CARE HOMES FOR OLDER PEOPLE
Aaron Grange Care Home Blacklow Brow Huyton with Roby Liverpool L36 5XG Lead Inspector
Mike Perry Key Unannounced Inspection 23rd May 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 Aaron Grange Care Home DS0000069135.V332357.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 Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Aaron Grange Care Home Address Blacklow Brow Huyton with Roby Liverpool L36 5XG 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) 0151 489 1127 0151 482 0778 Aaroncare Limited Mrs Pauline Ann Bowen Care Home 54 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (24) of places Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, (maximum number of places: 24) Dementia over 65 years of age - Code DE (E) (maximum number of places: 30) The maximum number of service users who can be accommodated is: 54 Date of last inspection 14.6.2006 Brief Description of the Service: Aaron Grange is a 54-bedded care home that offers residential and EMI (Elderly Mentally Infirm) residential care. There are two units, Emily Unit which houses up to 30 EMI beds and Beecham Unit, which houses up to 24 residential beds. The home does not offer nursing care. The home is located in the Huyton area of Liverpool and is close to local amenities. It is a large listed building located on three floors and is accessible via an upper and lower car park and appropriate lifts. 19 of the bedrooms are en-suite, however there are ample numbers of bathrooms and toilets located around the home. The Registered Providers are Aaroncare Ltd. The responsible person is Mrs C Jarvis. The home’s Registered Manager is Mrs Pauline Bowen. The current rates for care in the home are £327 - £381. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection took place over a period of two days. The inspector met with residents and spoke with a number of residents and a number of relatives and visitors who were visiting the home at the time. There were additional conversations with health care professionals. The inspector also spoke with members of care staff on a one to one basis and the registered manager. A tour of the premises was carried out and this covered most all areas of the home including some of the resident’s rooms [not all bedrooms were seen]. Records were examined and these included three of the resident’s care plans, staff files, staff training records and health and safety records. As part of the inspection a two hour observational tool was used to observe and assess care on the dementia care unit. Some findings are included in the report. Service user surveys were also sent prior to the inspection so that further comments could be collected. Six of these were returned and comments are used in the report. What the service does well:
Residents and relatives spoken to say that they had received enough information prior to and during admission and this had assisted them in both choosing and settling into the home. All residents are assessed prior to admission to the home. The home has developed a very comprehensive assessment form itself and this covers a mental health assessment, which is also very detailed and includes risk assessments. Relatives spoken to were generally positive in support of the staff’s approach to care and felt that staff had a clear understanding of residents needs. Some staff have attended specialist courses in dementia care. Residents have a range of risk assessments within their care plans covering, falls, nutrition, moving and handling, dependency and pressure sores. These look into the resident’s risk of harming themselves or others. These were completed to a good standard and then are included in the care plan.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 6 One resident has a diabetic condition monitored through the care plan with regular, daily, input from the district nurse team. The district nurse spoken to stated that the home were very good at referring residents when health care needs were assessed as requiring specialist input. The inspector spent a 2-hour period on the dementia unit observing care in the main day room and dining room. This area is always staffed and the level of staff interaction is therefore high and resident’s engagement with staff and surroundings was also high. Staff interventions were generally positive and were seen to enhance resident’s dignity. One relative interviewed summed up the general feeling of those interviewed: ‘There are no real problems in the home. Mum always looks clean and well presented and has settled well. Staff are very good and approachable. They always tell us of any changes. Told us recently about changes in medication. I can’t remember seeing care plan specifically although did discuss and sign a care document on admission some time ago’. Medication administration was discussed and records were examined. One resident had been prescribed eardrops at the time of the inspection and these were then clearly recorded on the medication record. There was a clear audit trail from medicines being received to their administration and return [if required]. The day areas in the home are bright and relaxed and residents are able to socialise. Residents spoken to were open and talked freely about daily life in the home and were generally pleased. One resident said ‘it’s a very nice place. You get looked after. The staff are nice’. Others commented and said that the general atmosphere in the home is ‘nice and staff are approachable’. Activities were observed to be taking place; for example exercises on the dementia care unit and a sing along on the general care unit. Photographs throughout the home show that residents have visited a variety of places. The manager said these trips were well attended by both residents and their relatives. The inspector watched residents when they were eating lunch, which was a social and happy occasion. A resident on the general unit commented ‘I like the cooked breakfast. There is choice for dinner. I know what is on the menu and there is an alternative available’. Another said ‘the food is generally good. It’s a nice dining room. Tables are set and it is very nice’. The home have a clear complaints procedure that is located throughout the home and in the service users guide. Relatives and residents spoken to said that they felt comfortable to approach the manager or staff with any issues and felt that they would be listened to. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 7 The manager was able to talk about the homes adult protection policy and how this linked in with locally agreed policies under the Protection Of Vulnerable Adults [POVA]. Staff interviewed were able to identify and describe what would be termed abusive care or mistreatment. Both units visited were clean, bright and well maintained. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Both units are on a number of levels but there is easy access for wheelchairs and residents with mobility difficulties. There were reported, and also observed, to be good proviosion of disability aids and nursing equipment such as bath hoists, walk in showers, raised toilets and handrails in corridors. The staff team works well together as most staff have worked at the home for a long time. Residents spoken to gave positive feedback and found them to be good at their jobs. The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. Training files were seen for staff and staff spoken to were clear that the training in the home is consistent and regular. NVQ training is available and currently the home is meeting the 50 plus figure for care staff having completed NVQ courses so that he home are able to demonstrate that staff have a good skill base. Pauline Bowen is the Registered Manager for Aaron Grange. She has 18 years experience working in the home and has been manager for 2/3 years. Staff spoken to were very supportive of the manager’s approach and in turn felt supported by her. Relatives and residents were comfortable with the manager and found her very approachable. Health and Safety is managed very well and the home is maintained safely through regular risk assessment. Those safety certificates and records seen were all up to date and well monitored. Both managers displayed an open attitude to the inspection and were positive regarding any discussions at the time. What has improved since the last inspection?
The requirements from the last inspection to provide curtains in the shared room have been actioned. Following the pharmacy inspection on the last visit the recommendations and requirements made at that time have been met and the medication administration is now satisfactory although some further recommendations have also been made [see below]. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 8 What they could do better:
There is the possibility of some confusion in terms of the ‘residential’ status of the home as some of the stationary refers to ‘caring and nursing’. The home does not provide nursing care and any references should therefore be deleted. Each resident has a plan of care and some work can be done to make the standard of these more consistent. Some of the care needs are described in very brief terms and lack clear personalised interventions that staff can follow. Not all care needs are included in the care plan, for example residents who self medicate. One resident reviewed had particular needs around the fact that hey were very agitated on occasions but the approach that staff used on these occasions was not on the care plan so that there can be some consistency in this area. Each plan is evaluated monthly. It would be an improvement if these evaluations could be a written record of progress made [or not] rather than ‘continue plan’. Standards of care are not always consistent. Relatives spoken to and some residents on the general unit felt that if anything needs improving it is staffing generally: ‘Sometimes staff appear a bit stretched’. There are not always staff around’. One commented ‘sometimes there can be little help with personal hygiene if staff are busy. We have to wait’. One resident was discussed who self medicates. The risk assessment needed to evidence the homes duty of care with respect to safety had not been carried out and there was no record on the care plan so that this aspect of care could be evaluated. Residents who are receiving PRN [give when necessary] medication were also discussed and would not normally be reviewed through the care planning system. This would be recommended for the same reasons. Opinions from residents and relatives varied regarding the provision of social activities. One commented that ‘activities have improved commenced recently. Very few staff are involved though and staff rarely find time to talk with residents’. The activities person works a total of 24 hours weekly and it was discussed with the manager that with over 50 residents in the home it would be difficult to spend enough time to involve everybody and that an increase in activity hours would benefit the home in terms of consistency and quality outcomes for residents in this area. The menus on the dementia care unit are the same presentation as the general elderly unit and this should be reviewed as they are long [over a 4 weekly period] and may be difficult to understand for those with dementia. The idea of a menu board in addition was discussed. There was discussion regarding the dementia care unit and how the environment could be improved to enable residents with dementia to better
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 9 access areas and improve orientation. Signage could be improved so that toilets etc can be located from corridors. Orientation boards, clocks and calendars could also be introduced. The number of care staff does not seem high and staffing levels have been an issue in past inspection reports. Some comments from relatives and residents indicated that staff were not always available for personal care at times and socialisation. The general dependency of residents is quite low [dependency levels are monitored] and staff stated that ‘there is enough staff to do the work’. In terms of quality outcomes for residents, however, around time for socialisation and personal care then staffing may need to be reviewed if the home wishes to achieve improved outcomes in these areas. Accident reporting was discussed and accident records were reviewed. The manager stated that relatives are always informed of accidents to residents but there was no written evidence of this and it is recommended that this is formally recorded. 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. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 10 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 Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 11 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 1,2,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is enough information available at the point of admission to the home so that prospective residents and their supporters can make an informed choice about moving into the home. The assessment process is thorough and helps ensure that the home is able to identify and therefore meet resident’s needs. EVIDENCE: The home has written information [Service User Guide] and this is available for residents and relatives. Residents and relatives spoken to said that they had received enough information prior to and during admission and this had assisted them in both choosing and settling into the home. Copies of contracts were seen in the care files and relatives were clear about the fee structure in the home. The manager stated that she had accessed copies of the last CSCI inspection report and these had been available in the home. There were none available on
