Inspection on 15/05/06 for Aashna House

This inspection was carried out on 15th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aashna House 02/10/07

Aashna House 27/10/05

Aashna House 23/05/05

Aashna House 05/11/04

Aashna House 30/06/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Aashna House ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP Lead Inspector Mary Magee Unannounced Inspection 15th May 2006 10:00 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 Aashna House DS0000022715.V291988.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. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aashna House Address ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP 0208-765-0822 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) aashna@asra.org.uk ASRA Greater London Housing Association Limited Mathini Navukkarasu Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include the current service user aged 56 years Date of last inspection 27th October 2005 Brief Description of the Service: Aashna House is a purpose built residential care home providing care and accommodation for frail elderly people of Asian origin. It is situated in a residential close and is within a ten-minute walk of local shops and public transport. Asra Greater London Housing Association own and manage the home. It is a pleasant and spacious two-storey building with the added advantage of enclosed gardens to the rear. The home is divided into five units, each has its own dining room and kitchen. A large catering kitchen is located on the ground floor. A passenger lift is also provided. The gardens and the buildings are wheelchair accessible. The home has 31 single bedrooms and 3 double bedrooms. Each room has an abundance of space with attached kitchenette and en-suite shower facility. A CCTV is provided by the front door. Fees range from £375 to £500nper week. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over a day and a half. An interpreter assisted the inspector with interviewing twelve residents. The inspector met with the interim manager and all fourteen of the staff team. Discussions were held with the service manager and the human resource manager present at the home. Three relatives met with the inspector during the inspection, four other relatives were spoken to by telephone. Others spoken to included two care managers and a district nurse. Comments received from residents, relatives and professionals from health and social care are included in the report. A selection of records were viewed relating to residents and care staff. A tour was conducted of all communal areas, twelve bedrooms were viewed. What the service does well: What has improved since the last inspection? Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 6 A small number of residents are now self medicating their medication and pleased to be able to do this following risk assessments. One resident showed the inspector a record book she maintains of her daily blood sugar readings. Areas of the environment that needed attention previously have been addressed contributing to the overall ambience of the home. Regular checks are made of the environment that promote health and safety and that ensure the welfare of service users and staff. Issues with hot water supplies have been resolved satisfactorily since the installation of a new boiler. Service users are pleased that there are no longer problems with hot water supplies. 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. Aashna House DS0000022715.V291988.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 Aashna House DS0000022715.V291988.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 46 Quality in this outcome area is excellent. This judgement was made using available evidence including a visit to the service. Service users enjoy the sense of community spirit fostered and are secure in the knowledge that they are cared for by a staff team that understand their culture. Members of staff on duty are fluent in at least one Asian language. Staff need more training on the specific needs of residents and also to work more closely with medical professionals in order to achieve the best outcome for residents. EVIDENCE: Pre- assessment admissions are completed for residents. Copies of two pre- admission assessments were present for residents recently admitted. Two residents at the home have additional mental health needs. Both residents are making quite steady progress. The interim manager is experienced in this field and is liaising with professionals from this discipline and working closely with the staff team. However the home is not fully meeting the specialist needs of these two residents as the majority of staff have not received training in this area of healthcare. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 9 A requirement is given about this. The registered person must ensure that staff receive training appropriate to the specialist needs of residents. The residents are all of Asian origin. They have specific language, diet and cultural needs. “The majority of other residential homes would not be able to understand me or know what my needs are”, was the comment received from a resident. Another resident spoken to feels that the staff team relates well to her needs. Residents have a strong identity and feel at ease living with other people that share similar cultural backgrounds. The service values the people’s rights as individuals. Two family members spoke to the inspector, they regularly visit their mother. They find that the home is a great place for older people requiring residential care to live, also that their mother is very happy. “She is able to decide if she wants to mix in other’s company or to spend time on her own” was