Inspection on 29/07/08 for Aaron House

This inspection was carried out on 29th July 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 House 04/07/07

Aaron House 22/11/06

Aaron House 05/12/05

Aaron House 28/06/05

Aaron House 21/09/04

Aaron House 22/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Aaron House 255 Preston New Road Blackburn Lancs BB2 6PL Lead Inspector Jane Craig Unannounced Inspection 29th July 2008 10:15 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 House DS0000005802.V368020.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 House DS0000005802.V368020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aaron House Address 255 Preston New Road Blackburn Lancs BB2 6PL 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) 01254 56208 01254 56208 alison.foster4@btinternet.com Mr Ahmad Ahmadi Mrs Badrolmolouk Abbaszadi Mrs Alison Foster Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must, at all times, employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 4th July 2007 Date of last inspection Brief Description of the Service: Aaron House is registered to provide personal care and accommodation for 23 older people with dementia. The home is situated on the outskirts of Blackburn on the Blackburn to Preston main road. The main public park, shops and churches are nearby. The town centre is within walking distance. Aaron House is a detached property and the small front garden leads onto the busy main road. At the rear of the house is a small parking area leading to an enclosed grassed area. The interior of the home is on four levels. The dining room is situated at basement level and leads into the conservatory. The office and staff room and three bedrooms are also situated at basement level. The car park and rear garden are accessed via a ramp from the dining room. There are two lounges on the ground floor and residents are able to access the dining room only via a passenger lift. The upper floors are accessed via the staircase or the passenger lift. The majority of bedrooms have single occupancy but there are some double rooms available. One single bedroom has an en-suite facility. At the time of this inspection the weekly fees were £341.00. There were additional charges for hairdressing, toiletries and newspapers. A charge was also made for transport and staff escorts to appointments. Written information about Aaron House was available at the dining room entrance and on request. Aaron House DS0000005802.V368020.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. A key unannounced inspection, which included a visit to the home, was conducted at Aaron House on the 29th July 2008. At the time of the visit there were 15 people living at the home. The inspector spoke with a few of them and some of their comments are included in this report. Two people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to people living and working at Aaron House. Five people using the service, some of who had received help from relatives and staff, and five members of staff completed surveys. During the visit discussions were held with the manager, members of the staff team and a visitor. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Before anyone moved into the home the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Aaron House. Staff were observed assisting residents in a friendly and respectful manner. They were aware of the importance of promoting people’s privacy and dignity. Staff had a good rapport with people living in the home. They spent time with them sitting and chatting in the lounge. There was also a limited programme of activities on offer. There was an open visiting policy, which meant that people could see their friends and relatives at any time. A visitor said they were made to feel welcome and were offered refreshments. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 6 People who returned surveys and those spoken with said that they always, or usually, liked the meals. Everyone received a copy of the complaints procedure. The procedure gave people clear information about how they could expect any complaints to be processed. Most residents and staff who returned surveys indicated that there were always enough staff on duty to meet people’s needs. The manager had recently increased the staff when the number of people using the service increased. What has improved since the last inspection? What they could do better: Care plans must clearly identify the needs of people who have dementia and provide sufficient directions for staff to meet those needs. Other care plans should be more person centred so that they take into account people’s individual wishes and preferences. In order to protect the health and safety of people living in the home, risks to their health must be assessed and plans to minimise the risks must be put into place. The manager find some formal means of monitoring the weight or size of people who are not able to stand on bathroom scales. This is especially important for those people who are on special diets to help them to gain or lose weight. Some medication practices were not completely safe and could place people at risk. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 7 The manager should review the way that activities are planned and recorded to ensure that more people have access to activity and occupation that meets their needs. There must be more suitable bathing facilities in the home for the people who use moving and handling equipment and need staff assistance. People using the service, and people interested in their care, should have more opportunities to make their views about the service known and be able to influence how the service develops. Any substances that are potentially hazardous to people using the service must be stored safely. 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 House DS0000005802.V368020.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to help them to understand the person’s needs. EVIDENCE: Anyone enquiring about a place at Aaron House was given a statement of purpose and a service user’s guide was made available at the point of moving in. The annual quality assurance assessment (AQAA) indicated that the manager was planning to review the information included in both documents. People who completed surveys indicated that they received sufficient information about the home and that they had a contract. People were generally referred to Aaron House after they had been assessed by health or social care professionals. Copies of those assessments were on file. Anyone thinking of moving into the home was also assessed by the Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 10 manager, which helped to ensure that the service provided at Aaron House could meet the person’s needs. The manager said that information gathered during the assessment was passed on to staff to ensure that they understood the person’s needs and could draw up a care plan. Standard 6 was not applicable. Intermediate care is not provided at Aaron House. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all of the care plans provided staff with the information they needed to satisfactorily meet people’s personal and health care needs. Some medication practices were not completely safe and could place people at risk. EVIDENCE: Care plans were drawn up using information from the pre-admission assessment and a physical and social assessment, which was carried out on admission. The assessments identified the person’s strengths and needs in all areas of daily living but important information was not always transferred to the care plan. Care plans were not person centred. For example, one resident’s personal care plan instructed staff to provide assistance and to promote independence. However, the plan did not include essential information from the assessment, Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 12 which told staff what she was able to do independently and her specific preferences for how she liked to dress. Care plans to assist people whose assessments showed they had needs related to dementia did not have plans to adequately address their individual needs. For example, one person’s assessment indicated their memory was impaired and they sometimes became anxious. There was no plan to address any of their mental health needs. Another person’s daily records showed that they regularly became agitated and upset. Although the manager could describe in detail the best way to help the person through this, it was not recorded on the plan, which could result in inconsistent care being provided. Care plans and risk assessments were reviewed every month. There were no evaluation notes to indicate whether the planned care was effective and people were making progress towards meeting their goals. None of the care plans seen had been altered or updated with any new information. Relatives were asked whether they wished to be involved in care planning. There were also records to show that relatives were kept informed of any important changes in the person’s health. One relative said that staff always updated her whenever she came to visit. Health care risk assessments were on files but there were not always appropriate plans to minimise the level of risk. For example, one person was assessed as very high risk of developing pressure sores. There were directions to try to address some of the contributing factors, such as continence and weight. However, there was nothing on the plan about using pressure relieving aids or assisting with positional changes to minimise the risk. One person had a care plan to assist her to lose weight. The plan indicated that she should be weighed monthly. There were no records to show that she had ever been weighed and the manager said this was because they had no suitable scales for people who could not weight bear. There was no evidence that staff had tried any other means to monitor the person’s weight or size. This meant that any positive, or negative, effects of her reducing diet were not being monitored. It was evident that people had access to GPs, district nurses and other health care professionals as needed. Everyone who returned a survey indicated that they received the care and medical support they needed. During the course of the visit a relative said that they were happy with the home and the care their relative was receiving. Medicines were stored safely and at the recommended temperature. There were some medication policies on display so that staff had easy reference. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 13 There was a very safe system for ordering medication and for checking and recording when medication was received. There were no records of any stocks carried forward, which meant that there was not a complete audit trail. Medicines waiting to be returned to pharmacy were not locked away and records were not completed until the end of the month. This system increased the risk of mishandling. There were no gaps on the medication administration record (MAR) charts and staff used appropriate codes to indicate why medicines were not given. Most people had a separate plan to alert staff when to give medication that was prescribed ‘when required’. However, these were not always specific and in many cases just duplicated the instructions on the prescription. This increased the risk of over or under medicating. Variable doses were recorded, which meant that staff could audit the effectiveness of a particular dose. Staff had altered one person’s medication from once a day to alternate days. There was no authorisation for this, which meant that the person was not being offered their medication as prescribed by their doctor. Controlled drugs were stored, recorded and administered according to good practice guidance. All staff received training in core values during their NVQ training. They discussed how they maintained people’s privacy and dignity on a day-to-day basis, for example, carrying out personal care routines in private. One member of staff talked about how she made sure that she always asked residents whether they wanted help and did not just assume that they did. During the course of the visit staff were seen to speak to people with respect. It was noted that toiletries were used communally. This practice does not promote people’s individuality or their dignity. There were also communal hairbrushes, which increases the risk of the spread of infection. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines and meals suited the majority of people living at the home. Some people’s social and recreational needs were met through activities and contact with family and friends. EVIDENCE: Both people who were case tracked had an activity care plan on their files. The plans listed their preferred pastimes but there were no specific directions to help them to pursue any of their interests. One person in the home said she liked to read and the manager said she had arranged for the mobile library to call more often so that she had a good selection of books. There was a list of available activities on display but no timetable or advance planning. The manager said she was looking into this. Staff said that they did some activity everyday if they had time. They gave examples such as ball games or sitting and chatting to people. On the day of the visit staff were observed throughout the day spending time with different residents in the lounge. Records of activities seen showed mainly one to one activities or Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 15 watching TV. There was nothing in the records about the level of enjoyment or participation. This meant staff could not evaluate whether the activity had been successful for that particular person. Assessments included information about the person’s likes and dislikes and preferences for daily routines. Staff