Inspection on 27/08/08 for Aaron Grange Care Home

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Adequate service.

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 Grange Care Home 23/05/07

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Aaron Grange Care Home Blacklow Brow Huyton with Roby Liverpool L36 5XG Lead Inspector Mike Perry Unannounced Inspection 27th August 2008 09:30 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.V365664.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.V365664.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 aaron.grange@new-meronden.co.uk 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.V365664.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 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. At the time of the inspection the registered manager, Mrs Pauline Bowen, was still in post but has since left [retired] and the current acting manager is Kathy Jones who will be applying for registration. The current rates for care in the home are £357 - £416.64 Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 one day [9 hours]. 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 and social care professionals. These concerned the investigation of recent incidents from the safeguarding team. The inspector also spoke with members of care staff on a one to one basis and the registered manager, deputy manager and also Responsible Person who was present for the inspection. A tour of the premises was carried out and this covered most of the day areas in the home and some of the bedrooms. Observations of the care were made. Records were examined and these included three of the resident’s care plans, staff files, and staff training records and health and safety records. Prior to the inspection the manager and Responsible Person completed an Annual Quality Assurance Assessment [AQAA] for the home, which is a comprehensive document outlining information about the service and any developments over the past year. This was returned in good time. Service user surveys were also sent prior to the inspection so that further comments could be collected. Although these were returned to the home and were sent by the home to the Commission, we did not receive them and therefore information from this source is not available. What the service does well: 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 comprehensive assessment form, which includes risk assessments. The home are trying to involve both residents and relatives in the planning of the care. Relatives spoken with said that they feel involved the care and that staff are always keen to discuss the care and report any changes. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 6 Each resident has a care plan and these were written in simple terms and where easy to follow. There was a lack of confusing [and disabling] medical terminology and residents needs were explained in terms that affected their daily life. For example one resident ‘hears voices in her head’ and the care interventions were personalised so that staff were aware of how to approach and support the resident. This displays a more person centred approach to care and shows residents as individuals. 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. One resident has a diabetic condition monitored through the care plan with regular, daily, input from the district nurse team. Another resident has a skin condition which is well monitored in liaison with the district nursing team. Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. Residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. One relative interviewed summed up the general feeling of those interviewed: ‘The home is very good. I sought high and low and the home came recommended by friends. My wife is always clean and well cared for. Always keep me informed regarding her condition and any doctor’s visits. For example [recently] she had to go to casualty and I was told immediately’. 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. General comments where that the general atmosphere in the home is ‘nice and staff are approachable’. 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 home provides the choice of a cooked breakfast, which is appreciated by some residents. Residents generally enjoy the food and comments were positive. The home have a clear complaints procedure that is located throughout the home and in the service users guide [SUG]. The complaints recording book was seen and two complaints are listed and have been investigated and responded to appropriately. 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]. The manager has had experience using the policies and was able to outline the homes role in this. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 7 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 are good provision 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. Staff were observed to be interacting and supportive of residents. Relatives spoken with were supportative of the staff and management. What has improved since the last inspection? New documentation has been introduced including all care documentation and the issues identified last inspection regarding the usage of the term ‘nursing’ on documents has therefore been addressed so that there is no confusion as to the role of the home. The care plans written by staff that describe the care for residents have improved. These were found to be a lot clearer and more descriptive and stated the care needs in simple terms. There was evidence that these plans had been discussed with residents and relative [where needed]. This is important because the care plan is the main way that care is recorded and evaluated and acts as a communication tool. The generally consistency in terms of carrying out personal care has improved. Relatives reported that generally there are good standards of care. Staff reported that since the increase of staffing on the dementia care unit in the afternoon [one extra staff] there is now more time to deliver the personal care required. The care environment on the dementia unit has improved in that there are now some appropriate signs on toilets and bathrooms etc to help orientate residents. Also there are some white boards in situ that contain information such as staff on duty. There is a menu board outside the dining room. There can be much more developed in this area but the home evidence that they have accessed good practice guidance and will continue to develop standards in this area. The day area has also been moved to the ground floor [was on