the comment received by the family members. The daughter of another resident spoken to by telephone feels secure in the knowledge that her mother is well cared for and lives with other people that are familiar with her cultural needs. She likes the fact that her mother has the option to share in the company of others or enjoy the benefits of entertaining family and friends in her excellent private accommodation. Residents represent all aspects of Asian society. The diversity evident includes people with many languages and beliefs, Gujarat, Urdu, Punjabi, are a representation of the first languages spoken. Religious observations include Buddhism, Hinduism and Islam. Residents respect the beliefs and practices of others living at the home. The staff team have a good understanding of the religious and cultural needs, sharing similar cultures and religious beliefs. Staff employed have a range of linguistic skills and communicate effectively with service users. Staff receive ongoing training and development. Two residents have additional mental health needs and require the support of district nurses with the monitoring of blood sugar levels. One displays challenging behaviour. This is an area in which the district nurses feel that staff should have more expertise. The registered person must ensure that staff receive training on mental health and managing challenging behaviour, also developing a competence in managing residents with diabetes. There are times when in emergencies it is necessary for senior staff to check the blood sugar levels of residents. Senior staff are trained to do this but frequently call the medical services in emergencies. The registered person should ensure that the staff team work closely with professionals visiting residents and that they are competent at taking the correct course of action for residents with insulin diabetes. The home offers respite care for one resident but it does not accept people for intermediate care. Aashna House DS0000022715.V291988.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 10 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service Residents are treated with dignity and respect at all times with their right to privacy upheld. Care staff are competent at delivering care in accordance with individuals’ wishes. This is due to presence of a staff team that share similar values and customs, and that are dedicated and committed in their role. Written care plans need to be expanded s little further. EVIDENCE: Care plans for four residents were examined. The care plans set out briefly how to manage individual health and personal care needs. The initial needs assessments are good and contain comprehensive information and include important information on likes, dislikes, histories, dietary needs, religious observations and information on prescribed medication and changes as result of statutory reviews. From discussions on the day with twelve residents and three members of staff it was evident that residents are cared for in accordance with agreed care plans. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 11 This was also the view of all seven relatives. Staff spoken with were knowledgeable about the individual needs of residents. Direct observations were made of a care worker caring for a resident who is currently experiencing increasing frailty due to a medical condition. He has been seen frequently by the GP. A referral has also been made to the allocated care manager. Staff in the meanwhile take guidance from the GP and senior care officers on how manage his condition. Care officers are kind and treat service users with dignity. The wishes of and feelings of residents are considered, examples seen of this included the consideration given to a couple that have lived at the home for numerous years. For a frail resident care staff provide increasing support with personal care, staff also provide emotional support to his wife through this difficult period and treat her with sensitivity. Referrals have been made to professionals in response to his changing needs The arrangements for personal care ensure that residents’ privacy and dignity are respected at all times. All bedrooms have en suite facilities with spacious showers that people with restricted mobility find easy to utilise resulting in a a great number of residents using their shower independently. Residents dress in traditional clothes reflecting their culture and ethnic backgrounds. Observations made during the visit to the home were that staff knew how to look after residents and were discreet in supporting individuals with personal hygiene. Same gender carers care for residents and are aware how important this is to the majority of residents. Bedroom doors are kept closed during such routines, staff knock on bedroom doors and do not enter unless invited to do so. Arrangements are in place for night checks include agreements for those that do not wish to be disturbed during the night. The majority of residents have telephones and keep in touch with family and friends. For those with restricted vision large keypads were in place for ease of use. The care plans are short but staff easily understand them. This is important because English is not the first language for the majority of staff. However the inspector found that plans are a little too brief. They should be further developed so that they include more detailed information. This would give a fuller picture on the support needed by residents including the objectives and goals. Individuals’ care needs are reviewed regularly at the home. On two of the files viewed it was evident that staff on occasions have become accustomed to writing no change in the review section and are not always including the changes in care