said they tried to give people as many choices about their daily lives as they were able. Some people were unable to understand their choices or verbalise their wishes and a member of staff said they tried to help by using visual cues where possible. Another said they made choices on behalf of the residents by thinking about what was best for that person. One member of staff said that she observed what people liked to eat so that she knew for the future but she did not always write it down. On the day of the visit staff were heard consulting people, for example, about what they would like to eat and drink. There were open visiting arrangements. One regular visitor said that she felt welcome in the home and staff offered her refreshments. There was some contact with visitors from the local community, for example church visitors. Menus were chosen by staff with very little input from people using the service. However, the four-week rotating menu showed that people were offered a varied and balanced diet with a choice at each meal. The weekly list was pinned up in the dining room but there nothing displayed about the day’s meals, which meant that people did not have any reminders. The AQAA indicated that the manager had started to keep more in-depth records to ensure that staff had a more accurate picture of what people were eating. On the day of the visit the meal looked appetising and people living at the home said they enjoyed it. One said they always liked the meals. People who returned surveys indicated that they always, or usually, liked the meals. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 16 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which were understood by staff. EVIDENCE: There was a clear complaints procedure on display in the dining room. Everyone who came into the home, or their relative, was also given a copy within the service user’s guide. Information in the AQAA indicated that there had been no complaints made to the home in the past year. People who returned surveys said that they would know who to speak to if they were unhappy and they all knew how to make a complaint. There was Information about advocacy on display should anyone need the service in the future. Staff surveys indicated that staff were aware of how to respond to any complaints from residents or their relatives. All staff had attended courses in safeguarding and they received regular refresher training. The new Blackburn with Darwen safeguarding policy and associated information was available for reference. The service had its own safeguarding and whistle blowing policies that gave staff information about protecting people and recognising abusive practice. Discussions took place with the manager about putting together a simple procedure to guide senior Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 17 staff who might be in charge of the home in her absence. Staff spoken with during the inspection were aware of the indicators of abuse and knew how to report inside and outside the home. The manager had not had any training about the Mental Capacity Act but said she would look into this in the next year. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 18 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): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home were comfortable and safe but there was lack of suitable facilities for people who were not independently mobile. EVIDENCE: The home was generally well maintained. During a tour of the building a few areas that were in need of attention were identified and discussed with the manager. For example, the staff call point in one of the rooms was not near enough to the bed and could not be fitted with an extension lead. Records showed that minor faults were reported and rectified by the maintenance staff. The communal areas of the home had satisfactory décor and serviceable furnishings. Despite a previous recommendation, only two of the fluorescent Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 19 lights had been replaced with more homely fittings. The manager said that there was a long-term plan to replace the others. Maintenance staff carried out a random audit of bedrooms to check that the décor was satisfactory and the furnishings were in a good state of repair. Some people had personalised their bedrooms with pictures and ornaments. One of the residents said their room was comfortable and a visitor said they were happy with their relative’s bedroom. Staff said the only bathroom in regular use was one with an assisted bath. However, the size of the room and the position of the bath meant that it was difficult to use moving and handling equipment. Records showed that one person, who required a hoist, had not had a bath for a number of weeks. One member of staff said that sometimes they could manage to use a hoist if there were three staff to help. It was not clear from talking to staff, how many people did not use the bathing facilities regularly. At the time of the visit the home was clean and fresh smelling. Most people who returned surveys indicated that it was always like that. The AQAA indicated that the manager had used the Department of Health guidance to assess the infection control systems within the home and found them to be satisfactory. Most staff had received recent infection control training and others were booked on a course. There was protective clothing available and staff said it was used appropriately. The laundry facilities were limited but the manager said they were sufficient to meet the needs of the people using the service. There were no dedicated laundry staff which meant that care staff had to take time from direct care duties to do laundry. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient staff, with appropriate training, to meet the needs of the people using the service. EVIDENCE: The manager had very recently increased daytime staffing levels to ensure that there were sufficient staff to assess and help three new residents to settle in. She said that she would continue to staff the home to meet the needs and dependencies of the people living there. People who returned surveys indicated that there were usually enough staff to ensure they had attention when they needed it. Most staff indicated that there were always enough staff on duty. The manager said she ensured that there were always sufficient staff to provide adequate supervision of people in the lounges. A visitor to the home agreed that this was important and said, “There are always staff about, and that gives you confidence” There was a stable staff team within the home and no new staff had been recruited since the last inspection. Following a previous recommendation, the manager said she was aware of what pre-employment checks were needed to protect people using the service. The AQAA indicated that the manager was planning to improve the application form to assist with the process. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 21 There was an induction training programme in place which covered the common induction standards. Most staff had done recent training in the safe working practice topics. Those who were not up to date had been nominated for courses. Most staff had received dementia care training, which was regularly updated. Many of these were only one day awareness courses. A few had attended more in-depth training that included aspects of care provision. Training records showed that some staff had attended other courses such as palliative care and health emergencies. Staff said that training opportunities were good and those who returned surveys indicated that they received training relevant to their roles. The AQAA showed that all care staff held at least NVQ 2 in health and social care. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in systems for consultation and improving the quality of the service, and in health and safety practices meant that the home was not always run in the best interests of people using the service. EVIDENCE: The registered manager had many years experience of managing care homes for older people. She held an NVQ level 4 in care and the registered manager’s award. She is also a qualified NVQ assessor. The manager said she keeps herself up to date by attending courses, networking and reading new guidance. She was supported in her management role by the registered provider, who carried out unannounced checks of the home every month. The Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 23 manager had acted on a previous recommendation to increase the amount of staff supervision. Records showed she carried out supervision approximately every two months. Most staff who returned surveys confirmed that they met with the manager on a regular basis. Since the last inspection the home had lost the Blackburn with Darwen quality assurance award but were due to be re-assessed the week after this visit. The last surveys for residents and other stakeholders were sent out over a year ago. Although the results had not been collated and published, most of the surveys seen were positive. The AQAA stated that the manager was working on simplifying the surveys and looking at ways of making the results available. The manager carried out some occasional audits of records and procedures to ensure that they were still relevant and being followed but this was not on a regular basis. Following a requirement at the last key inspection the owner of the home had opened a residents’ bank account to ensure that residents’ money was not included in the business assets. Two people living at the home had money in the account. The manager kept records of the amount of money paid into the account for each person and the amounts spent on their behalf. The records were not witnessed and there were no systems for checking. This could result in any errors in calculations not being identified. All other residents’ finances were handled by relatives and the manager did not keep money or valuables in the home. Following a recent fire safety inspection the fire risk assessment had been reviewed. Other recommended actions, for example, new strips on fire doors, were almost complete. Most staff had attended fire safety training in the last year and the manager was arranging dates for the few remaining staff. Records showed the last fire practice drill was over six months ago and only involved two staff, which meant that most staff had not been involved in recent practice drills. The AQAA showed that maintenance of other installations and appliances was up to date. Those due in the month following the visit had been booked. Tubes of caustic denture cleaner was seen in two bedrooms. There were no risk assessments to show that the occupants of the rooms were able to recognise the contents of the tubes and the potentially fatal consequences of ingesting them. Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 X 2 Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must clearly identify the needs of people with dementia and provide sufficient directions for staff to meet those needs. In order to protect the health and safety of people living in the home, strategies to reduce the assessed risks to people’s health must be included in their care plan. The manager must provide some formal means of monitoring the weight or body mass of people who are not able to stand on bathroom scales. This is especially important for those people who are on special diets to help them to gain or lose weight. In order to promote their health and welfare people must be offered their medicines as their doctor prescribes them. There must be enough suitable DS0000005802.V368020.R01.S.doc Timescale for action 30/11/08 2. OP8 13(4)(c) 30/11/08 3. OP8 12(1)(a) 31/10/08 4. OP9 13(2) 30/09/08 5. OP21 23(2)(j) 31/12/08 Page 26 Aaron House Version 5.2 bathing facilities for people who are not independently mobile. 6. OP38 13(4)(a) Storage of potentially hazardous substances such as denture cleanser must be assessed for the risks they present to people using the service and action must be taken to reduce any identified risk. 31/08/08 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 All care plans should be person centred to ensure that staff have sufficient information about people’s individual needs and how they wish to be supported. In order to reduce the risk of mishandling medication and to continue the audit trail, medicines waiting to be returned to pharmacy should be stored safely and records completed at the time of storage. In order to promote dignity and reduce the risk of cross infection each person should have and use their own toiletries. The manager should review the programme of activities to ensure that it meets the individual needs of the people living at the home. Consideration should be given to providing an alternative to the fluorescent light fittings in communal rooms and bedrooms. This will provide a more homely atmosphere in the home. The call point in Room 21 should to be moved nearer the bed in order for the resident to access it in case of an emergency. DS0000005802.V368020.R01.S.doc Version 5.2 Page 27 2. OP9 3. OP10 4. OP12 5. OP20 6. OP22 Aaron House 7. OP33 The manager should improve the systems for seeking and acting upon the residents’ and other stakeholders’ views of the service. Records of financial transactions carried out on behalf of people using the service should be signed and witnessed. There should also be random checks to ensure that the records are accurate. The manager should increase the number of practice fire drills and ensure that more staff have opportunities to be involved. 8. OP35 9. OP38 Aaron House DS0000005802.V368020.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Local office 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 House DS0000005802.V368020.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!