first floor] so that there is now immediate access to the garden for residents. The garden itself has been enclosed and made safe so that residents can freely access the garden in safety. Accident reporting was discussed in some detail and accident records were reviewed. The manager stated that the policy of the home is to inform relatives of accidents immediately. The records seen supported this and the information Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 8 is clearly recorded. This was in all cases seen apart from one [discussed under ‘complaints and protection’]. What they could do better: 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’. This was a recommendation on the last inspection report. We were able to audit and track the administration of medicines but this did prove difficult because of some anomalies in the record keeping that should be addressed: • One resident was on PRN medication [give when necessary]. The care plan did not reference PRN medication for this person and there appeared to be an inconsistency in the way the medication was administered. This was discussed with the manager and must be addressed as the inconsistent approach may put the resident at risk. The issue of PRN medication being monitored through the care plan was recommended on the last inspection. It was difficult to track the stock of medicine for one resident, as the stock balance had not been carried over on the MAR chart. The stock was recorded in the controlled drug register but the entry for new stock arriving had not been dated which again confused the auditing process. • It is important that clear and accurate records are maintained which are easy to reference and audit. There are no residents self-medicating in the home although this has occurred occasionally in the past. The self medication policy indicates a passive promotion of independence in this area. Staff stated ‘we ask but it’s their choice’ [to self medicate]. The need for residents to maintain as much independence as possible should extend to the self administration of medicines and the policy and practice needs to reflect this by being more positive and proactive in promoting good practice in this area. The risk assessment tool needs further development as currently it does not assess thoroughly any risk for residents. The planned activities for residents are limiting. One relative’s comments summed up the general opinion: ‘Staff are very good and caring. I would like to see more stimulation. Never see any activities. The TV on the top floor is always on but is not big enough for people to see. Used to have [staff member activities person] she was great but now she’s gone. Can now go in the garden, which is really good. They do have trips out sometimes. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 9 There was some discussion with management about how this can be further developed and recommendations are made in the report so that the quality of life for residents can be further improved. 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 Service User Guide, when discussing the complaints procedure, does not give information on how to contact outside agencies such as Social Services or the Commission for Social care Inspection [CSCI] and this should be added. There were some concerns listed in the complaints book, which were not clear and it was difficult to see what action had been taken. For clarity it would be appropriate if each complaint were listed on an initial ‘complaints form’, which could then be individually acted on and form part of the auditing process. During the inspection we found that a number of concerns were being expressed about clothing going missing in the home and also other residents clothing being placed in residents rooms. None of these concerns were recorded in the complaints files however. This was fed back to the managers who need to review this area of concern. Staff files were seen and we found some anomalies in the recording of basic recruitment checks that must be addressed: • One staff reviewed did not have the required check made of the Protection of Vulnerable Adults [POVA] register prior to commencing work. This is a basic requirement and check that must be made prior to commencement of employment so that residents are protected from staff who may be unfit to work with vulnerable people. Following further discussion it became apparent that a check of all records needs to be made to ensure that this check has been complied with. The application form needs to be reviewed. There was no previous work record available for applicants records seen and some sections such as references where not recorded. Therefore managers are not able to check the applicants previous work record • There must be more robust recruitment records and checks made so that residents are assured staff working in the home are fit and suitable. The depth of the induction training for new staff was not clear. One induction record consisted of an initial checklist of work based instruction [routines etc] and another checklist of basic training requirements conducted over a few days. This would not have allowed any time for the employee to assimilate the information. There was no evidence that this staff member had had any previous experience. There was some discussion again about the adequacy of Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 10 the induction for new staff and whether this meets the skills for care common induction standards and it is recommended that manager further assess this. There was some discussion around the use of the audits undertaken by the managers so that systems in the home can be monitored effectively. The audits must be robust enough to pick up and monitor quality issues. Medication audits have been carried out for example but have not picked up some of the issues highlighted in this report [same goes for recruitment files and checks]. The home have experienced a number of residents falling and sustaining serious injury recently and these have not been reported through under RIDDOR regulations to Health and Safety executive and this must be carried out. 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.V365664.R01.S.doc Version 5.2 Page 11 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.V365664.R01.S.doc Version 5.2 Page 12 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 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. This has been updated over the past year. 