Inspection on 17/10/05 for Aaron Lodge

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Lodge 14/04/09

Aaron Lodge 09/10/08

Aaron Lodge 24/04/07

Aaron Lodge 25/10/06

Aaron Lodge 24/05/05

Aaron Lodge 05/01/05

Aaron Lodge 20/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Aaron Lodge Marmaduke Street Liverpool Merseyside L7 1PA Lead Inspector John McCabe Unannounced Inspection 17th October 2005 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 Lodge DS0000025077.V258986.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 Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aaron Lodge Address Marmaduke Street Liverpool Merseyside L7 1PA 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 261 0005 0151 236 0005 Aaroncare Plc Paula Marie Gamble Care Home 48 Category(ies) of Dementia - over 65 years of age (48) registration, with number of places Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 48 DE(E) Personal Care The home may admit two persons DE Personal Care between the ages of 55 and 65 20th May 2005 Date of last inspection Brief Description of the Service: Aaron Lodge is registered to provide personal care to 48 elderly people who have an age related mental health condition. Aaron Lodge is a purpose built home. Each resident has a single bedroom. Bathrooms and toilets are situated on both floors. Each floor has a dining area and a lounge. There is a private enclosed garden to the rear of the home with patio furniture. Parking is also available at the rear of the building. A lift and bathing aids are provided. There is access to a bus service from the home. The home is close to local shops and amenities. The city centre is approximately 10 minutes away by public transport. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 0930 hours, the registered manager of the home was present, and the inspection took 7 hours. A full tour of the building took place, which was clean and tidy. All relevant documents pertaining to residents and staff were reviewed. The registered provider was also present from 1100 hrs till the end of the inspection. The inspector spoke with residents, staff, and a Practice Nurse from local GP centre, as to the conduct of the home. What the service does well: What has improved since the last inspection? The majority of the homes policies and procedures have been reviewed (September 2005), and all staff have been involved in getting to know the new policies. Fire training for staff is now undertaken on a regular basis, for both day and night staff. Information on Adult Protection issues is now communicated to all new staff when they commence employment in the home. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 7 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 Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 8 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): 1,2,3,4,5. The resident’s pre admission assessment documentation needs to be reviewed so as to include aspects of the symptoms of the Organic Psychoses (Dementia). This to ensure that the assessed and changing care needs of the service users is recognised and met. Specialist training (Person Centred Dementia Care) needs to be implemented in the home, to help ensure that changing care needs of the resident are met. EVIDENCE: The home pre admission assessment document consists of 10 pages, mostly information that would be suitable for nursing residents; there are only few questions relevant to Dementia. The document needs to include more information on the cognitive impairment of the residents, and the symptoms expressed in residents who suffer from Dementia. The symptoms may include, hallucinations, delusions, altered body image, challenging or aggressive behaviours, wandering, communication (especially speech), and the achievable activities of daily living. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 9 On the completion of a robust and comprehensive pre admission assessment document, it helps to ensure that the person being admitted to the home is within the registration category of the home, and the home has the skill mix of staff to care for the resident. Other health care professionals, and family known to the resident should be involved in the pre admission assessment procedures. The pre admission document will contain the information needed to formulate an initial care plan for the resident. The sample of residents files viewed contained contracts. Each resident is provided with a contract after a period of settling in, usually within 4 weeks of admission. The contract contains all the required information. Sample copies of the contract used are available in the Statement of Purpose and resident’s guide. Increased specialist training for (Person Centred Dementia Care) be increased to ensure that the changing care needs of the resident are met by staff. Specialist care training might include, disorders of perception i.e. hallucinations and delusions, cognitive impairment which includes memory loss, speech, aggressive or challenging behaviours, breakaway techniques. The inspector told the registered persons that both Bradford and Stirling Universities have all relevant information on caring for residents with dementia. Plus the Alzheimer’s Disease Association will provide information leaflets free, on many aspects of Person Centred Care. Staff, including the registered persons have a good rapport with all the residents and care workers showed good levels of communication and engagement with the residents. Aaron Lodge DS0000025077.V258986.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): 7,8,9,10,11. Resident’s individual health, personal and social care needs are fully recorded in the care plan, and provide care staff the information they need to meet the residents care needs . EVIDENCE: A sample of residents care plans was seen. These contained sufficient information to enable staff to meet the health, personal and social needs of the residents. The care plans seen had been reviewed monthly. Staffs spoken to were aware of how to access resident’s records. The manager reported that she endeavours to obtain the views of residents and their relatives regarding the care plan. Records showed that some signatures of relatives had been obtained. The accident book was examined; the information was the same as what had been recorded in the resident’s daily health record sheet. The manager should consider doing monthly audits of resident falls and other incidences. