Inspection on 25/10/06 for Aaron Lodge

This inspection was carried out on 25th October 2006.

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 17/10/05

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 Natalie Charnley Unannounced Inspection 10:00 25 October 2006 th 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.V298377.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 Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 261 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.V298377.R01.S.doc Version 5.2 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 17.10.05 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. The home is currently in the process of being sold, however the commission have had no official notification of this. Information was gathered during the inspection process regarding this matter. It costs £388.00 to live at the home Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 10:00 and left at 16:00.The inspector spoke with 5 staff and 9 residents. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection using all information held on file at Commission for Social Care Inspection regarding the home, to ensure that all areas that needed covering were done so. Feedback was given to the person in charge during and at the end of the inspection. This report is based on pre inspection information provided by the home as well a site visit. Discussion took place with regard to how the home deals with equality and diversity. The manager was able to give examples of how they had address this in the past and evidence a variety of policies and procedures for both staff and residents. What the service does well: What has improved since the last inspection? What they could do better: Pre admission assessments, care planning and risk assessments need auditing and improving. Details need to be recorded regarding how the residents dementia presents itself and how this needs to be monitored by staff. Care plans must be made in collaboration with the resident and or their families. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 6 Activities at the home must be accurately recorded. Residents must be given access to a variety of activities in order for them to be fulfilled. The use of an activity co-ordinator may assist in this area. Whilst training at the home is good, staff showed some elements of institutional practices with regard to offering choice and treating people as individuals. The home may wish to focus upon this area in future training. Consideration must be given to the way meals are served. Residents must be offered a homely location in which to eat and have access to appropriate items such as placemats and salt and pepper. The home must be given the results of quality assurance checks in order to act on any necessary information in order to improve care. 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.V298377.R01.S.doc Version 5.2 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.V298377.R01.S.doc Version 5.2 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): 3 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service. The home undertakes assessments before a resident is admitted, however there is insufficient detail with regard to residents dementia and how they need to be cared for. EVIDENCE: Five care plans were sampled during the inspection. A number of these were emergency admissions where no pre admission assessment had been completed. The home had received information from social services regarding these residents, however the manager stated that a formal policy for emergency admissions was in place. The home needs to devise a policy for use in these circumstances. Those residents who had been assessed prior to them coming to live at the home, had a recorded assessment. Very little detail was available regarding their dementia and how this presents itself. Basic phrases such as ‘restless’ and ‘confused’ were recorded. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 9 These pieces of information do not allow staff to make an informed decision about if they can meet the residents needs. Assessment information needs to be in more detail and take into account full details of a residents function, risk and ability with regard to their dementia. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 and 10 Quality outcomes in this area are poor. This judgement has been made using available evidence including a visit to the service. Care plans and risk assessments do not reflect the residents needs, this puts residents health and safety at risk. Information regarding residents prone to challenging behaviour is not met with a plan on how to minimise the behaviour, the lack of assessment and review of residents needs means their wellbeing and safety could be compromised. Although residents were observed to be treated with respect by staff verbally, the lack of specific and vital written detail concerning residents personal profiles and needs that staff need to maintain and understand may affect the service to residents and not protect their dignity. EVIDENCE: One plan sampled was for a resident who had Alzhiemers Disease. There was only one reference to this condition in the residents care plan, under activities stating he found concentrating difficult. Care plans within this care setting should contain details about how a persons dementia effects their every day life. Advise was given to the manager on how this could be achieved. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 11 Another resident had an assessment stating that he was prone to wandering around the unit, and could be at risk, however no reference was made to this in his care plan. A personal profile which is contained within the care plan and should detail a residents likes and dislikes was blank. A further care plan noted a resident was verbally and physically aggressive, however his mental state was recorded as ‘normal’. His care plan had last been reviewed in August 2006.No records were available for September or October. None of the care plans sampled showed that they had been made along side input from the resident or their family. This needs to be done to ensure that care plans are made available and that residents can be fully involved in this process. Risk assessments within care plans were not consistently recorded. A number had not been signed or dated and others had not been reviewed for over a year. This could place residents at risk. The manager was given advice regarding the use of risk assessments and how to ensure they are used correctly. Medication administration records were sampled. A small number of gaps were noted in the records, however generally, records were well recorded. Staff must ensure that when they had write medication onto records, these are signed and dated by 2 members of staff. This is to ensure records are accurate and safe. Storage facilities were satisfactory. Staff were observed throughout the inspection. Residents were spoken to in a polite and caring way. Staff were addressing residents in a courteous manner and ensuring that they maintained their dignity. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 and 15 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service. The quality of food is good; however the way the food is served is of concern, as it is not promoting choice. This can then have the effect upon residents. Activities for residents are not always recorded in their files and residents are not aware of what is available for them join in with. Visiting times are flexible and are enjoyed by residents. EVIDENCE: The home has an activities plan that is displayed on the walls around the home. This is used as an advert to promote activities, but is only written in small print and has no colour or pictures on it. Residents spoken with stated that they didn’t know what this piece of paper was for and did not know what activities they could join in with. It is recommended that the plan be made in a more suitable format so the residents can read it. Within care plans there is a record of what activities a resident joins in with. These records were not always completed. One resident had 10 entries recorded since 10th October, 15 stated his activity had been ‘watching TV’. It appears that the resident had not been social included in any activity during this time, which could have an effect on his physical and mental health. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 13 This appeared to be the case in other files and must be reviewed and kept up to date. It couldn’t be evidence what activities individuals had actually joined in with. The manager stated that residents had gone on a recent trip on a narrow boat and that they had been involved in a Halloween party on October 31st. Details of these activities were not in the activity records within the care plans. Currently care staff undertake responsibility for organising activities. Staff felt that this put a strain on them and their time providing direct care to residents. It is recommended that the home employ an activity co-ordinator so care staff can ensure that staff have time to care for both the physical and social needs of residents. Residents and staff confirmed that visitors could come to the home at any time. Whilst no visitors were at the home during the inspection, staff stated that they could visit in either private or communal areas of the home, depending on residents choices. Lunch was observed on the ground and upper floor of the home. Residents were being served lunch on a small plate. No tablecloths, napkins or salt and pepper pots were on the tables. Staff were asked why this was the case. The inspector was informed that residents “don’t eat very much” and that “ the residents would pull the table cloths off if we put them on”. This demonstrates that the attitude and practice of staff appears to be dated and not in keeping with current practice. It also raises an issue concerning the competency and skills of staff to create an ordinary approach to mealtimes. The dining rooms appeared to be stark and bare due to the lack of homely items such as tablemats and could easily be improved to create a more homely environment. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 and 18 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure that is available to everyone. Staff are appropriately checked before they start work to ensure residents safety. EVIDENCE: The complaints policy is located around the home and is in the service user guide. The policy is easy to follow and contains all the necessary points of contact. Only 1 complaint has been received by the home since the last inspection, and was resolved in a timely way. Staff felt able to support residents if they needed or wanted to make a complaint. 2 concerns have been raised to CSCI during the inspection year and 1 formal complaint was received. This was investigated and concluded by the home under their internal procedures. The complaint was not upheld. All staff working at the home have a police check carried out on them before they start work. This is to ensure they are suitable to work with vulnerable people. Files for a selection of staff were checked for these records, including the 2 most recently appointed staff members. These were found to be satisfactory. Policies and procedures are available at the home to ensure the safety of residents and how to manage an allegation of abuse. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 and 26 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Residents are happy with their surroundings. The home is suitable for their needs and kept clean and tidy. EVIDENCE: A full tour of the home was undertaken. The home was clean and tidy. There was no evidence of malodorous smells. Bedrooms areas had been personalised by the family and had a good standard of fixtures and fittings. Communal areas were pleasantly decorated and homely, with the exception of the dining room areas. Residents stated “its nice living in here” and “I like my room, I have my own things”. The home has a lift and a set of stairs to access both floors. Residents can access both of these areas, however staff felt that they were safe. The home should consider risk assessing these areas for safety. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 16 Laundry facilities are satisfactory and meet the needs of the size of the home. Domestic staff are employed to keep the home clean and infection control policies are in place for staff to follow. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 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 and 30 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The staff team at the home work well together. Training is up to date, however NVQ (National Vocational Qualification) training needs to be improved. The home needs to consider training staff on how to provide appropriate activities and choice to residents with dementia. Residents like the staff that care for them. EVIDENCE: The home is currently recruiting 1 night care assistant, a cook and an acting assistant manager. These post are currently being filled by current members if staff. Staffing rotas show that there are sufficient staff employed to meet the needs of the individuals living at the home, and staff confirmed that they felt happy with staffing numbers, apart from when they are undertaking activities. One member of staff commented that some residents who are at the early stages of their dementia, require more support and that she felt staffing levels didn’t allow for this, however this wasn’t the view of the majority. Evidence gathered on how staff serve meals to residents and how they record activities showed that training is needed in this area. This is to ensure staff are aware of their practices and can provide care that is individual and up to date. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 18 Staff were able to list various training courses that they had attended since the last inspection. A variety of training had been arranged on dementia care and staff reported that they had enjoyed these days. Other training had been given using videos on subjects such as food hygiene, health and safety and customer care. Staff were observed to work well as a team and one member commented, “ We all have a laugh together, its fun working here”. 9 staff out of 25 have a NVQ qualification in care. This covers 35 of staff and is short of the required 50 . The home manager needs to address how she intends to meet this target. Residents spoken with stated they liked the staff who cared for them and commented “ staff are nice “ and “ we are looked after well here”. Staff files sampled showed that the home had carried out the necessary checks to ensure they are employing suitable staff. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 19 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): 31,33 and 38 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The home manager is well thought of by her staff. Policies are in place to monitor health and safety in order to ensure the safety of residents. Quality assurance is being carried out, however no results of the surveys are available at the home for them to action. EVIDENCE: The manager at the home holds a specialist management qualification (NVQ level 4) and has worked in the care sector for a number of years. Staff spoke highly of the support she offers, stating she is “ supportive” and “a very good manager”. The manager is supported in the running of the home by the director of administration, who visits on a regular basis. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 20 The manager explained that the home send out annual questionnaires as part of quality assurance monitoring, this was last done in April 2006. No results are sent to the home from head office who gather the information and therefore no plan of action is put in place. This must be done in order for effective quality assurance to take place. Resident and relatives meetings take place at the home, which also help with the quality assurance process. Accident reports are stored correctly to protect the confidentiality of the residents. Records showed that there was a number of slips, trips or falls recorded in July, August and September. The manager is aware of these numbers and is in the process of auditing the records to look for patterns. Health and safety certificates are up to date and policies are available for staff regarding safe working practices. Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 21 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 136 3 17 X 18 3 3 X X X X X X 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 X 2 X 3 X X 3 Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 22 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 OP3 Regulation 14 Requirement The registered person must ensure that all pre admission assessments contain adequate details regarding residents dementia related illness and how this effects them. The registered person must ensure that all care plans are formulated with the involvement of residents and or their families and that care plans reflect the care to be provided to residents and that it is updated monthly The registered person must ensure that risk assessments are clear and accurate to ensure the safety of residents and is reviewed on a regular basis. The registered person must ensure that medication records that are handwritten are double signed and dated by staff. Timescale for action 01/02/07 2 OP7 15 01/01/07 3 OP8 13(4) 01/01/07 4 OP9 13(2) 01/12/06 Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 23 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 OP12 Good Practice Recommendations It is recommended that the activity plan at the home is made in bolder and larger print and made more appealing by the use of colours/pictures It is also recommended that the home consider the appointment of an activity co-ordinator It is recommended that the home start using dinner plates when serving meals and that the dining room is made more homely by the use of condiments, place settings and tablecloths. It is recommended that the home risk assess those residents who use the stairs and the lift at the home. It is recommended that the manager carries out her intention to audit accidents and look for any patterns regarding slip, trips and falls. It is recommended that all residents have access to appropriate activities and that these are recorded. It is recommended that the provider provide the home manager with the outcomes of quality assurance checks 2 OP15 3 4 5 6 OP19 OP38 OP12 OP33 Aaron Lodge DS0000025077.V298377.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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.V298377.R01.S.doc Version 5.2 Page 25 - 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!