needs. Whilst daily diary notes provides evidence that changing needs are recognised and actioned this information should be Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 12 collated and included in care plans. The registered person should ensure that all changes are recorded and that care plans reflect these changing needs. For a resident that has experienced major changes to his conditions the care plan reflected accurately the current situation. The risk assessment also detailed the support needs including those needed for enabling residents to mobilise safely. Comments received from care managers and reviewing officers were positive about the care delivered at the home. All professionals felt that staff are responsive to the needs of residents. The risk assessments seen also provided guidance to staff on supporting residents to mobilise and encourage mobility. An example was observed of a resident who can be unstable and frequently requires a wheelchair to mobilise. The risk assessment included guidance on supporting him to walk if his condition allowed him to weight bear. Residents are generally active and were observed during the inspection using the spacious corridors for exercise. Nutritional needs of service users are carefully monitored. Residents’ files contained evidence that the weights of service users are recorded and that consultation takes place with appropriate professionals about any concerns regarding weight changes. Records were present on files of appointments attended with opticians and hearing specialists. A resident had new dentures supplied by the dentist recently. Residents are registered with various local GP practices. The majority of consultations take place at surgeries unless it is an emergency when a home call is requested. One area the inspector felt was a concern was regarding residents with additional mental health needs. While the current manager has experience and expertise in this area staff do not have the necessary skills to manage the challenging behaviour sometimes exhibited. She is working closely with staff on how to manage these conditions The registered person must ensure that staff receive training on mental health and managing challenging behaviour. Staff at the home have worked on developing an assessment procedure for residents that take responsibility for their own medication within a risk management framework. Medication is always checked when a resident returns from hospital. Cabinets with a locking device are supplied in bedrooms to all residents for holding medication safely. Fridges are also supplied to store medication that needs to be stored at lower temperatures. Records were viewed for two residents self medicating and the system used by staff to monitor that this is effective. Medication is dispended in a dosset system and delivered by the pharmacist every month. Further improvements are needed as medication received is not checked for accuracy. Staff spoken to were of the understanding that this was not necessary as it is dispensed in a dosset boxes. The registered person must ensure that the medication procedures are developed and that records are kept of all medicines received and leaving the home so that there is no mishandling. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 13 Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 14 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 in this outcome area is excellent. This judgement was made using available evidence including a visit to the service. The environment promoted is one that is supportive and caring with a thorough understanding by staff of the people they serve. The cultural and dietary requirements of residents are sensitively observed. EVIDENCE: Residents are empowered to make choices about the type of lifestyle they prefer to lead. Focus at the home is on helping residents to sustain and develop independence as much as possible. An area that care staff are particularly good at is recognising the importance of enabling residents to do tasks rather than taking on the role of performing the tasks. The lives of residents are enhanced in an environment that is lively and vibrant to live in. Couples as well as single people are accommodated at the home. This gives them the opportunity to maintain their married lifestyle, share interests and support one another. A couple currently benefit from this support met the inspector and gave their views. The gentleman’s deteriorating health is recognised and staff sympathetically considers his wishes and those of his wife. His wife has some her current anxiety relieved as staff help her care for her husband. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 15 Residents find that the lifestyle they experience matches their preferences and meets their social, cultural, religious and recreational interests and needs. Residents do not feel obligated to participate in activities. A number of residents spoken to enjoyed the responsibilities of family life in their younger days and still enjoy regular contact with family visiting as often as possible. All of those spoken to find that they like to lead a sedate lifestyle and take part in activities as and when they feel they want to. Many residents spoken too feel that if too many activities were organised or if the days were too structured that it would not be in accordance with their wishes. The majority enjoy watching the Asian channels available and lively discussions in the lounges. Feedback received from a care manager indicated that this was an area that should be given more consideration and that residents should be encouraged to enjoy more stimulation. A recommendation is made regarding this. The registered person should ensure that positive efforts are