CARE HOMES FOR OLDER PEOPLE
Aarons Unit Epinal Way Care Centre Hospital Way Loughborough, Leics LE11 3GD
Lead Inspector Mrs C A Burgess Unannounced 18th April 05 09:30 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 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. Aarons Unit Version 1.10 Page 3 SERVICE INFORMATION
Name of service Aarons Unit Address Epinal Way Care Centre Hospital Way Loughborough Leics LE11 3GD 01509 212666 01509 262710 surjit@rushcliffecare.co.uk Rushcliffe Care Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 44 Category(ies) of Dementia (44), Dementia - over 65 years of age registration, with number (44), Mental disorder, excluding learning of places disability or dementia (44), Mental Disorder, excluding learning disability or dementia - over 65 years of age (44) Aarons Unit Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: No one under the age of 55 years of age falling within category MD or DE may be admitted to the home. To admit the named person subject of variation application number V11494 26th SI & LD September 2004 Date of last inspection 26th October 2004 Brief Description of the Service: Aarons Unit is one of three units, contained within the purpose built Epinal Way Care Centre, in Loughborough, Leicestershire, which opened in March 2000. It is a specialist unit for older residents with Mental Health and Dementia needs. The home is registered for forty-four residents of both sexes and provides a safe and caring environment. The home is bright and clean with a high standard of décor throughout. All rooms have en-suite facilities. The home is situated on two floors with a lift servicing the first floor. It is staffed twenty-four hours a day by care staff and trained nurses, some of whom are Registered Mental Health Nurses (RMN). The home has a multi sensory room and a multi purpose room for private meetings etc. It also has a safe, attractive courtyard garden in the centre of the unit. Situated adjacent to the Loughborough Hospital, and approximately one mile from the centre of Loughborough, it is accessible by public transport or car. There is ample parking for visitors. Aarons Unit Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. An opportunity was taken to look around the home, view records, policies and care plans and to talk to staff and residents. Many of the residents were seen during the inspection and four of the residents’ relatives spoken to gave the inspector their impressions of the home. What the service does well:
Aarons Unit provides safe, supportive and specialist care for a specific client group of residents who have varying degrees of dementia. The home has many adaptations to assist with care and to help residents achieve their optimum independence and exercise personal choice within the residents capacity to do so. Assessments, care planning and risk assessment are detailed to ensure that the residents’ health and welfare needs are met. This was particularly evident in the residents’ risk assessment regarding falls, resulting in their reduction/prevention for a number of residents who were particularly at risk. Staff relationships with residents were good, demonstrating care, patience and understanding of each resident’s individual care needs. Meals are nutritious and well-presented and individual preferences and health needs are catered for to ensure that residents personal and medical needs are met. The staff team is well trained and includes both registered nurses and carers who are able to meet the needs of the residents. The standard of care is good, and the home is clean and well maintained and has a cheerful and busy atmosphere. Relatives, in general, felt that their relatives are well cared; that the standard of care and cleanliness in the home is high and that they themselves were welcomed and well supported by the staff. Aarons Unit Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Aarons Unit Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Aarons Unit Version 1.10 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 standard(s) 1, 2, 3, 4, 5 & 6 The admission process is well managed and residents and their relatives/representatives are given clear and detailed information regarding the service; thereby ensuring that the residents’ health and welfare needs are being met. EVIDENCE: There is a comprehensive Statement of Purpose & Service Users’ Guide, which includes a summary of the Service User Satisfaction Survey. The current pre-assessment process is robust. However, two of the residents’ files did not have the pre-assessment documentation but both people had been in residence for a number of years and current staff did not know where the pre-assessment paperwork was. All recently admitted residents had both the home’s comprehensive preassessment and the social service assessment in their files, which assesses the resident’s health and welfare needs prior to admission.
Aarons Unit Version 1.10 Page 9 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 standard(s) 7, 8, 9 & 10 Residents are well looked after in respect of their health and personal care. However, relatives or the resident’s representative should be encouraged to take a participative role in drawing up and reviewing the resident’s care plan to ensure that residents who are unable to do this for themselves have their care needs are met. EVIDENCE: Care plans reflect residents’ specific needs and contact with other healthcare professional is well documented. Risk assessments are comprehensive, particularly in relation to the prevention of falls, which, in some cases, have been significantly reduced. However, further attention needs to be given to involving residents and/or their relatives in the care planning process. Two relatives had concerns over their relative’s care needs, which they felt were not being fully met but felt more at ease after discussing them with the acting manager (Care Manager). It was stated that their resident’s clothes were not always washed as frequently as they should be and that the resident, sometimes, was not wearing her own clothes, thereby not promoting the dignity of the resident.
Aarons Unit Version 1.10 Page 10 A small number of residents’ files did not show continuing relative/representative involvement. Nevertheless, other relatives said that they were consulted and were able to voice general comments and/or concerns at any time and at the three monthly relatives forum. A number of relatives commented that some of the overseas recruited care and nursing staff were poor communicators (acknowledged by the acting manager), although most have excellent English language skills. This needs to be improved to provide a ‘rounded’ approach to residents’ care. Medication policies and procedures are sound. Observation during the inspection showed that staff have a good awareness of how to protect residents privacy and dignity. They were seen to be kind and patient and treated the residents in a respectful, friendly and supportive way. Six residents’ relatives spoken to said that staff are respectful and very caring. Agreements with relatives, with supporting documentation, should be adhered to where an agreement is reached, i.e. to lock a resident’s door during the day when they are elsewhere. Aarons Unit Version 1.10 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 standard(s) 12, 13, 14 & 15. The staff work hard to ensure that residents experience a safe, homely life style. EVIDENCE: The home has a routine, which includes specific meal times and activity timetables. Routine is important to the specific client group of residents at Aarons Unit, most of whom are unable to be consistent in their choices and tend to be very forgetful and confused. The home provides an initial assessment and a care plan, which includes a social history and relative/representative input, and is a valuable tool integral to planning care, which identifies individual care needs. There is a weekly programme of activities, suited to the residents’ particular needs and abilities, which include; therapeutic games, hand massage, hairdressing, movement to music, art and craft, skittles and gym ball. A number of residents had visitors during the inspection. One group of visitors brought their dog with them, which seemed to please some of the residents who were able to pat the dog. Visitors said that they are always made welcome. Some visitors stay for long periods throughout the day with their relative, and this is appreciated and supported by the care staff.