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 12 this visit however and the recommendation to include the inspection report, as part of the homes information and that this is available is again made. There is the possibility of some confusion in terms of the ‘residential’ status of the home as some of the stationary refers to ‘caring and nursing’. This particularly noticeable on the care planning documentation for some residents. The home does not provide nursing care and any references should therefore be deleted. All residents are assessed prior to admission to the home. 3 care files were reviewed and appropriate social care and, if required, health care assessments had been completed. The home has developed a very comprehensive assessment form itself and this covers a mental health assessment, which is also very detailed and includes risk assessments. Some of the assessments are repetitive and this was mentioned and discussed and could be reviewed. Residents spoken to felt that staff attended to their needs although some felt that staff were not always available a specific times [see health and personal care]. Relatives spoken to were very positive in support of the staff’s general approach to care and felt that staff had a clear understanding of residents needs. Some of the comment cards received were not always positive and cited staff availability also. Staff have attended specialist courses in dementia care. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 13 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care needs are addressed safely and with attention to the privacy and dignity of residents. There needs to be some attention paid to areas of care planning and medication so that care needs are met consistently. EVIDENCE: Care plans were looked at on the dementia units. Three care plans were looked at in total. The home are trying to involve both residents and relatives in the planning of the care and some resident/relatives had signed plans to say they agree with how their care is going to be given although others interviewed were not clear about their involvement in the care planning process. Plans were being reviewed by staff on a monthly basis, or sooner if needed. This evaluation process was discussed. Care plan evaluations should contain more than a general statement of ‘continue care’ and should be a discussion and statement of progress made set against the aims / goals of the care plan. This should show evidence of discussion with key workers and periodically relatives and residents.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 14 Care plans varied in their quality to include all aspects of the care and to explain in any detail how the care should be carried out. Some lacked the required detail. For example staff interviewed described one resident as ‘agitated’ on occasions and aiming to seek reassurance through repetitive behaviour and requests to staff for cups of tea. The staff talked about how they intervened by spending time to reassure her through touch. None of this was on the care plan in any detail however. The care plan listed ‘dementia’ as a need and care interventions were very generalised and none personalised to the resident concerned. There was some discussion as to how medical terminology such as dementia is very generalised and can be disabling if the way that the disability affects the person is not personalised. Residents have a range of risk assessments within their care plans covering, falls, nutrition, moving and handling, dependency and pressure sores. These look into the resident’s risk of harming themselves or others. These were completed to a good standard and then are included in the care plan. One resident has a diabetic condition monitored through the care plan with regular, daily, input from the district nurse team. The district nurse spoken to stated that the home were very good at referring residents when health care needs were assessed as requiring specialist input. The nurse felt that there was good ongoing dialogue with staff who were responsive to any requests made. For example the staff were monitoring the blood sugar levels of the resident daily and had a good understanding of what to do if the resident needed any urgent intervention. Residents can choose their own GP (General Practitioner) and are visited by a range of health professionals such as district nurses, social workers, opticians and dentists. Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. The inspector spent a 2-hour period on the dementia unit observing care in the main day room and dining room. This area is always staffed and the level of staff interaction is therefore high and resident’s engagement with staff and surroundings was also high. Staff interventions were generally positive and were seen to enhance resident’s dignity. The requirements from the last inspection to provide curtains in the shared room have been actioned. Residents on the dementia unit were observed to be appropriately dressed and clean and well presented so that dignity is preserved [exception being that some residents needed attention to their nails]. One relative interviewed summed up the general feeling of those interviewed:
