CARE HOMES FOR OLDER PEOPLE
Aarondale Residential Home Sunny Brow, Off Chapel Lane Coppull Chorley Lancashire PR7 4PF Lead Inspector
Val Turley Unannounced Inspection 21st March 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aarondale Residential Home DS0000005948.V327581.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. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Aarondale Residential Home Address Sunny Brow, Off Chapel Lane Coppull Chorley Lancashire PR7 4PF 01257 471571 01257 470220 aarondale@highfield-care.com 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) Southern Cross Care Homes Limited Mrs Ann Margaret Sheward Care Home 48 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (28) Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The home is registered for a maximum of 48 service users to include: Up to 20 service users in the category of DE (E) (Dementia over 65 years of age). Up to 28 service users in the category of OP (Old Age not falling into any other category). 1 named female service user in the category MD (Mental Disorder, excluding Learning Disability and Dementia) may be accommodated within the overall number of registered places. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st March 2006 6. Date of last inspection Brief Description of the Service: Aarondale is a purpose built care home, situated in a residential area. It is registered to provide care for 48 older people, 28 of whom require personal care, and 20 who have a mental illness or cognitive impairment. The accommodation comprises of 5 communal areas, 24 en suite single bedrooms and 24 single bedrooms. There is an open sided garden to the premises and a large rear garden, which is landscaped and enclosed. The home is close to local shops, a post office, a public house and local churches, all of which may be accessed by residents with assistance from staff if required. The fees at the home range from £320 - £460. Items not covered by the fees include hairdressing, incontinence products, chiropody, newspapers and toiletries. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection that took place over a twelve-month period and culminated in a site visit to the home over one day in March 2007 by one regulatory inspector. The inspection involved discussion with people living at the home, discussion with staff, observation of staff supporting the residents and an examination of records, policies and procedures. Information was also provided through a questionnaire completed by the manager, through surveys completed and returned by 9 of the people living at the home and 12 completed by relatives of the residents. As part of the inspection, the inspector used ‘case tracking’ as a means of assessing some of the National Minimum Standards. This process enabled the inspector to focus on three of the people living at the home. Records relating to those individuals were inspected and discussion took place with those residents. What the service does well:
Aarondale provides a clean, comfortable, safe and homely environment for the people who live there. Routines are relaxed with people being able to make choices about their own lifestyle. There is a range of activities organised that the residents may join in if they wish. Staff also support the residents to follow their own interests and hobbies. The people living at the home said they enjoyed the food. Snacks and drinks are always available and the there are choices available at each meal. The home has a thorough approach to the admission of new people to the home. An assessment is undertaken to ensure that the home is able to provide the care and support prospective residents may need and information provided by other health and social care professionals is taken into account. Care plans are developed on the basis of this information that give staff good guidance as to the help and support each person living at the home needs. The care plans and associated risk assessments are reviewed on at least a monthly basis to help ensure that the changing support needs of the people living at the home Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 6 are met safely. Medication in the home was well managed keeping the residents as safe as possible. People living at the home said they were happy with the support that they received from the staff and the staff had a good knowledge of the support needs of the individual residents. The home had good links with health and social care professionals who provided additional support and guidance where necessary. There were plans to improve the way people were supported by the introduction of Person Centred Planning which will help to focus on the individual needs and wishes of the people involved. Visitors are made to feel welcome at the home and were able to visit their relatives in private. Information from visitors and those relatives who completed comment cards said they found the staff team very approachable and helpful. The home has good policies and procedures in place to help protect the people living at the home and to enable them to raise any concerns they may have about the service provided. The approach to staff recruitment is thorough with the home taking up all of the checks and references necessary to ensure as far as possible that the people living at the home are supported safely. Staff are well supported by the senior staff and are appreciative of the training made available to them. The staff team as a whole has a good mix of experience and skills and specific training is provided where residents have specific support needs. The home is well managed with the needs of the people living there in mind. There are a number of quality assurance systems in place at the home to ensure that it is run and operates safely. What has improved since the last inspection?
