CARE HOMES FOR OLDER PEOPLE
Aarons Unit Epinal Way Care Centre Hospital Way Loughborough Leicestershire LE11 3GD Lead Inspector
Mrs C A Burgess Unannounced Inspection 3rd April 2006 09:45 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 Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Aarons Unit Address Epinal Way Care Centre Hospital Way Loughborough Leicestershire LE11 3GD 01509 212666 01509 262710 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) Rushcliffe Care Limited Jane Lavinia Lindley 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 DS0000001881.V286120.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No person under 55 years of age falling within category MD or DE may be admitted to the home To be able to admit the named person subject of variation application number V11494 dated 3rd September 2004. 21st July 2005 Date of last inspection 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 twentyfour 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 DS0000001881.V286120.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over five hours. An opportunity was taken to look around the home, view records, policies and care plans and to talk to staff, residents and their relatives and visitors. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through a review of their records, discussion with their relatives (where available), the care staff and observation of care practices. Many of the residents were seen during the inspection. Three of the residents’ relatives, spoken with gave the Inspector their impressions of the home. What the service does well:
Aarons Unit provides a well managed, safe, supportive and specialist care for a specific client group 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 their capacity to do so. Specific, mandatory dementia care training is provided for all nursing and care staff, with additional training by the Registered Manager. Assessments, care planning and risk assessment are detailed to ensure that the residents’ health and welfare needs are met. Risk assessments are detailed. Risk assessments of ‘falls’ are audited three monthly to identify trends and reduce risks. Staff relationships with residents and relatives are good (sharing information through regular residents meetings and on an individual basis) and demonstrated care, patience and understanding of dementia and 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. Medication administration is audited weekly by the Registered Manager to ensure that medication administration policies and procedures are adhered to. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 6 The staff team is well trained and includes registered nurses, carers and additional ancillary staff who are able to meet the needs of the residents. The standard of care is good, and the home is clean and well maintained throughout and has a cheerful and busy atmosphere. Visitors said that their relatives are very well cared for; that the standard of care and cleanliness in the home is high: that the food was very good and well presented and they were welcomed and well supported by the staff. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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 Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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 & 6. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission process is well managed. Residents receive a comprehensive assessment, thereby ensuring that their health and welfare needs are being met. EVIDENCE: The assessment process is robust. Case tracked residents had a detailed and comprehensive pre-admission assessment to ensure that the residents’ health and welfare needs prior to admission were identified. In addition, the home undertakes a 72-hour assessment, on admission, to fully evaluate the residents needs. From this a detailed care plan and risk assessments are produced to ensure that residents needs are fully met. Aarons Unit does not provide intermediate care.
Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 & 11. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are well looked after in respect of their health and personal care. EVIDENCE: Residents are well looked after in respect of their health and personal care. Care plans and risk assessments were detailed and reflective of residents specific healthcare needs. Two care plans had been updated and/or rewritten but had not been re-signed by residents’ relatives/representatives, on behalf of the resident, to demonstrate agreement with the care plan. However, relatives said that they were consulted and fully informed about the residents care. Three- monthly relatives meetings were well attended, minutes produced with any action plans required to ensure that relatives play a valued role in the running of the home.
Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 10 Medication policies and procedures are sound. The Registered Manager audits medication delivery weekly to ensure that residents receive medication in a safe and timely manner. 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, gentle and patient, and treated the residents in a respectful, friendly and supportive manner. Three residents’ relatives spoken with said that staff are respectful, patient, very caring and kind. Residents who are near to the end of their life can remain in the home where this is appropriate in consultation with their GP and relatives. Staff consult with relatives and are able to provide sensitive and supportive care at this difficult time. Cultural and religious needs and specific ‘end of life’ requests are discussed and recorded and adhered to wherever possible. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff work hard to ensure that residents experience a safe, homely life style. EVIDENCE: Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 12 The home has a routine, which includes specific meal times and activity timetables. Routine is important to the specific 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. There is a weekly programme of activities devised by the activities organiser, 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; but most activities tend to be on a one-to-one basis to support individual cognitive abilities. There are celebrations throughout the year at Christmas, Valentines Day, and Easter etc. This enables residents and their relatives to enjoy seasonal and community activities. Residents’ religious and cultural needs are discussed, recorded and supported such as special dietary requirements and specific religious days or festivals to be celebrated as required. Where English is not the first language of the resident staff endeavour to master some basic phrases in the resident’s first language to aid communication. 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. Visitors said that they are always made welcome. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are sound resulting in satisfactory protection of residents’ rights. EVIDENCE: The home’s complaints process reflects the government’s adult protection guidelines, set out in the local Multi Agency Policy & Procedure For The Protection of Vulnerable Adults from Abuse, No Secrets’ publication. Staff are aware of these procedures and receive relevant training. Complaints and concerns made to the home are dealt with appropriately. Neither the home nor the CSCI has received any complaints about the home since the last inspection in July 2005. The home had many ‘Thank You’ cards on the relatives’ communication board thanking staff for the care provided for individual residents. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 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 the following standard(s): 19 & 26. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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, domestic staff, catering and caretaking staff. The Senior Manager and Unit Manager are also on duty during the day and are suparnumery. One member of staff and a relative said that, sometimes, they appeared to be a little short of staff. Training for staff and extensive ‘in house’ training supports staff in meeting the residents’ health and welfare needs. Rushcliffe Care Limited, Epinal Way Care Centre undertakes the recruitment process centrally and appears to be robust.
Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Registered Manager manages the home efficiently and ensures that residents’ rights are protected. Staff are effectively supervised to ensure that the quality of care is maintained. EVIDENCE: The Registered Manager is a Registered Nurse with many years of experience in care and manages the home well for the benefit of the residents and their relatives and staff. There is an ethos of openness in the home.
Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 17 There are regular residents’ meetings that ensure that general concerns are addressed and demonstrate an inclusive, open and constructive management style. Records demonstrate that staff receive supervision and staff training to ensure that staff maintain the standard of care expected throughout Rushcliffe Care Limited. Health and Safety Policy and Procedures, such as regular recorded fire drills fire alarm tests. Hot water checks etc are completed to ensure the health and safety of the residents and staff. Rushcliffe Care’s central administrative office located, in BKR Hall, Epinal Way Care Centre, manages residents’ finances. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 19 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. Refer to Standard OP77 Good Practice Recommendations The Registered Persons are recommended to ensure that updated or re-written care plans are signed by the residents’ relative/representative. Aarons Unit DS0000001881.V286120.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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