CARE HOMES FOR OLDER PEOPLE
Aaron House 255 Preston New Road Blackburn Lancs BB2 6PL Lead Inspector
Mrs Jennifer M Turner Unannounced Inspection 5th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 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) 681071 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.V255838.R01.S.doc Version 5.0 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. 28th June 2005 Date of last inspection Brief Description of the Service: Aaron House 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 ensuite facility. Toilet and bathing facilities are easily accessible to residents. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 05.12.05 between 10.30am and 4.45pm. 21 of the beds were occupied. Information was obtained by talking with the registered manager, staff members, residents, a visitor and visiting professionals. One comment card was returned to the CSCI by a relative. Views were obtained on a variety of topics and information was also obtained by case tracking. This gives the inspector an overall view of the specific care provided for the individual residents, by checking their care plans, other documentation and by speaking with them (if they are able) and staff. Views have been recorded collectively where the answers obtained were similar. Any specific or differing comments have been recorded in the main body of the report. Staff were observed both directly and indirectly carrying out their tasks and interacting with the residents. Paperwork examined included care plans, assessment documentation, policies and procedures or documentation relating to the individual standards assessed. A tour of the building was undertaken. The inspector’s notes have been retained as evidence of the inspection. There has been a change to the home’s fax number. It is now 01254 56208 (Ring first). The home’s email address is :- mics03@dsl.pipex.com Since the last inspection an investigation has been initiated under the Protection of Vulnerable Adults Procedure. This investigation is still proceeding. What the service does well:
A sound procedure in relation to the Protection of Vulnerable Adults ensures that residents are protected from possible abuse. Staff continue to undertake National Vocational Qualification training at level 2. This will ensure that the staff obtain the required knowledge to care for the residents. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Records should be available in respect of what is available at suppertime. This will ensure that there will be a full record of food available to the residents. The individual items of blended meals should be blended separately to ensure that the meals are colourful in presentation and offer a variety of taste and texture for the residents. Training records should be kept up to date to show what training staff have completed.
Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 7 Maintenance records should be dated to indicate when the required work was completed. Bedroom audits should be carried out in order for prospective residents to be aware of what facilities are available in their rooms prior to admission. Reference forms should have the name of the member of staff on the return section in order to identify the member of staff it refers to. A list should be retained of CRB disclosures and POVA checks and should be retained until examined by the inspector. Staff members should be supplied with a contract of employment at the time of employment. A monthly visit should be made to the home by one of the registered partners under Regulation 26 of the Care Homes Regulations 1991. This would ensure that the manager and staff are receiving appropriate support from the registered persons. A development plan should be produced for the home. This should reflect how staff at the home are meeting the aims, objectives and the requirements of the Statement of Purpose. This would ensure that the needs of the residents are being met. Where staff at the home administers residents’ personal allowances, these should be kept and recorded separately. This will enable residents or their representatives to be aware of the amount of money held in individual savings accounts. A number of policies and procedures were in need of review. This ensures that staff at the home are “up to date” and aware of current working practices. Core training must be provided for all staff to ensure that qualified and trained staff care for residents. All appliances should be serviced on a regular basis to ensure that residents and staff live and work in a safe environment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 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.V255838.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1;2 Documentation is available to ensure that new residents have all the required information about the home prior to admission. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated and now contain all the required elements of the standard. The results of the residents and relatives’ surveys are being documented in the Service Users Guide. Copies of the Statement of Purpose and Service User’s Guide were on display near to the dining room and anyone was welcome to take one of these. Each resident was issued with a Statement of Terms and Conditions at the point of admission. One resident remembered signing a contract. The manager said contracts were discussed with the resident, although due to varied levels of capability, it was often the family or other representative who was most active in discussing this. The number of the room allocated to the new resident appeared in the Terms and Conditions of Residency, the letter of acceptance and the Care Plan.
Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication was handled according to current Pharmaceutical Society of Great Britain Guidelines. EVIDENCE: All the requirements and recommendations made following the previous inspection in relation to medication practices had been attended to. As a result, medication documentation examined was good. Medication procedures were observed during the inspection. Only trained staff administered medication. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Meals offered ensured that the individual dietary needs of the residents were met. EVIDENCE: Since the last inspection a cook had been appointed. Cleaning schedules and dietary records required were available. There were records available for breakfasts, lunches and teas served but no indication of what was available for supper. The daily menu was displayed on a board in the dining room. The manager said that staff asked residents in a morning what they wanted for lunch. The inspector had lunch with the residents and noticed that although residents were encouraged to eat their meals independently, staff were available to assist discreetly if required. The inspector discussed with the cook the presentation of various specialised meals. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16;18 Residents were protected from abuse and had access to the homes complaints procedure. EVIDENCE: No complaints had been recorded since the last inspection. The Service User Guide contained a complaints procedure and a copy of the procedure was posted on the notice board. The manager said that the procedure was drawn to the attention of the resident’s representative at the time of admission. When asked if they knew who to speak to if they had any concerns, one resident said ‘I would speak to staff.” A comment card received from a relative showed an awareness of the complaints procedure. There were a number of letters and cards of appreciation on display in the hall. Procedures complied with the Blackburn with Darwen Borough Council protocol for the Protection of Vulnerable Adults. The majority of staff spoken with had attended an “adult abuse” course and this was being cascaded to other staff. The training matrix did not show the number of staff who had completed POVA training. Staff were aware of differing forms of abuse and were able to discuss the right approach to be taken. An appropriate policy regarding physical and verbal aggression was also available. Since the last inspection an investigation under the POVA procedures had commenced. This investigation was progressing and was almost completed. Appropriate action had been taken by the manager.
Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19;24;25;26 The home was warm, clean and comfortable. A good standard of hygiene was achieved. Residents live in a safe, well-maintained environment. EVIDENCE: There was a routine programme of maintenance and records were kept. Staff recorded in the maintenance book any areas that required attention and the handyman signed the book when the work was completed. The inspector asked him to date when the work was completed. Fire safety issues were maintained “in house” and regular checks and maintenance was noted. Bedrooms were viewed and were clean and comfortable. Residents were assessed upon admission and if they were capable of managing a key, a lock would be fitted onto their bedroom door. Door locks should be fitted to each bedroom door and residents should be provided with a key, which he or she can retain (unless their risk assessment suggests otherwise). Some risk assessments appeared in care plans. A lockable storage facility had been provided in each bedroom but again, keys were not available to all residents. Again, these should be offered unless the reason for not doing so appears in a
Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 14 risk assessment and mentioned in the care plan. Where bedrooms do not have the furniture as recommended in NMS 24.2 a bedroom audit should be carried out. All rooms were individually and naturally ventilated. The windows had been fitted with appropriate restrictors. At the time of the inspection the home was at a comfortable temperature. All of the rooms were centrally heated, with individual thermostatic controls on the radiators. All radiators had been fitted with guards. There was adequate lighting of various types in the communal areas and emergency lighting was fitted throughout the home. Hot water outlets to baths and hand-basins had been fitted with pre-set valves. Records showed that Legionella testing had been carried out. Laundry facilities met requirements. There was no sluice, although a sink was designated for this purpose only. The shelf coverings in the laundry had been replaced. The manager confirmed that services and facilities complied with the Water Supply (Water Fittings) Regulations 1999. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28;29 Staff were recruited to current guidelines and received training suitable to the residents residing in the home. EVIDENCE: Staff training was ongoing. Of the thirteen care staff, six had completed a National Vocational Qualification (NVQ) at level 2 and the remaining seven staff were undertaking the course. The manager anticipated meeting requirements of 50 care staff obtaining an appropriate NVQ by the end of the year. The files of two recently employed members of staff were examined. All the requirements of Schedule 2 of the Care Homes Regulations 2001 were addressed but some areas required further improvement. The inspector advised that return reference sheets should contain the name of the staff member for easy identification. There was evidence to demonstrate that CRB’s had been applied for but not all POVA checks were available. The inspector offered advice in respect of the retention of information. Staff said that they were issued with a copy of the GSCC Code of Conduct and practice. Staff members spoken to said that they had still not received a contract of employment. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31;32;33;35;37;38 The welfare of residents was sufficiently protected although some of the homes management practices could be improved. There was a good staff and management team. EVIDENCE: The manager had completed NVQ level 4 and was “in the final stages” of the Registered Managers Award. She was aware of the need to complete the training by the end of the year. She had obtained her D32 and D33 qualifications, and there was evidence that other relevant courses had been undertaken. There were no records available to indicate that the registered persons were visiting the home under the requirement of Regulation 26 of the Care Homes Regulations 2001.
Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 17 Aaron House had achieved the ‘Investors in People Award’. Resident questionnaires (in the main completed by their representatives) contributed towards self-monitoring. Consideration was being given to using questionnaires for other professional opinions. Currently this was informal, through ongoing discussion. The annual development plan had not been reviewed since 31.12.04 but the manager said that the new plan was “still being worked upon”. Pensions were generally paid from the Department of Work and Pensions into the Proprietors account. The manager administered the finances of four residents. She indicated that she spent money on behalf of these residents and then requested reimbursement from the Proprietor. Monies were not paid to residents on a weekly basis. The residents’ monies were kept in a joint residents account at Barclays Bank. There were no clear records for the inspector to check how much money was held for each resident. It was required that where residents monies are held in a joint residents account, the account records separate deposits and withdrawals for each individual. It must be demonstrated how individual interest is calculated to individual residents own savings. The majority of policies and procedures viewed by the inspector still required to be reviewed. It was recommended that each policy and procedure be dated when it had been reviewed. Records were maintained for accidents. The fire records and fire equipment examined were up to date. Health and safety policies, procedures and legislation were available at the home for staff to ensure the health and safety of residents and each other. The manager continued to address the issue of all staff receiving moving and handling training. The manager was to pursue the outstanding work required following the issuing of the Gas Safety Certificate on 15.06.05. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 3 3 STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 1 X 2 2 Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP32 Regulation 26 (2) Timescale for action The registered person must 31/01/06 ensure that the home is visited under the requirement of this regulation and the appropriate report produced. A copy of this report must be supplied to the registered manager and to the CSCI. The registered person must 31/03/06 ensure that an annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting the aims and outcomes for residents, is produced. Previous timescale of 30.09.05 not met. The registered person must 31/12/05 ensure that there are clear and accurate records of the amount of personal allowance received by residents and the individual balance held in safe keeping for them. Previous timescales of 25.10.04 and 30.09.05 not met. The registered person must 31/12/05 ensure that where residents’ monies are held in a joint residents account, the account
DS0000005802.V255838.R01.S.doc Version 5.0 Page 20 Requirement 2 OP33 24 (1)(a)(b) 3 OP35 17(2) Sch 4(9) 4 OP35 17(2) Sch 4(9) Aaron House 5 OP38 13 (5) 6 OP38 23 (2)(b) records separate deposits and withdrawals for each individual. It must be demonstrated how individual interest is calculated to individuals’ own savings. Previous timescale of 30.09.05 not met. The registered person must 31/12/05 ensure that all staff receives moving and handling training. Previous timescale of 30.11.04 not met. The registered person must 31/12/05 ensure that any outstanding requirements made following the inspection of appliances are completed. Previous timescale of 28.06.05 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP15 OP15 OP18 OP19 OP24 Good Practice Recommendations Records should be available in respect of what is available at suppertime. The individual items of blended meals should be blended separately to ensure that the meals are colourful in presentation and offer a variety of taste and texture. The training matrix should be brought up to date to show which members of staff have completed POVA training. The maintenance person should date, in addition to his signing, the maintenance record when work has been completed. Bedroom door locks should continue to be considered. Risk assessments should continue to be completed where residents are unable to use keys to their bedroom doors or lockable facility. A bedroom audit should be carried out in each resident’s bedroom showing what furniture is available. At least 50 of the care staff should have achieved NVQ level 2 (or equivalent) by the end of 2005.
DS0000005802.V255838.R01.S.doc Version 5.0 Page 21 6 7 OP24 OP28 Aaron House 8 9 10 11 12 OP29 OP29 OP29 OP31 OP37 Reference forms should have the name of the member of staff on the return section in order to identify the member of staff it refers to. A list should be retained of CRB disclosures and POVA checks and should be retained until examined by the inspector. Staff members should be supplied with a contract of employment. The manager should complete the Registered Managers Award by the end of 2005. Policies and procedures should be reviewed on an annual basis or more frequently if required. They should be signed and dated when reviewed. Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aaron House DS0000005802.V255838.R01.S.doc Version 5.0 Page 23 - 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!