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 15 ‘There are no real problems in the home. Mum always looks clean and well presented and has settled well. Staff are very good and approachable. They always tell us of any changes. Told us recently about changes in medication. I can’t remember seeing care plan specifically although did discuss and sign a care document on admission some time ago’. Standards are not always consistent however. Relatives spoken to and some residents on the general unit felt that if anything needs improving it is staffing generally. ‘Sometimes staff appear a bit stretched’. There are not always staff around’. One commented ‘sometimes there can be little help with personal hygiene if staff are busy. We have to wait’. Medication administration was discussed and records were examined. One resident had been prescribed eardrops at the time of the inspection and these were then clearly recorded on the medication record. There was a clear audit trail from medicines being received to their administration and return [if required]. One resident was discussed who self medicates. The risk assessment needed to evidence the homes duty of care with respect to safety had not been carried out and there was no record on the care plan so that this aspect of care could be evaluated. Residents who are receiving PRN [give when necessary] medication were also discussed and would not normally be reviewed through the care planning system. This would be recommended for the same reasons. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 16 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in activities although there is a realisation that more can always be developed in this area to ensure a better quality of life for residents. Residents are encouraged to maintain their independence and exercise choice. A choice of good quality home cooked food is provided to the residents. EVIDENCE: The day areas in the home are bright and relaxed and residents are able to socialise. Residents spoken to were open and talked freely about daily life in the home and were generally pleased. One resident said ‘it’s a very nice place. You get looked after. The staff are nice’. Others commented and said that the general atmosphere in the home is ‘nice and staff are approachable’. During the observation of residents in the day room on the dementia care unit there was a high level of staff interaction and engagement from residents. Staff interviewed were clear that this area was always staffed and it was observed that staff regularly interacted and supported residents.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 17 There is a designated activities organiser and activities were advertised on units. [The poster was written in small type and would be difficult to read for an elderly person with poor site]. Activities were observed to be taking place; for example exercises on the dementia care unit and a sing along on the general care unit. Photographs throughout the home show that residents have visited a variety of places. The manager said these trips were well attended by both residents and their relatives Residents also spoke about the routine of the day and one stated that there is no set time for getting up and that staff would work around individuals needs. Relatives who said that they were free to visit at any time supported this. Relatives reported that the manager continues to hold meetings to collect ideas and exchange information about the home. Opinions from residents and relatives varied regarding the provision of social activities. One commented that ‘activities have improved commenced recently. Very few staff are involved though and staff rarely find time to talk with residents’. Another said that he enjoyed living in the home but did not get out much as staff do not have the time. Both staff and relatives/ residents felt that the garden was an excellent facility but could be used more. The activities person works a total of 24 hours weekly and it was discussed with the manager that with over 50 residents n the home it would be difficult to spend enough time to involve everybody and that an increase in activity hours would benefit the home in terms of consistency and quality outcomes for residents in this area. Some understanding of the social needs of residents with dementia was evident from the personalisation of bedrooms and the fact that some residents have been encouraged to bring in items of furniture so that surroundings are more familiar. Names and photographs on doors assist with orientation but some were missing and again names were in small print. The inspector discussed at length the care needs of people with dementia in terms of the environment and orientation aids needed and more could be done to develop the unit in this area [also see ‘environment’]. The garden is accessible from the dining room although the door was locked and residents only go out with staff present. There are tables and chairs so that residents can sit out. There is a second garden area also available for residents. Both residents and visitors said they enjoyed this facility. The home has a rolling menu that changes week to week. Menus are displayed around the home and residents can have a choice of meals. The menus on the dementia care unit are the same presentation as the general elderly unit and this should be reviewed as they are long [over a 4 weekly period] and may be difficult to understand for those with dementia. The idea of a menu board in addition was discussed.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 18 The inspector watched residents when they were eating lunch, which was a social and happy occasion. The home provides the choice of a cooked breakfast, which is appreciated by some residents. Since the last inspection the cook speaks to residents on a regular basis so that individual needs can be catered for as much as possible. A resident on the general unit commented ‘I like the cooked breakfast. There is choice for dinner. I know what is on the menu and there is an alternative available’. Another said ‘the food is generally good. It’s a nice dining room. Tables are set and it is very nice’. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 19 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): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that protects the rights of residents. Staff have a knowledge of adult protection procedures which protects service users from abuse. EVIDENCE: The home have a clear complaints procedure that is located throughout the home and in the service users guide. The manager records complaints and a copy is sent to head office. The home has 28 days in which to investigate them and respond. Details are also available on how to contact the Commission for Social Care Inspection. The manager discussed an addition to the complaints policy in that ‘concerns’ are now recorded and acted on as this feeds into the quality assurance in the home. Relatives and residents spoken to said that they felt comfortable to approach the manager or staff with any issues and felt that they would be listened to. The feedback from the survey forms was that relatives are aware of the complaints procedure. The manager was able to talk about the homes adult protection policy and how this linked in with locally agreed policies under the Protection Of Vulnerable