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 11 Daily health records are documented for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses etc. No resident in the home self medicates, all medications for residents are administered by the carers in the home, who have undertaken drug administration training. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). Handwritten scripts on residents MARS must be accompanied by two signatures. PRN medications must state the maximum 24- hour dos. This is a recommendation for the Royal Pharmaceutical Society of Great Britain. The manager told the inspector that some residents were having Aromatherapy from a visiting aroma therapist. It has been shown that dementia sufferers benefit from aromatherapy, especially when massage techniques are used. However the residents GP must be consulted, as to the appropriateness and safety of any oils used on the resident, in case the oil which is being applied on the skin, once absorbed has any effect on the medications the resident is receiving. All residents in the home can access their NHS entitlements, which include dentists, opticians and chiropodist. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 12 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): 12,13,14,15. The residents routines of daily living are flexible and activities are available that reflect needs and preferences. Residents receive appealing well-balanced nutritious meals in pleasant surroundings. EVIDENCE: Observations and a discussion with staff indicated that the routines of daily living are flexible. There is a list of weekly activities available at the home. The manager said that this is drawn up following consultation with residents and family. A record is made of activities that residents take part in, and recordings are made in the resident’s daily health record sheet. Activities include gardening, board games, and outings to the park, pubs and shops, karaoke. The home hopes to employ another member of staff to undertake activities with the residents. Also, the home could introduce “Rummage Boxes”, basacially this is a plastic box filled with safe material of different textures, wool, wood, paper, plastics. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 13 Many dementia sufferers enjoy “rummaging “through the box, and enjoy feeling the different textures. Visitors are allowed in the home at any reasonable time for day, residents may entertain their visitors, in the communal lounges, or in their own bedroom. The secure gardens are ideal setting for residents to sit with their relatives, especially in the summer months. Observations of the dining areas at meal times indicated that a pleasant environment is provided for residents to have their meals, meals are unhurried and appropriate assistance to eat is given. It was observed that the independence of residents at mealtimes is promoted. The records of menus indicated that a variety of meals that would provide a balanced diet are available Any special dietary needs are written in to a residents care plan. The cook reported that he is informed about any dietary needs and ensures these are taken into account when meal planning. However whilst visiting the kitchen with the registered provider, the cook told the inspector that there were no diabetic diets, yet during cases tracking of resident’s files, four residents have Diabetes Type 2. This medical condition is treated with a special diet as well as medication. The manager of the home could not understand why the cook was not informed as the information is contained on the residents risk assessment for nutrition. It was observed that residents appeared to be enjoying their meals. A resident said that they like the food provided. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 14 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): 16,17,18. Staff training and policies and procedures are in place to ensure that residents views are heard and appropriate action taken, to ensure residents are protected from abuse. EVIDENCE: The home has an up to date complaint procedure that includes the name and contact details of CSCI. Staffs spoken to are aware of the complaint procedure and are able to advise residents and their relatives of the steps to take to make a complaint. Currently, one resident is subject to an Adult Protection inquiry, this investigation is in the early stages and no outcomes have been confirmed. The care home has up to date information on the Protection of Vulnerable Adults (POVA), it could was evidenced, that newly recruited employees were instructed on this important topic, on their induction course. Three care staff spoken with, were aware of the procedures and explained to the inspector the correct procedures if they witnessed any type abuse of a resident. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 15 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): 19,20,21,22,23,24,25,26. The home is well maintained and there is a good standard of cleanliness and hygiene, providing residents with a pleasant environment to live in. EVIDENCE: The tour of the home showed that the home is well maintained and decorated to a high standard. There is a rolling programme of re-decoration and refurbishment. The home was clean and fresh smelling. The home employs full time domestics who are also responsible for the homes laundry. The private secure garden area of the home is well tended and provides a patio area and patio furniture. All the residents’ chairs in the dining room have “Ski” bases, which are an excellent safety feature that prevents the resident from tipping the chair over while they are sitting. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 16 The communal baths and toilets were bright and have a homely appearance, Bedding in the home is constantly been upgraded and most duvets/ bed covers match the décor of the rooms. Windows in all residents’ bedrooms, especially on the first floor need to be inspected, as some of the windows restrictors are broken. Also, all residents must be risk assessed to ascertain their safety as regards liquid soaps (shampoo) and other cosmetics stored in their bedroom. In the past in the UK, there have been fatalities when dementia sufferers ingested a liquid soap product. Any of these products should not be in the communal bathroom, unless they are locked in a cupboard. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 17 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): 27,28,29,30. The standard of vetting and recruitment practice is unacceptable. Appropriate checks have not been carried out on all new staff. This means that the residents are potentially put at risk. EVIDENCE: Two staff files reviewed could not evidence an up to date CRB/ POVA enhanced certificate, or a POVA First clearance, yet the staff members were currently working in the home. The inspector reminded the registered persons, that CRB/POVA enhanced certificates were not portable from other employers, and any prospective employee for Aaron Lodge must have a new CRB/POVA certificate in the name of Aaron Lodge. Most of the staff files reviewed did contain terms and conditions, and a contract, but only a few have a photograph of the staff member. Staff spoken with said they would like to see more staff on duty, especially morning times. There are vacancies for care staff and a housekeeper, which the manager hopes to appoint in the near future. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 18 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): 31,32,33,34,35,36,37,38. There are quality-monitoring systems in place and the policies and procedures of the organisation ensure that the health and safety of service users is promoted. EVIDENCE: The manager has worked in the home for ten years. She has an NVQ level 3 in care of the elderly and has successfully completed an NVQ 4 in management. A discussion with manager and records show that the manager has undertaken training to keep her skills and knowledge up to date. . Questionnaires are sent to residents, their relatives and professionals who have contact with the home such as psychiatrists and doctors. There was evidence that when needed, action is taken to address findings. The finalised surveys when complete should be published in the homes Statement of Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 19 Purpose. The manager chairs both meetings for staff and residents/relatives on a regular basis; minutes are recorded for the meetings. The registered provider does visit the home at least once a month to undertake various audits, though the monthly reports on the conduct of the home are not forwarded the CSI Liverpool/Wirral office, as they should be The records of fire safety checks fire drills certificates of insurance and worthiness for electricity and gas were in were in date and valid, this includes the Employers Liability Insurance. Both residents and staff files are kept secure in accordance with the Data Protection Act 1998. All staff in the home does not have documented supervision six times per year, which could ensure that all staffs have the opportunity to discuss with the manager, and other seniors any issues, which can effect or improve the care for the residents. Documented supervision of all staff also gives the staff and managers opportunities to discuss their own /or identified training needs, which in some cases have not been done. Training records showed that staffs are given appropriate training in safe working practices. The timescales recommended by the fire service for fire safety training (day staff every 6 months and night staff every three months) was being followed. The home has no bank accounts for residents; residents access their personal allowances via the manager or relatives. Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 20 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 2 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 2 3 Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 21 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 3 Regulation 14 Requirement The registered person must ensure that the pre admission assessment for resident includes the more details of the residents dementia The registered person must ensure the staff receive specialist training in Person Centred Dementia Care to ensure that the assessed and changing needs of the resident is met. The registered person must ensure that the residents GP is consulted before the resident has Aromatherapy sessions. The registered person must ensure that the homes cook is an informed of resident who require special diets. This refers to residents who have Type 2 Diabetes The registered person must ensure that windows in resident’s bedrooms, which have opening restrictors, are functional. The registered person must ensure that residents are risk assessed to ascertain their safety DS0000025077.V258986.R01.S.doc Timescale for action 30/11/05 2 4 19 30/11/05 3 7 12 30/11/05 4 15 16 30/11/05 5 19 23 30/11/05 6 25 1 30/11/05 Aaron Lodge Version 5.0 Page 22 7 33 26 8 36 19 with liquid soaps and shampoos in their bedrooms. The registered person must 30/11/05 ensure that a monthly written report on the conduct of the home is forwarded to the CSCI Liverpool/Wirral office The registered person must 30/11/05 ensure that all care staff receives documented supervision six times per year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Aaron Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Lodge DS0000025077.V258986.R01.S.doc Version 5.0 Page 24 - 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!