Since the last inspection the manager ensures that prospective residents are informed in writing that the home is able to meet their assessed needs. The residents are encouraged to sign their care plans to indicate their agreement with it, wherever this is possible. Care plans are kept up to date and are reviewed on a regular basis to help ensure that they meet the changing needs of the people living at the home. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 7 The people living at the home expressed their satisfaction with the meals provided and there were plans in place to further improve the nutritional content of the meals. The home itself was in the process of being redecorated and several steps had been taken to improve the overall environment within the home. A door had been fitted to the homes smoking lounge to improve the environment for the non-smokers in the home. Bedroom doors were being gradually replaced with conventional front doors to give the people living at the home more of a sense of ownership and to enable them to recognise their room doors more easily. 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. The summary of this inspection report can be made available in other formats on request. Aarondale Residential Home DS0000005948.V327581.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 Aarondale Residential Home DS0000005948.V327581.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): 3 (standard 6 was not applicable) Quality in this outcome area is good. The pre-admission process was detailed and enabled the home to make an informed decision as to whether they could meet the needs of people applying for a place at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care provided for three of the people living at the home was tracked during the course of the site visit. The documentation on the three files showed that the home had undertaken its own detailed assessment of the support needs of these people before their admission to the home. The individual care managers had also provided
Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 10 information. From all of this information the home were able to decide if they were able to provide the support and care that each of the prospective residents needed. A care plan had been developed from the initial information provided which gave staff good guidance about how best to provide care and support to each person. There were also letters on the files that showed that the home had informed each person that the home could provide a place and the necessary support. Wherever possible there were opportunities for prospective residents of the home to visit the home before admission, to look around and meet staff before making a final decision to move there. Aarondale Residential Home DS0000005948.V327581.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 good. The personal, health and social care needs of the people living at the home were well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three people living at the home were examined. The care plans were detailed and outlined the specific health, social and personal care needs that each person had. All three people said that they were happy living at the home and were satisfied with the care and support they received. There was evidence on the files that a range of health and social care professionals were involved in providing expertise and support to the home. These included District Nurses, GP’s, a chiropodist and a community psychiatric nurse. On the
Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 12 day of the site visit a Doctor visited the home and it was clear that the home had a good working relationship with him. The care plans were reviewed on a weekly basis by the key workers to ensure that the support staff met any changing needs of the people living at the home. Risk assessments, including nutritional assessments and falls risk assessments, were also undertaken on at least a monthly basis to help ensure that the people living at the home received the appropriate care and support. Where it was possible the care plans had been signed by the individual residents living at the home to signify their agreement with their plan. On the day of the site visit, people living at the home were observed to be clean and tidy and well dressed. One lady, who had recently had her hair done spoke highly of the support she received from the staff team. The people living at the home appeared to be comfortable and relaxed in their surroundings and appreciative of the care and support that they received from the staff. Two members of staff spoke of the homes intention to introduce person centred planning for some of the residents of the home. It is anticipated that this will make the care and support provided much more personal, based on the wishes of each individual resident. All of the staff spoken to had a good knowledge of the individual support needs of the residents in the home they were also respectful and sensitive in their approach towards them. Several visitors were at the home on the day of the site visit. They were made to feel welcome and able to visit their relatives in the privacy of their own rooms. Visitors spoken to said that they were very pleased with the care provided to their relatives. One relative wrote in one of the returned surveys ‘my family are very pleased with the care my mum receives.’ Medication in the home was managed well with records being well maintained and medicines stored appropriately. It was recommended that some guidance should be developed regarding the administration of ‘as required’ medications to help ensure that staff are aware of when these medications should be administered. It was also recommended that staff should be periodically observed administering medication and that a record be kept of this. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 13 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. The home enabled service users to make choices and decisions regarding their daily routines and lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the people living at the home and the information received through surveys and comment cards it was clear that the routines within the home were flexible with people being able to make decisions regarding their own lifestyle. Both the people living at the home and visiting relatives spoke about the activities that were organised there. Some of these activities were advertised on posters around the home. Activities included trips out, arts and crafts, films, entertainers, birthday celebrations and good use of the garden in the summer. Some people had their own special areas of the garden where they liked to sit
Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 14 or feed the birds. One person had his own greenhouse. A member of staff was employed at the home to organise activities. The care plans for the people living at the home, included information about their individual interests and hobbies and the people spoken to said that they were supported and encouraged to follow these if they wished. The home had a relaxed atmosphere and the people living there had a range of areas where they could choose to sit. They could take meals in the dining room or in their own rooms. The residents spoken to confirmed that the food was good and that they had a choice of food. They also said they could have a drink or a snack whenever they wished. The cook had a good knowledge of the residents individual dietary needs and preferences and said there was always scope to ask for something that was not on the menu. Although the menus indicated that the meals were well balanced, the manager said that work was being undertaken by the company to improve on their nutritional content for the benefit of the residents. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 15 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. Policies and procedures ensured as far as possible that people living at the home were protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes policies and procedures included up to date guidance and information for staff regarding the protection of the people living at the home. The staff training records showed that some of the staff had received training in this as well. The manager said she planned to ensure that staff read the most recent versions of these policies and that information would be made available around the home for staff guidance. Information received through comment cards and surveys suggested that the people living at the home and their relatives were aware of how to raise any concerns they may about the service provided at the home. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. The home provided a clean and homely environment for the service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, tidy and homely. One visitor said that the staff worked extremely hard to keep the home clean. Another said it was always clean and tidy. The home was in the process of being decorated throughout. A lot of thought had been given to the decoration and use of different areas of the home. Small seating areas had been created. One had a garden theme with garden benches and a wishing well. A water feature was planned for
Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 17 another area. Bedroom doors were gradually being replaced with conventional front doors to give the people who lived at the home more of a sense of ownership of their rooms. The home employed a maintenance man who was able to attend to most of the repairs around the home and also ensure that the environment remained safe for the benefit of the people who lived there and the staff who supported them. On the upper floor of the home one of the bathrooms and a shower room were not in use as they were in need of repair. There was evidence that the refurbishment of these areas was planned. Since the last inspection a door had been fitted to the residents smoking room providing a safer and more pleasant environment for the other residents in the home. The garden was large and secure with a lawn area, flowerbeds and seating. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 18 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. The staff team provided a safe and supportive environment for the service users living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three recently recruited members of staff were recruited. These showed that the home recruited staff safely making sure that references were taken up and necessary checks made. There was also evidence that staff received supervision from a senior member of staff and that a record was made of this. Supervision enabled staff to discuss their professional development and training needs. The homes training record showed that the staff team had a good range of skills and experience with some specialist training being provided where residents had specific support needs. The home was continuing to work towards 50 of its staff achieve a nationally recognised qualification in care. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 19 The staff spoken to on the day of the site visit said they were very happy with the support provided by the management team and appreciative of the training opportunities provided. One relative wrote that ‘the senior staff are very approachable at any time over any matter’. Staffing rotas indicated that the home was well staffed and those staff spoken said that they felt that the staffing levels were sufficient to meet the needs of the people living at the home. The manager said that some staffing difficulties had been experienced last year but these had been resolved. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. The home was well run and managed with the needs of the service users in mind. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home had qualifications and experience to enable her to run the home confidently and efficiently. She had attended a range of training courses to ensure that her skills and knowledge remained up to date. There were clear lines of accountability in the home and the staff were fully aware of
Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 21 these and knew that they would receive support and guidance as needed from the senior staff. There were a number of quality assurance systems in place at the home to ensure that it ran safely and with the interests of the people who lived there in mind. The senior staff, the manager and the operations manager from the parent company undertook the audits that included checks on the environment, the management of medication and documentation within the home. There was evidence that the home conducted surveys on an annual basis when the views and opinions of the people living at the home and their relatives was undertaken and any concerns acted upon. Policies and procedures were reviewed and updated by the parent company as and when this was necessary. Equipment and systems at the home were maintained appropriately to ensure that the environment was as safe as possible for the people living there. Training in health and safety issues was also provided for staff ensuring that they were able to work safely for their own and the resident’s benefit. Accidents and incidents were recorded appropriately, enabling the manager to recognise any trends or patterns. The home held a small amount of money for each of the people living at the home. This was managed well at the home with clear records of expenditure and receipts being kept. The manager stated that the parent company planned to run a pilot scheme to look at the feasibility of residents holding an individual bank account giving them more independence in relation to the management of their money held at the home. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP9 OP9 OP28 Good Practice Recommendations Guidance should be developed as to when ‘as required’ medication should be administered to individual residents. Staff should be periodically observed administering medication and that a record be kept of this. 50 of care staff should achieve a nationally recognised qualification in care. Aarondale Residential Home DS0000005948.V327581.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd 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
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