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. There has been new stationary and forms available in the home which clearly identify the come as a care home not a nursing home [some confusion prior to this] so that people are sure of the status and role of the home when choosing. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 13 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 comprehensive assessment form which includes risk assessments. 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. They felt involved in the care and had been involved in the assessment process. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 14 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): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are met so that their right to receive health care and maintain personal dignity are supported but there needs to be attention paid to standards of medication recording and administration so that so that residents are supported safely. EVIDENCE: Care plans were looked at on the dementia unit [2] and also on the residential unit [1]. 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. Relatives spoken with said that they feel involved the care and that staff are always keen to discuss the care and report any changes. One relative, who was new to the home, explained how the staff had given her a social history form to complete and how the care plan made for the resident concerned had been discussed. Plans are being reviewed by staff on a monthly basis, or sooner if needed. This evaluation process was discussed. Care plan evaluations should contain more Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 15 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. This was discussed on the last inspection and still needs actioning. The care plans seen were written in simple terms and where easy to follow. The manager explained that some staff had been on training around care planning. There was a lack of confusing [and disabling] medical terminology and residents needs were explained in terms that affected their daily life. For example one resident ‘hears voices in her head’ and the care interventions were personalised so that staff were aware of how to approach and support the resident. This displays a more person centred approach to care and shows residents as individuals. 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. Another resident has a skin condition which is well monitored in liaison with the district nursing team. 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 and this is recorded in the care notes. Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. We sat for a period on the dementia care unit and observed the care. The level of interaction varied with different residents but the staff interventions were positive and were seen to enhance resident’s dignity and feeling of well-being. Residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. One relative interviewed summed up the general feeling of those interviewed: ‘The home is very good. I sought high and low and the home came recommended by friends. My wife is always clean and well cared for. Always keep me informed regarding her condition and any doctor’s visits. For example [recently] she had to go to casualty and I was told immediately’. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 16 Medication Senior staff who administer medicines had received training. We inspected the medication administration on the residential unit and looked at records. We were able to audit and track the administration of medicines but this did prove difficult because of some anomalies in the record keeping that should be addressed: • One resident was on PRN medication [give when necessary]. The care plan did not reference PRN medication for this person. This was recommended last inspection. It was observed from the record [MAR] that the PRN has been given in batches of 4 nights depending on which staff is on duty. This could indicate that different staff are giving the medicine for different reasons which could potentially put the resident at risk. This needs consistency and the importance of including the reasons why the medicine is needed is therefore made obvious. The care plan, and also the rear of the medication administration [MAR] chart can be used to record the reasons for administration. It was difficult to track the stock of medicine for one resident, as the stock balance had not been carried over on the MAR chart. The stock was recorded in the controlled drug register but the entry for new stock arriving had not been dated which again confused the auditing process. • It is important that clear and accurate records are maintained which are easy to reference and audit. Apart from these anomalies the records were clear in that signatures and times of administration were recorded generally. There are no residents self-medicating in the home although this has occurred occasionally in the past. The medication policy states that ‘if the person expresses a wish’ [to self medicate] then a risk assessment would be completed. The policy indicates a passive promotion of independence in this area. Staff stated ‘we ask but it’s their choice’ [to self medicate]. The need for residents to maintain as much independence as possible should extend to the self administration of medicines and the policy and practice needs to reflect this by being more positive and proactive in promoting good practice in this area. The risk assessment tool seen is actually a consent form. It does not measure or assess any risks involved when considering whether, or to what level, a resident is capable of self-medicating. As such it needs reviewing. The medications are audited on a regular basis by the management and should be robust enough to pick up such anomalies as described above. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 17 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): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and families are encouraged to be socially active although it is realised that more needs to be developed around planned activity so that quality of life can be enhanced. 