made so that residents have the opportunities for stimulation. The home demonstrates a spiritual sensitivity and actively celebrates all religious feasts and observances. Residents enjoy activities with Asian themes such as daily religious themes, Bhajans, armchair exercises, walking in the garden are some of the activities availed of. Residents feel that they have ownership of the home and that their views are taken into account. Pictures and temples displayed in the lounge reflect religious observations and cultural backgrounds. Celebrations of important days such as Dwali, Eid, New Year and other religious fests are a regular feature at the home. A number of residents spoke of the happy occasions celebrated. Staff also celebrate with residents and observe fasting periods in preparation for feast days. The home is homely due to the layout. It is broken up into five units. Each with it’s own dining room. The dining rooms are pleasantly furnished and make eating an enjoyable occasion. Mealtimes are not hurried. Residents sit in small groups of their choice. All find this to be a relaxing time. Dishes are placed in the centre so that residents may help themselves. Assistance is given to those that need it. Food served at the home continues to be of an excellent standard. Up to seven different dietary preferences are met. Vegetarian and nonvegetarian dishes are always on the menu. Menus are arranges according to what residents like and are completed on a four week cycle. The majority find that the menus suitable and according to their needs and preferences and medical recommendations. Examples were seen of how this is managed, for example lists in the kitchen and on dining notice boards have listed residents that prefer food where oil is not used in the preparation. An area that staff should ensure more attention is paid to is regarding the options available at short notice. Some residents feel that they would like more options at short notice and the choice of fresh fruit. The registered person should ensure that provision is made for those service users Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 16 that wish to choose at short notice other than a dish that is not on planned menu. Residents like to keep in touch with news from around the world, Asian channels are provided on televisions in communal lounge. The rights of residents are respected. For those that like to socialise and interact with other residents this is facilitated. The majority of residents mobilise independently, but for those requiring assistance care staff support them to the communal lounge. All bedrooms are self contained with en suite facilities and kitchenette. This ensures privacy and enables residents to entertain family and friends. The inspector spoke to three visiting relatives. They enjoy visiting the home and are made welcome by staff. One relative visiting recognises that her grandmother experiences some dementia. She was in the lounge and joined in discussions with other residents which she feels gave an inclusive feel. The design of the accommodation provides ample opportunities for activities, socialising and exercise. The home is close to public transport that benefits residents and visitors. A resident was preparing to travel and enjoy his favourite hobby. He attends a music group every week in South East London using the public transport system. He finds the home conveniently located for amenities. Residents handle their own financial affairs for as long as possible. Eight residents have been supported to set up individual bank accounts. For others a large number have family members that support them to manage their finances. All bedrooms viewed with the exception of one had personal items on display reflecting residents’ individual religious and cultural interests and reminders of family and friends . It was observed that one resident has not many items of personal possessions on display and that he did not have many relatives visiting. The registered person should ensure that residents are supported to personalise their bedrooms and make them as homely as possible. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 17 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 in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are confident that any issues or concerns raised with management are treated seriously and responded to promptly. The environment provides a safe environment with a staff team that are trained on safeguarding residents from abuse or neglect. EVIDENCE: The home has a complaints procedure. Copies of the procedure are displayed in each dining room. They are available in three languages, these are Urdu, Guejerat, and Hindi. A copy is also available in English. No complaints were recorded in the complaints book. From discussions with residents it was evident that any issues of concern raised were dealt with sensitively. One resident spoken to finds that the person responsible for undertaking Regulation 26 visits speaks to residents to find out about the services. She is happy with his method. According to three residents spoken to staff are responsive and do all the tasks that are necessary to meet residents’ needs. There have been no allegations of abuse or neglect at the home. In the past twelve months staff have received training in safeguarding people from abuse or neglect. From discussions it is evident that they know the correct procedures to adopt to safeguard people from abuse or neglect and know what to look out for. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 18 Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good This judgement was made using available evidence including a visit to the service. People live in surroundings that are pleasantly decorated with furnishings and fittings that help remind them of their cultural heritage. The accommodation is well designed and maintained to a good standard, it meets the needs of service users comfortably. EVIDENCE: The lovely environment provided enhances the quality of life experienced by residents. The standard of hygiene maintained is good. The inspector observed the operations underway in the laundry. Care was taken by staff to iron clothing and make it very presentable. Residents find that their clothing is well organised, there are no reports of mislaid items. The building is purpose built and laid out over two floors, it is spacious and well designed. A well maintained enclosed garden is available that is wheelchair accessible. The building has spacious corridors with handrails to support those less mobile. There is also a good sized passenger lift in place. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 20 There are thirty one single rooms, three double rooms are available to accommodate married couples. All rooms have en suites with showers and have their own kitchenettes. The home is divided into five units each with it’s own dining room, this allows residents to become better acquainted and share mealtimes if they so wish. There is a large well furnished lounge on the ground floor, this has a kitchen and a small quiet area. The laundry is located on the ground floor. The programme of maintenance and repair was in progress during the inspection. A number of bedrooms looked very pleasant following recent redecoration. The service manager explained the difficulty experienced with decorating some bedrooms. One resident told the inspector that she did not want her bedroom repainted as she disliked the smell of paint. Two other bedrooms viewed were identified as requiring redecorating. The registered person should ensure that the remaining bedrooms identified as requiring repainting are attended to. Areas identified as needing attention on previous inspection such as floor sealants in shower rooms have been attended to, other works were awaiting for attention when the workmen are available. Retiling was in progress in bathrooms to prevent any damage to ceilings underneath. The registered person should forward confirmation to the inspector when all of the maintenance work on the showers has been completed. Records were viewed of monthly visual checks. These were evident of a visual check undertaken of the environment. These linked up with the maintenance and repair programme. Systems are in place to monitor hot water temperatures regularly and to ensure that they are within safe limits. Difficulties previously with hot water supplies have been rectified. The service manager told of the plans for two more new boilers for the home that will be fitted during Summer. Staff are finding that work undertaken by contractors is not satisfactory and needs further attention. A leak previously repaired had reoccurred and caused staining on a ceiling in the lounge. Work was in progress during the inspection to rectify this. A vacant bedroom where work was ongoing was left unlocked, it was attended to immediately when brought to the attention of staff. The service manager was present and spoke of plans for the future that included not reengaging the contractor due to the poor standard of work. The registered person should ensure that the contractors engaged for repair works are monitored so that work is completed to satisfactory standards and that the health and safety of residents is safeguarded. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 21 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 in this outcome area is good. This judgement was made using available evidence including a visit to the service. Staffing levels are maintained as such to reflect the needs of residents. The staff team have the right qualities which residents value, they have all received essential mandatory training, a high percentage have also completed NVQ programmes. The training and development programme needs to be developed so that staff are competent at meeting the changing needs of residents. EVIDENCE: Staffing levels examined demonstrated that appropriate levels are maintained. One care worker is allocated to each unit as well as a senior care worker. Currently one resident with increasing frailty requires two staff members to assist with transfers, levels provided are adequate. Care staff are very responsive and at times dedicate more time in responding to the demands of some residents. Staff are gentle caring and totally committed but they need to be more assertive. A recommendation is made that the staff team would benefit from assertiveness training. Over 50 of residents require support with personal hygiene. Two members of staff are on waking night duty; in addition a senior member of staff is available on sleep over duties. According to three staff spoken to and twelve residents this number is adequate for the needs of residents. Residents spoken to felt that there were always appropriate numbers of staff available to assist them. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 22 Records were viewed of all the mandatory training provided to staff in the past twelve months. Staff spoken to demonstrate the benefits from training and are progressing well in their development. Over 50 of care staff have achieved NVQ Level 2 in care, the remainder of staff will have completed the NVQ programme by the end of Summer 2006. This achievement is to be commended. The service manager spoke of the plans for the next recruitment programme. It is planned that an Open day will take place at the home so that residents have the opportunity to meet prospective care workers and give their views. The human resource manager was present at the home and spoke of the recruitment practices. She spoke of the robust systems in place by the organisation and that all the essential information was available for new staff before they commenced employment. The organisation also addresses areas of staff performance efficiently including absenteeism. Head office maintains recruitment files. These were not viewed on this occasion. The inspector met with the team of care staff. While the progress is excellent on NVQ and mandatory training for staff more consideration must be given to the individual training needs of care staff. A training and development programme has not been developed as yet to respond to the individual training needs of staff or that reflects the aims of the home and meet the changing needs of residents. While acknowledging that remarkable progress has been made in the NVQ programmes and with mandatory training it is essential that individual training needs are addressed. A requirement was stated at the previous inspection, this requirement is restated with extended timescales. The registered person must ensure that there is a staff training and development programme including induction and foundation training, which meets Sector Skills training targets and is tailored to the needs of the staff team including presentation in suitable formats for staff. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 23 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 36 37 38 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. Procedures in place for enabling residents to manage their finances are good and ensure that residents’ finances are safeguarded. Areas relating to maintaining a safe environment are well managed. The interim management arrangements in the absence of the registered manager are good. Some further improvements are needed to the supervision arrangements so that staff are effectively guided and supported in their role. EVIDENCE: The registered manager is currently on maternity leave and due to return to work in August 06. In the interim period an experienced manager is in charge. Residents are pleased with her leadership and also the fact that the temporary manger has additional language skills and can communicate in a language understood by a majority. The interim manager also demonstrates extensive knowledge and experience in care planning and is providing guidance to staff. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 24 Residents feel safe in the knowledge that the manager is competent and experienced. A requirement was stated at the previous inspections relating to further training required by the registered manager. This has not been possible to achieve due to periods of maternity absence in the past two years. It is restated with a new timescale to allow for achievement. The registered person must ensure that the registered manager receives training for the role and responsibilities of the care home manager and the conditions affecting older people. The systems in place to monitor staff performance and working practices are not totally effective. Records of one to one supervision in the past year show that supervision is not priority and that one to one sessions are inconsistent despite recommendations made at previous inspection. Staff appraisals are held annually and were in progress during the inspection. Regular team meeting are held but care staff require further guidance and support. Some difficulties are experienced with the delegation of responsibilities to senior staff, care staff do not receive ongoing feedback on their work or always receive the guidance that they need. Discussions with residents and care staff as well as with professionals visiting are that on occasions in the past year there is a lack of leadership. Care staff are interested and are developing well following ongoing training. But direct guidance from senior/team leaders results in a breakdown in communications with professionals visiting the home. Examples were given of this, these included senior staff failing to ensure continuity of care, on occasions nursing professionals have not been kept informed following the hospital admission or discharge of residents. The registered person must ensure that staff are supervised and supported and that there clear lines of accountability in the home, senior staff must ensure that all professionals involved in the care of residents receive the information on time. The home uses various methods to evaluate the services. No report was available on the results or of the outcome for residents. Unit meetings are held for residents and relatives as part of a quality monitoring system. Attendance according to staff and from records can be poor and is not always effective in gaining peoples’ views. The minutes of recent meetings were not prepared or available. In other areas some development work has taken place. The inspector viewed some of the work recently undertaken by staff in a workshop held for staff, this enables staff to put forward views on effective monitoring contribute to a quality assurance system. It was stated as requirement at the previous inspection that an effective quality assurance system be developed for the home. While it is acknowledged Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 25 there have been some developments in this area the home is not demonstrating fully how it meets the aims and objectives of residents. This requirement is restated. The registered person must ensure that there is an effective quality assurance system is in place for the home to ensure that the home is successful in meeting its aims and objectives If they wish and for those that are able residents are helped to manage their money. The housing