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 20 Adults [POVA]. The manager has had experience using the policies and was able to outline the homes role in this. Staff spoken to had completed some training around abuse awareness and this was also evidenced in staff files. Staff interviewed were able to identify and describe what would be termed abusive care or mistreatment. Some staff had not seen the local adult protection policies but were aware that they were located in the main office. Staff had ‘alerter’ cards with the contact details id they needed to report any allegations of mistreatment or abuse. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 21 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, comfortable and homely environment in which to live. The demetia care unit needs to develop with rspect to orientation aids so that residents are enabled to access facilities more independantly. EVIDENCE: Both units visited were clean, bright and well maintained. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Both units are on a number of levels but there is easy access for wheelchairs and residents with mobility difficulties. There were reported, and also observed, to be good provision of disability aids and nursing equipment such as bath hoists, walk in showers, raised toilets and handrails in corridors.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 22 The home has two large car parks and the home can be accessed from either. A lift is available to take residents between floors. Grounds are well maintained and pleasant to look at from the home. There were no areas in the home which had offensive odours at the time of the visit although some survey forms returned reported this as problem with some areas and the management should take note of this. The extenal grounds are maintained well and can be accessd by residents although improvments in access was a feature of the discussion with the manager, particulary with respect to he dementia care unit. Currently the access is via the dining room which is only used at meal times. Day areas are on the upper floors. Practically it is not possible to access the garden with out staff assistance and this was reported to be sporadic and dependant on staff avalability. The manager was asked to consider changes to day areas so that this might be better accomodated. Only a sample of bedrooms was looked at during this inspection, however those seen were clean and personalised with resident’s belongings. The home has an in house laundry and residents reported that items are returned promptly. Residents and relatives said that standards are maintained and consistent. There was discussion regarding the dementia care unit and how the environment could be improved to enable residents with dementia to better access areas and improve orientation. There were some orientation aids such as photographs on bedroom doors and signs on toilets but these were inconsistent. For example the names on bedroom doors were generally to small for an elderly person with sight problems to see. Signage could be improved so that toilets etc can be located from corridors. Orientation boards, clocks and calendars could also be introduced. The manager was referred to available information on the Alzheimer’s disease web site. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 23 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): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained well and although staff numbers are currently adequate to meet service user’s basic care needs these may need to reviewed if quality of outcomes for residents is to be further improved. EVIDENCE: The dementia care unit had 30 residents on at the time of the inspection and was staffed with 4 carers in the morning and 3 care staff in the afternoon. The deputy manager supplements this number. On the general elderly unit there were 23 residents with 3 care staff. The over all staffing ratio is therefore 1 staff to 8 residents and on the dementia care unit in the afternoon the ratio is 1:10. In addition to the basic care staff numbers there are also ancillary staff such as laundry and kitchen staff as well as domestic cover. There is an activities organiser in the afternoon. The Manager is also supernummery and has administration support. The number of care staff does not seem high and staffing levels have been an issue in past inspection reports. This was again discussed with the manager with respect to comments received from relatives and residents around the
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 24 availability of staff at times to carry out personal care and socialisation [see ‘health and personal care’ and ‘daily life…’ sections of this report]. The general dependency of residents is quite low [dependency levels are monitored] and staff stated that ‘there is enough staff to do the work’. In terms of quality outcomes for residents, however, around time for socialisation and personal care then staffing may need to be reviewed if the home wishes to achieve improved outcomes in these areas. The staff team works well together as most staff have worked at the home for a long time. Residents spoken to gave positive feedback and found them to be good at their jobs. Staff were observed to be interacting and supportive of residents. Relatives were generally supportative of the staff and management. The recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. Three staff files were seen and all contained full references and Criminal Record checks [CRB]. Training files were seen for staff and staff spoken to were clear that the training in the home is consistent and regular. There is induction material for new staff and ongoing foundation training using the Alzheimer’s Society training package. NVQ training is available and currently the home is meeting the 50 plus figure for care staff having completed NVQ courses. The induction appears thorough although the manager should audit it against the ‘skills for care’ standards to ensure that all areas are covered. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of the home displays the skills and knowledge to manage the home so residents and staff needs are supported and there are systems in place so that the quality of the service can continue to be improved with reference to service users needs and comments. EVIDENCE: Pauline Bowen is the Registered Manager for Aaron Grange. She has 18 years experience working in the home and has been manager for 2/3 years. Pauline has completed the Registered Managers Award. She was able to demonstrate recent clinical updates in dementia care for example and has made useful contacts with the local Primary Care Trust with the home hosting the local managers meetings [forum for care home managers] chaired by a member of the trust.
Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 26 Staff spoken to were very supportive of the manager’s approach and in turn felt supported by her. All staff are in receipt of some formal supervision and they found this useful in terms of general support and discussing training issues. Relatives and residents were comfortable with the manager and found her very approachable. A deputy manager who has just completed her management ward at NVQ 4 level supports her. The manager was able to demonstrate a continuing progress and raising of the care standard in the home. There are residents and relative forums, which aim to elicit the views of people using the service. There are various internal audits such as the cook going around and asking residents their views and preferences for food. There are also Health and Safety audits and the supplying pharmacist has started doing medication audits. There are also resident and relative surveys undertaken by head office and the results are passed onto the manager. Some of these were seen and the outcomes are acted on. From previous inspection reports the manager has generally addressed requirements in a timely manner. Health and Safety is managed very well and the home is maintained safely through regular risk assessment. Those safety certificates and records seen were all up to date and well monitored. The fire safety officer was conducting an inspection at the time of the visit and was satisfied that standards in this area are maintained. Accident reporting was discussed and accident records were reviewed. The accident rate in the home is generally very low. The manager stated that relatives are always informed of accidents to residents but there was no written evidence of this and it is recommended that this is formally recorded. Both managers displayed an open attitude to the inspection and were positive regarding any discussions at the time. Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 27 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 2 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 N/A 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 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 4 Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Timescale for action 30/07/07 2 OP9 13(40)b All care needs must be included on the care plan so that effective interventions can be planned and evaluated. There must be a risk assessment 30/07/07 carried out for any resident who wishes or is involved in self medication so that this activity can be carried out safely. 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 OP1 OP1 OP7 Good Practice Recommendations The Manager should ensure that an up to date copy[s] of CSCI inspection reports are made available in the home. All stationary should be reviewed and any reference to the home providing nursing care should be deleted. Evaluations of the care plan should be documented more fully and include an assessment of the progress set Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 29 against the goals of the care plan. The care plans should contain more detail and be personalised to the resident concerned. The comments in the report about the disabling effect of medical diagnosis should be taken into consideration when drawing up care plans. 4 OP9 Residents who self medicate or are on PRN medication should be monitored through the care plan so that consistence and effective interventions and evaluation can be planned. The comments around the personal care offered should be considered by the managers and any action needed should be addressed so that consistency of standards can be more effectively maintained. The development of activities for residents should continue to be developed with reference to comments in this report. Menus on the dementia care unit need to be easier for residents to engage with. A menu board in recommended so that residents can be mad easily aware of the days meal. The management need to review the dementia care unit with respect to developing the environment so that residents are enabled to access facilities more independently with the introduction of good practice around orientation. The manager should consider the care staff numbers, particularly on the dementia care unit in the afternoon given comments by relatives and service users under the care sections of this report. The induction-training package should be audited against the skills for care standards to ensure all areas are covered. It is recommended that there is a written record of relatives being informed of accidents to residents. 5 OP10 6 7 OP12 OP15 8 OP19 9 OP27 10 OP30 11 OP38 Aaron Grange Care Home DS0000069135.V332357.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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