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. General comments where that the 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 good level of staff interaction and engagement with residents. Staff interviewed were clear that this area was always staffed and it was observed that staff regularly interacted and supported residents. Relatives spoken with said that staff are consistent and ‘they obviously care’. The home employs an activities coordinator for 24 hours weekly. The post was vacant at the time of the inspection however and the managers reported that this was a difficult post to maintain as staff found it difficult to organise activities on an ongoing basis. There had been four activities persons in the recent past. There was some discussion around how this could be managed Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 18 more effectively and in particular providing training for such a role as well as extra support by perhaps increasing the available hours and sharing this between two staff who can provide mutual support. 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 activities listed on the rota posted outside the dementia unit consists of ball and chair activities and bingo which is rather limiting. On the day of the inspection staff reported that they had engaged residents during the morning in a session of physical activity. Staff also reported regular attendance by an entertainer and also trips out of the home occasionally. Overall however there remain long stretches of time with little planned activity at present. One relative’s comments summed up the general opinion: ‘Staff are very good and caring. I would like to see more stimulation. Never see any activities. The TV on the top floor is always on but is not big enough for people to see. Used to have Lynn [activities person] she was great but now she’s gone. Can now go in the garden, which is really good. They do have trips out sometimes. 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. 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. There is now more orientation aids and signage for toilets etc but this could be improved and built on. 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 although now benefit from a menu board which displays the days menu for easier reference. [The board is currently in the passage way outside the dining room – this could be moved or repeated inside the dining room]. The home provides the choice of a cooked breakfast, which is appreciated by some residents. Residents generally enjoy the food and comments were positive. Throughout the day drinks were made available and there are also extra jugs of juice provided and some residents were seen to be helping themselves. Aaron Grange Care Home DS0000069135.V365664.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents and relatives feel able to raise issues of concern and there is an open culture with respect to complaints although some of the recording could be improved so that all concerns can be responded to. EVIDENCE: The home have a clear complaints procedure that is located throughout the home and in the service users guide [SUG]. The home has 28 days in which to investigate them and respond. The SUG does not give information on how to contact outside agencies such as Social Services or the Commission for Social care Inspection [CSCI] and this should be added. The complaints recording book was seen and two complaints are listed and have been investigated. The first concerned standards of hygiene in a resident’s bedroom and the second was a concern by a relative over the personal care of a resident. Both had been investigated and responded to appropriately. There were some other concerns listed in the book which were not as clear and one seen was not signed by the person making the entry. It was difficult to see what action had been taken although it was explained that these related to the first compliant investigated and all of the issues had been covered. For clarity it would be appropriate if each complaint was listed on an initial ‘complaints form’ which could then be individually acted on and form part of the auditing process. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 20 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. In terms of concerns/complaints during the inspection we found that a number of concerns were being expressed about clothing going missing in the home and also other residents clothing being placed in residents rooms. None of these concerns were recorded in the complaints files however. One relative said that concerns had been raised with the manager a number of weeks ago but there had been no feedback to date. The manager was able to talk about the home’s adult protection policy and how this linked in with locally agreed policies under the Protection Of Vulnerable Adults [POVA]. The manager has had experience using the policies and was able to outline the home’s role in this. Staff spoken to had completed training around abuse awareness and this was also evidenced in staff files. Since the last inspection the home have undergone a number of investigations by the social services safeguarding team. The general outline and main themes of the investigations are listed below: • Alleged abuse verbal and physical of a resident. The investigation was inconclusive due to the incapacity of the resident concerned. The home’s management also investigated this and introduced measures, which further protected the resident concerned and also staff. Complaint by relative of resident with poor standards of personal hygiene, poor staff supervision and no personal toiletries. This was investigated by a social worker who arrived unannounced and standards were found to be satisfactory. A resident who sustained a fracture to a leg. The investigation proved inconclusive in that it could not be substantiated how the injury had been caused. The picture was complicated as the resident had other medical conditions which clouded observations of staff at the time. There are currently two ongoing investigations concerning injuries to residents in the home. As part of the inspection we looked at how accidents are managed and how risk to residents is measured and actions taken to reduce risks to residents. Overall the management was found to be satisfactory [see details under ‘management’ section of the report]. Accidents are recorded and appropriate observations made. These are also audited monthly and any action to reduce risk is recorded. • • • Aaron Grange Care Home DS0000069135.V365664.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): 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 continues to be developed with the needs of the residents in mind so that they are provided with a safe and comfortable environment to live. 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. 