that the owners, staff and residents did not know it was taking place until the inspector arrived. A pre-inspection questionnaire was completed before this inspection and the information helped in the planning of the visit. Time was spent sitting and talking with people who use the service, alongside their relatives, and observing the day-to-day routines of the home and care staff, as they provided support. A tour of the home included looking at bedrooms, lounges and dining areas, toilets and bathrooms. This was to assess whether the home provided a comfortable, homely environment for the enjoyment of everyone, and to ensure the residents’ safety. Three relatives completed comment cards, which showed a good level of satisfaction with the care at the home. Two visiting relative’s were spoken with and their comments included – “I am very happy with the care at the home.” “Good care is given here, I have no complaints.” Discussions took place with the registered manager Mandy Harris, deputy manager, and members of the care staff. Administration records were also looked at. Everyone at the home was friendly, welcoming and co-operative throughout the visit. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 7 Written confirmation that the home complies with the Water Supply Regulations 1999 had been obtained, making sure that the residents are protected. All pipe work in bathrooms had been covered, thus protecting the safety of the residents. There were 67 of the carers who had achieved NVQ at either level 2 or 3. This showed that the staff were appropriately trained to care for the residents. Recruitment files were found to be in order, and showed that satisfactory preemployment checks are in place for the protection of the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home gathers good information about prospective residents, so that their needs can be met. EVIDENCE: The manager gave assurances that all residents were provided with a statement of terms and conditions and contract of care when they entered the home. The pre-admission assessments were looked at for the four residents’ and these were completed satisfactorily; they were comprehensive and included all aspects of physical, social and psychological care, making sure that the
Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 10 prospective resident’s strengths and needs were identified, and that the home could provide the care that was needed. These assessments were done by the deputy manager, and agreed by the resident and/or their family. Three residents were asked if they had been visited before going into Aaroncrest and were able to confirm that they had been assessed before entering the home. Generally all residents were assessed by the same tool, thus promoting equality of assessment and care provision. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The residents health and social care needs were met and people were treated with dignity and respect at this home. EVIDENCE: Care plans are written records that describe the care that is given to each resident. Four of these were looked at and found to be satisfactory. Most aspects of care had been considered, including some social history.
Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 12 Some of the residents were unable to say that they knew about their care plans; others were able to confirm that they knew about them, but that they were not really interested. Health care opportunities were offered equally to all residents and there were records of GP, chiropody and physiotherapy visits. There has been a medical alert about blood testing devices; this has come to light because a problem has been identified about the way that blood is taken from people with diabetes; the deputy manager said that she was aware of this alert and that the home always followed the required procedures for testing blood sugar. The medication system was looked at and found to be satisfactory. Trained nurses administer the medicines. The treatment room where the drugs are stored showed records of the temperature being over 25 degrees, which is the optimum for the storage of drugs and lotions; the manager said that there were plans to move the treatment room, where it would be cooler and more spacious. The residents were seen to be treated with respect, privacy and dignity, and there were good personal interactions between residents and carers. There were locks on bedroom doors and the residents were encouraged to keep their keys. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The residents benefit by being supported, so as to promote the quality of their daily lives. EVIDENCE: The home offered activities such as card and board games and reminiscence. Musical entertainment was planned on a regular basis and the residents said that they always enjoyed this. Some residents went out with their relatives on a regular basis Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 14 Religious ministers also visit the home. A number of residents said that they enjoyed having their relatives visit and that they were always welcomed by the staff at the home. Visiting relatives and friends said that they were always welcomed at the home, were happy with the care, and had a very good relationship with everyone there. There is a full choice of breakfast and morning tea or coffee with biscuits: There was a choice of main course and there is equality of choice, as records showed, that there are very varied options if requested. The home caters for any other preferred diets that are requested or required, for example vegetarian and diabetic food. The evening meal also offers full choices, with afternoon tea and suppers available. The midday meal served at the home during the visit looked quite basic, however, the residents seemed to enjoy it. Residents commented about the food saying “It is ok I daresay.” “It is quite good.” However one or two residents said that they did not like the food; when this was passed on to the manager, she immediately said that she would get feed back from the residents so that any issues with the food could be addressed. The mealtime was relaxed and unhurried, with the carers helping discretely when needed. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected and are able to voice their concerns. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and three members of staff on duty staff said that they were aware of these. There has been one concern raised with Commission for Social Care Inspection and advice was given in respect of this. One complaint had been levelled at the home, and this had been dealt with promptly and brought to a satisfactory conclusion. Some residents were asked if they knew about the complaints procedure and who they would speak to if they were unhappy; each of those spoken to said that they knew who to speak to; however they insisted that they had no complaint to make at all.
Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 16 A visiting relative said that they knew about the complaints procedure and who to speak to if they were unhappy; however they also insisted that they had no complaints to make about the home. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were provided with a comfortable and clean environment and bedrooms were personalised. This means that residents feel at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was satisfactory and furnishings were comfortable. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 18 There is equal access to all areas of the home for residents and visitors with mobility problems, in that there are wheelchair ramps and a passenger lift in place. There were aids and adaptations in place to give equal access and to help with the residents’ toilet and bathing needs. Most of the residents were able to say that they were happy with their rooms, and all the bedrooms that were visited were clean, personalised and comfortable. The laundry area was very clean and hygienic. Policies are in place for the prevention of any cross infection and domestic staff said that they knew about this. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents care needs were met through adequate staff provisions who were appropriately trained. EVIDENCE: The home’s equal opportunities policy was reflected in that there were male and female staff, between the age of 18 and 65 employed at the home. The list of staff on duty showed that there were adequate levels of nurses, carers and domestic staff on duty. Residents who were able said that they never had to wait very long for the carers to help them and that they were happy with the levels of staff on duty. The nurse, carers and the domestic staff were very helpful and showed that there was a good mix of people in place.
Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 20 National Vocational Qualifications (NVQ) and staff training programs were in place and 67 of carers have currently achieved the NVQ award. The staff who have completed their NVQ training had also done a unit covering Equality and Diversity issues and this means that they will be aware of how they can make sure that the residents were treated equally, and given care according to individual choice and preference. Recruitment files were satisfactory and showed that pre-employment checks were done so that the residents were protected. The manager sent a pre-inspection questionnaire to the commission before this visit, and this showed that there were induction and training programmes being given. Staff on duty during this visit confirmed that they were up to date with training programmes. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were supported and there were quality systems in place to make sure that they were protected. EVIDENCE: Although the registered manager had not been complying with regulation 37 of the Care Homes Regulations 2001, in that she had not forwarded to the commission, any notifications of residents’ deaths, accidents or incidents that
Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 22 affect the wellbeing of the residents, she apologised and gave assurances that this would be attended to in the future. In view of this, standard 37 has been assessed as having a score of 2, showing that there was a shortfall identified. However, standards 31, 33, 35 and 38 were each met and therefore the quality outcome of the management and administration standards has been assessed as generally good. There was a quality monitoring system in place, which is the Residential and Domiciliary Benchmarking (RDB). The home undertakes a yearly quality survey and the results of this will be posted on the notice board for stakeholders to see. There were regular audits of the medications, care plans and kitchen inspections. Some residents were able to say that they were asked about the home and the service, and a visiting relative said that they were happy with the quality of care. Staff said that they were encouraged to be proactive in improving the quality of care that was provided at the home. The home’s pre-inspection questionnaire provided information about residents’ financial arrangements and records that were kept at the home; also information was given that the safety certificates at the home were up-to-date, making sure that the residents were safe and secure: The safety and servicing certificates are currently kept at the head office. Aaroncrest Nursing Home DS0000025549.V323463.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 24 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 OP37 Regulation 37.1 (a) (b),(c), (e),(f),(g) . 37.2 Requirement The registered manager must give notice to the Commission without delay of the occurrence of any death, outbreak of infectious disease, serious injury to a service user, any incident that adversely affects the service users, any theft, burglary or accident, any allegation of misconduct by any person who works at the home. Timescale for action 09/02/07 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. Refer to Standard OP7 OP9 Good Practice Recommendations Actual times of report writing should be noted on the daily recording of care. Hand written drug instructions should have the signature of the person who is writing it and also a witness signature for accuracy. The drug storing facility should be reviewed so that it does
DS0000025549.V323463.R01.S.doc Version 5.2 Page 25 Aaroncrest Nursing Home not exceed the optimum temperature of 25 degrees. Aaroncrest Nursing Home DS0000025549.V323463.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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