association is corporate appointee for eight residents. For these residents individual bank accounts are held in safe keeping by the administrator, cheques are drawn by the organisation and lodged in their accounts every month. Records of financial transactions show that these are well maintained by the administrator. The records viewed included receipts to acknowledge that residents are in receipt of personal allowances every week, also of other financial transactions. Residents are happy with the arrangements for supporting them manage their finances, some residents have agreed for relatives to manage their finances. Secure facilities are provided for the safekeeping of money and valuables. Insurance cover is maintained with a current policy displayed. Records required by regulation are effectively maintained. It was observed that some outdated information was still on display on notice boards in the dining areas. The registered person should ensure that old information displayed on notice boards is removed. Improvements were found in health and safety procedures. A number of written records were viewed. The information recorded confirmed that regular health and safety checks of the environment are undertaken including the monitoring of hot water temperatures. Weekly tests are undertaken of the fire alarm system, there are also the recommended number of fire drills. Records were held on files that evidenced that the fire fighting equipment is regularly serviced including emergency lights. The service manager informed the inspector of the plans to provide two new boilers for the home as two of the current ones are unsatisfactory. Accidents and incidents are recorded. These were filed according to resident and room number. This was not easily accessible and proved difficult when analysing the information. On the second day of the inspection this system had been revised and organised in a format that can easily be audited every month to analyse any particular patterns or trends. Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 26 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 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 3 2 3 3 Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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 OP4 OP8 Regulation 18 (1) c Requirement The registered person must ensure that staff receive training appropriate to the specialist needs of residents including mental health and service users with challenging behaviour. The registered person must ensure that the medication procedures are developed and that records are kept of all medicines received and leaving the home so that there is no mishandling. The registered person must ensure that there is a staff training and development programme including induction and foundation training, which meets Sector Skills training targets and is tailored to the individual needs of the staff team including presentation in suitable formats for staff. (Previous timescale of 30/03/06 not met) The registered person must ensure that staff are supervised and supported and that there DS0000022715.V291988.R01.S.doc Timescale for action 30/08/06 2 OP9 13 (2) 30/08/06 3 OP30 12 (10 a b18 (1) b 30/10/06 4 OP31 OP32 18 (2) 30/07/06 Aashna House Version 5.2 Page 28 5. OP31 10 (3) clear lines of accountability in the home The registered person must ensure that the registered manager receives training for the role and responsibilities of the care home manager and the conditions affecting older people. (Previous timescale of 31/01/06 not met) 30/12/06 6 OP33 24 The registered person must 30/08/06 ensure that there is an effective quality assurance system is in place for the home to ensure that the home is successful in meeting its aims and objectives.( Although there has been progress in this area more work is required to develop an effective system,( Previous timescale of 30/03/06 not met) 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 OP4 Good Practice Recommendations The registered person should ensure that the staff team work closely with medical professionals visiting residents and that they are competent at taking the correct course of action in emergency for residents with diabetes and requiring insulin. The registered person should ensure that more detailed information is included in care plans, this to include changes to goals or objectives following reviews. The registered person should ensure that positive efforts are made including encouragement so that residents have the opportunities for stimulation. The registered person should ensure that all residents are DS0000022715.V291988.R01.S.doc Version 5.2 Page 29 2 3 OP7 OP12 4 OP14 Aashna House 5 OP15 supported to personalise their bedrooms and make them as homely as possible. The registered person should ensure that provision is made for service user’s choice of food, consideration to be given to choosing at short notice a dish that is not on the planned menu or fresh fruit if they wish. The registered person should ensure that attention is given to the remaining bedrooms identified as requiring repainting. The registered person should ensure that staff receive assertiveness training. The registered person should ensure that the broken dishwashers in the kitchen are repaired. The registered person should ensure that the contractors engaged for repair works are monitored more closely so that work is completed to satisfactory standards and that health and safety regulations are adhered to. The registered person should ensure that outdated displayed on notice boards is removed. 6 OP24 7 8 9 OP27 OP26 OP19 OP38 10 OP37 Aashna House DS0000022715.V291988.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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