Aarons Unit Version 1.10 Page 12 Menus are balanced and appealing, and are flexible enough to accommodate individual needs and preferences. They are freshly prepared and are of a good standard. Lunch looked appetising and well presented and a number of relatives said that the meals were always of a high standard. Aarons Unit Version 1.10 Page 13 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 standard(s) 16, 17 & 18 Arrangements for receiving and responding to complaints are sound. EVIDENCE: The home’s complaints process reflects the government’s adult protection guidelines, set out in the No Secrets’ publication. Staff are aware of these procedures and receive relevant training. Complaints and concerns made to the home are dealt with appropriately. The concerns raised by two relatives regarding a specific aspect of their relative’s care had not been passed on to the staff as they felt apprehensive about this affecting their relative’s future care. Following positive discussions with the acting manager (Care Manager) it was apparent that the relatives felt that their concerns were received in a positive manner and would be dealt with appropriately and said that they would inform staff if there were any other problems. However, management and staff should make it very clear that all comments, concerns and complaints received will not adversely affect a resident’s care to ensure that the complaints process remains effective. Aarons Unit Version 1.10 Page 14 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26. A comfortable, clean and safe standard of accommodation is provided for the residents. EVIDENCE: The home is safe and well maintained with many adaptations to suit residents’ specific needs. It is decorated and furnished to a high standard that creates a comfortable and homely environment, and there is a system of maintenance and refurbishment. The garden is a safe area but needs a general tidy up. Relatives commented that the garden had looked very well cared for last summer and was appreciated by both the residents and their relatives. Residents’ rooms are clean, well decorated and residents are able to bring items of their own furniture and possessions with them to personalise their rooms. All rooms have en suite facilities and there are sufficient toilet, bathing and assisted bathing facilities.
Aarons Unit Version 1.10 Page 15 The home has a specific odour throughout the home, on entry, which whilst not objectionable, does not smell completely fresh. After a short time in the home it ceases to be noticed but the acting manager acknowledged that the odour was present. Nevertheless a high standard of cleanliness was noted throughout the building and there were no adverse comments made by other visitors. Aarons Unit Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs. EVIDENCE: Staffing levels, at the point of inspection, were above that suggested by the Department of Health Residential Forum Guidelines and were sufficient to meet the residents’ needs. There are registered nurses on duty at all times. In addition there are carers, an activity leader, domestic staff, catering and caretaking staff. The Senior Manager and Unit Manager are also on duty during the day. Relatives said that they felt staff were capable and caring, and that there were sufficient staff on duty to meet the complex needs of the residents. Training for staff is well planned and supports staff in providing for the varied needs of the residents. A training matrix gives a clear indication of staff training for the year. Four of the care staff hold National Vocational Qualification (NVQ) in Care, Level 2 or above. Extensive ‘in house’ training supports staff in meeting the residents health and welfare needs. The recruitment process was not inspected during this inspection but will be checked during the next unannounced inspection later in the inspection year. Aarons Unit Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38. The acting manager (Care Manager), who has applied for Registered Manager status, manages the home efficiently and ensures that the residents’ rights are protected. Staff are effectively supervised to ensure that the quality of care is maintained. EVIDENCE: There is no manager registered at present but the acting manager is to be interviewed for the position of Registered Manager on 22nd April 2005. She is a registered nurse with many years of experience in care. There is an ethos of openness in the home but it is evident that this needs to further clarified with certain staff and some relatives to ensure that relatives feel ‘safe’ to speak to staff regarding their concerns. Aarons Unit Version 1.10 Page 18 Staff support the residents to make the small decisions in their everyday life, which promote a degree of independence, such as a choice of food and what they wish to wear. Rushcliffe Care’s central administrative office located, in BKR Hall, Epinal Way Care Centre, manages residents’ finances and no money is kept in the home. Records demonstrate that staff receive supervision but the acting manager (Care Manager) is in the process of implementing clinical supervision (a regular review of staff performance and training needs) to ensure that staff maintain the standards of care expected throughout Rushcliffe Care Limited. Health and Safety Policy and Procedures, such as regular recorded fire drills and fire alarm tests are completed, to ensure the health and safety of the residents and staff. Aarons Unit Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 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 3 3 3 4 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 2 3 3 3 3 3 3 Aarons Unit Version 1.10 Page 20 NO 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. 2. Standard 10 (3) 7 (6) Regulation 12 (4) 15 (1) Requirement The Registered Person is required to ensure that residents wear their own clothes The Registered Person is required to ensure that residents care plans are drawn up with the involvement of the residents or their representative Timescale for action 18/05.05 18/05/05 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. Refer to Standard 32 32 Good Practice Recommendations The Registered Person is recommended to ensure that all staff are effective communicators, especilaly with residents relatives to ensure that all care needs are met. The Registered Person is recommended to ensure that the ethos of the home is such that residents and/or their relatives feel comfortable about discussing the residents needs, or making a complaint, and that staff support them to do so. Aarons Unit Version 1.10 Page 21 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park Enderby LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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