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 Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 22 had offensive odours at the time of the visit. Residents and relatives said the home was always clean. The external grounds are maintained well and can be accessed by residents. The recommendation previously made for better access for residents on the dementia unit have been actioned and the day area now opens directly onto the garden and this has also been made safe so that residents are free to wander out if they wish. 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 and relatives did raised some concerns that although the home was generally good the fact that clothing went missing was a common feature: ‘My only complaint is that clothing goes missing. Everything is marked but it still goes missing. A few weeks ago found clothing in mums room which was not hers’. The laundry was visited and found to be clean and well managed generally although there was an admission by staff that the above concern is ongoing. 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. Some improvements have been made such as orientation boards in some areas but signage could be further improved so that toilets etc can be located from corridors. Aaron Grange Care Home DS0000069135.V365664.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): Key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill level of staff currently meet residents care needs but there needs to be improvements made in the rigour by which staff are recruited so that residents can be assured that employees are fit to work with vulnerable people. 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 afternoon. This represents an increase in basic staffing levels since the last inspection with one extra staff allocated to the afternoons [recommended at the time]. On the general elderly unit there were 24 residents with 3 care staff. The over all staffing ratio is therefore 1 staff to 8 residents on the residential unit and on the dementia care unit in the afternoon the ratio is 1:7.5 on the dementia care unit. The manager and deputy are in addition to these figures and generally work office hours. 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 for 24 hours a week although the post was vacant at the time of the inspection. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 24 Both staff interviewed and residents and relatives spoken to on the day felt that staffing was adequate in terms of numbers and staff on the dementia care unit explained that personal care was now more consistent because of the additional staff in the afternoon. The general dependency of residents is quite low [dependency levels are monitored]. In terms of quality outcomes for residents, however, around time for socialisation and observing residents at particular times then staffing may need to be reviewed if the home wishes to achieve further improved outcomes in these areas [management could look at any correlation between staffing availability and falls for example as part of their auditing process]. 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 spoken with were supportative of the staff and management. Staff files were seen and we found some anomalies in the recording of basic recruitment checks that must be addressed: • One staff reviewed did not have the required check made of the Protection of Vulnerable Adults [POVA] register prior to commencing work. A check was made with the Criminal Records Bureau [CRB] and the reason for this was that the check had not been requested on the application form. This is a basic requirement and check that must be made prior to commencement of employment so that residents are protected from staff who may be unfit to work with vulnerable people. The manager stated that by doing the ‘enhanced’ check she understood that the POVA check was automatic. Following further discussion it became apparent that a check of all records needs to be made to ensure that this check has been complied with. The application form in the same file had no references listed on application [section was blank]. There was also no previous history of work recorded [a note on the form says ‘should be listed on CV’ but there was no CV available either]. Therefore managers are not able to check not able to check the applicants previous work record. There were two written references available but none of these were from care organisations and it was not possible from the records to say whether this staff member had worked in a care environment previously. Another staff file seen had the same application form and again there was no work history listed [no CV available]. References were listed on the form but one had no address. The references available were checked and one was from another person not listed on the application form • • Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 25 [managers stated that this was form another member of staff working at the home]. There must be more robust recruitment records and checks made so that residents are assured staff working in the home are fit and suitable. Training files were seen for staff and staff spoken to were pleased with the ongoing training in the home. Managers explained that most staff have NVQ training or are on an NVQ course. Training needs are continually assed through supervision and there is a training plan of training events for the immediate future. The depth of the induction training for new staff was not clear. One induction record consisted of an initial checklist of work based instruction [routines etc] and another checklist of basic training requirements. The manager explained that the first is completed over the first couple of days and the second is in more depth and is covered over a number of weeks. We found in this example however that the induction was recorded over one day. This would not have allowed any time for the employee to assimilate the information. There was no evidence that this staff member had had any previous experience. One staff spoken with during the inspection was new to the home [second day] and explained she was shadowing anther staff member. It was a surprise that this person was not supernummery to the staffing in the home for this period, as she also had not had any previous experience of care work. There was some discussion again about the adequacy of the induction for new staff and whether this meets the skills for care common induction standards and it is recommended that manager further assess this. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. The management team 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 but there needs to be more robust monitoring of some systems so that a consistently safe standards are maintained. EVIDENCE: The registered manager Pauline Bowen was working her last two shifts in the home at the time of the site visit. We understand that Kathy Jones is now acting manager for the home and will be applying for registration. Kathy has had many years experience working in the home at deputy level and has completed a management qualification at NVQ level 4. The management team have made progress since the last inspection and have met some of the requirements and recommendations previously made and were able to demonstrate a continuing progress and raising of the care Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 27 standards 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 that the company have introduced and some of these were seen. For example there are audits conducted around accidents in the home and general health and safety issues. Also quality audits around activities and regular medication audits. There was some discussion around the use of the audits and a recommendation would be to use some of the auditing tools [activities for example] in each of the two separate units rather than the home overall as the feedback may be different and more pertinent. Also the audits must be robust enough to pick up and monitor quality issues. Medication audits have been carried out for example but have not picked up some of the issues highlighted in this report [same goes for recruitment files and checks]. Overall however the auditing system should provide constructive feedback to the management so that continuous improvements can be made. 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. General satisfaction with the service is good. Health and Safety is managed and the home is maintained safely through regular risk assessment. The AQAA submitted by the home and those safety certificates and records seen were all up to date and monitored. Accident reporting was discussed and accident records were reviewed. [See previous notes under ‘complaints and protection’] and the monitoring of this area is good. For example a recent fall was recorded well and the daily notes following the fall referenced appropriate observations showing that staff were aware how to monitor such incidents. On all but one of the accident reports seen there was a note that relatives had been informed on the day of the accident. The home have experienced a number of residents falling and sustaining serious injury recently and these have not been reported through under RIDDOR regulations to Health and Safety executive and this must be carried out. The guidance from Health and Safety Executive [HSE] is: Any accident that causes a member of the public (including service users) to be taken away from the premises for medical treatment and all major accidents involving employees should be reported immediately. Managers displayed an open attitude to the inspection and were positive regarding any discussions at the time. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement Residents who are on PRN medication must be monitored through the care plan so that and effective interventions and evaluation can be planned consistently and staff are consistent in their practice and administration is safe. All people applying for employment must be thoroughly vetted and the required pre employment checks carried out in full so that residents are assured of the fitness of the staff working in the home. Timescale for action 01/10/08 2 OP29 19(1) 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Evaluations of the care plan should be documented more fully and include an assessment of the progress set DS0000069135.V365664.R01.S.doc Version 5.2 Page 30 Aaron Grange Care Home 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. 2 OP9 • All medication records need to be clear and accurate. Medication stock should be carried over on the MAR charts and all entries for the recording of medications need to be dated. The policy and practice of encouraging and support residents to self medicate should be reviewed with an emphasis placed on residents retaining independence in this area within a safe risk management programme. The risk assessment tool seen for self medication is actually a consent form. It does not measure or assess any risks involved when considering whether, or to what level, a resident is capable of selfmedicating. As such it needs reviewing. • • 3 OP12 The development of activities for residents should continue with reference to comments in this report. Series consideration should be given to developing the activities coordinator role including the provision of more hours. 4 OP16 The SUG does not give information on how to contact outside agencies such as Social Services or the Commission for Social care Inspection [CSCI] and this should be added. For clarity it would be appropriate if each complaint was listed on an initial ‘complaints form’ which could then be individually acted on and form part of the auditing process. During the inspection we found that a number of concerns were being expressed about clothing going missing in the home and also other residents clothing being placed in residents rooms. None of these concerns were recorded in the complaints files however. This was fed back to the managers who need to review this area of concern. Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 31 5 OP19 The management need to continue to develop good practice principals with respect to the environment on the dementia unit so that residents are further enabled to access facilities more independently with the introduction of good practice around orientation. It is recommended that staff files are checked to ensure that all recruitment checks have been appropriately made. The induction-training package should be audited against the skills for care standards to ensure all areas are covered. Auditing systems must be robust enough to pick up and monitor quality issues. Medication audits have been carried out for example but have not picked up some of the issues highlighted in this report [same goes for recruitment files]. It is recommended that recent accidents to residents in the home be further assed and any that require reporting under the RIDDOR regulations are referred appropriately to the HSE. 6 7 OP29 OP30 8 OP33 9 OP38 Aaron Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North West Region 3rd 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 © 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 Grange Care Home DS0000069135.V365664.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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