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Inspection on 31/07/07 for Aden House Nursing Home

Also see our care home review for Aden House Nursing Home for more information

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The atmosphere at the home has improved and is warm and friendly. Staff and people living at the home interact well with each other and there were appropriate conversations between staff, visitors and people living at the home. People said the staff are "very friendly and helpful." One person said, "I enjoy being here. The staff are good and the meals are good". Relatives were asked as part of the survey they completed, what does the home do well; comments received include "Considering the difficulties the resident`s have I think the staff do a good job. Having cared for my husband who has dementia I know the pressures they are under." "The care of my Dad is very good". "Staff are friendly, patient. The home is clean, laundry washed, it is warm, diet quite good." "I feel they cover all areas really well and the staff are kind, helpful and work with the residents extremely well. The home is very clean, food seems good and they do try to give residents a bit of independence." "They understand individuals needs. They give social stimulation. The home is clean and welcoming to visitors. The food is designed to suit the individual". " We consider the staff and the dedication they show to the residents is the key to the standard of care provided, what we have seen since our relative came here is excellent". Before a planned admission to Aden House a senior member of staff carries out a pre admission assessment to make sure the home and the staff at the home can meet the prospective resident`s needs. Visitors are made to feel welcome. The meals at the home continue to be very good and people living in the home are able to make choices about their life in the home. The staff recruitment policy and records remain good and these help to safeguard people. The manager is approachable and listens to people. She understands what improvements need to be made at the home and is committed to achieving the changes needed to ensure good standards of care and services are provided consistently. The home is generally well maintained and a safe place to live and work in.

What has improved since the last inspection?

Since the last inspection in March 2007 improvements have been made at the home. The level and amount of training has improved. Staff have received training to help them move and handle people safely, some staff have received training to help them meet the needs of the people with dementia and to understand how to care for them properly. Sixteen staff have received first aid training and the number of staff with National Vocational Qualification (NVQ) level 2 in care has increased, this means the staff have been trained to care for elderly people. Members of staff are being supervised and trained so they are more aware of maintaining people`s privacy and dignity. The amount and variety of activities offered in the home has improved and the manager is trying to provide more trips out of the home, which some people have requested. The management of unpleasant odours on the Butterfly unit have improved and some new furnishings and redecoration has taken place in the home. Work has been done on care planning and some improvement has been made so that staff have the written information they need to help them care for people in the home. Overall staffing levels have increased since the last inspection, however this should be continually monitored to make sure there are enough staff on duty. This will help ensure everyone`s care needs are met.

What the care home could do better:

Work is still needed to ensure care plans provide staff with clear and specific detail to enable them to give individualised care. Staff must make sure that if someone is admitted to the home in an emergency they obtain all the information necessary to meet that persons needs and staff must make sure there is a full care plan in place for that person within 24 hours. People`s cultural and spiritual needs should be discussed and recorded so that staff know what to do to meet these needs. The management of medications must improve. All medications entering the home must be accounts for and correctly administered. Although improvements were noted there is still an odour problem on the Butterfly unit and the lighting on the corridor area in this part of the home was poor. Action should be taken to address these issues to improve the environment for the people living on this unit. The home still lacks an effective quality assurance system. This allows people to be consulted about the services provided. Where quality or service issues are identified an action plan should be developed by the home to address the issues and in so doing make positive improvements.

CARE HOMES FOR OLDER PEOPLE Aden House Nursing Home Long Lane Clayton West Huddersfield West Yorkshire HD8 9PR Lead Inspector Sally McSharry and Bronwynn Bennett Key Unannounced Inspection 08:00 31st July 2007 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 Aden House Nursing Home DS0000001105.V342561.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. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aden House Nursing Home Address Long Lane Clayton West Huddersfield West Yorkshire HD8 9PR 01484 866486 01484 861928 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) Aden House Ltd Mrs Alyson Shaw Care Home 60 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability (4) Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Physical disability - Code PD and Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 60 6th March 2007 2. Date of last inspection Brief Description of the Service: Aden House is a purpose built home situated in Clayton West close to the main Wakefield Road. The home offers personal and nursing care for a maximum of 60 older people; it is also registered to accommodate up to 4 adults with physical disabilities and has a 20 bedded unit caring for elderly people with dementia. This Unit is known within the home as The Butterfly Unit. Aden House is situated on the same site as its sister home Aden Lodge, and is within a short walking distance of the main bus route on the Wakefield Road. Aden House offers single, en-suite bedroom facilities on the ground and first floor. Communal sitting and dinning areas are located on the ground floor. The first floor is accessed by a passenger lift. The home also offers a day care service for up to 15 people, however at this visit it was reported that this service is being run down with a view to stopping the service once current attendees have left. There are garden areas to the front and rear of the building and there is a patio area where people can sit out if they so wish. The provider informed the Commission for Social Care Inspection on 31/07/07 that fees range from £385.80 to £495 per week. Additional charges include hairdressing, personal newspapers, private chiropody and a charge of £5.35 per hour made to people to out patient and non-emergency hospital appointments. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home carried out by two inspectors on 31 July 2007. The visit commenced at 08:00 am and the inspector left the home at 3.35 pm. During this visit, the inspectors spoke to some of the people living in the home, some of the staff and the home’s manager. The inspectors read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the home and observed staff caring for people. The inspectors also had lunch with some of the people living in the home. The staff at the home also provided information that was requested by CSCI (Commission for Social Care Inspection) about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, their relatives and people’s doctors. Twenty five surveys were sent out to people living at the home, nine were returned. Some people received support from their relative/friend in completing the survey. Twenty three surveys were sent out to relatives, seven were returned. Five surveys were also sent to the people’s doctors and other health care professional. Two were returned. The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: The atmosphere at the home has improved and is warm and friendly. Staff and people living at the home interact well with each other and there were appropriate conversations between staff, visitors and people living at the home. People said the staff are “very friendly and helpful.” One person said, “I enjoy being here. The staff are good and the meals are good”. Relatives were asked as part of the survey they completed, what does the home do well; comments received include “Considering the difficulties the resident’s have I think the staff do a good job. Having cared for my husband who has dementia I know the pressures they are under.” Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 6 “The care of my Dad is very good”. “Staff are friendly, patient. The home is clean, laundry washed, it is warm, diet quite good.” “I feel they cover all areas really well and the staff are kind, helpful and work with the residents extremely well. The home is very clean, food seems good and they do try to give residents a bit of independence.” “They understand individuals needs. They give social stimulation. The home is clean and welcoming to visitors. The food is designed to suit the individual”. “ We consider the staff and the dedication they show to the residents is the key to the standard of care provided, what we have seen since our relative came here is excellent”. Before a planned admission to Aden House a senior member of staff carries out a pre admission assessment to make sure the home and the staff at the home can meet the prospective resident’s needs. Visitors are made to feel welcome. The meals at the home continue to be very good and people living in the home are able to make choices about their life in the home. The staff recruitment policy and records remain good and these help to safeguard people. The manager is approachable and listens to people. She understands what improvements need to be made at the home and is committed to achieving the changes needed to ensure good standards of care and services are provided consistently. The home is generally well maintained and a safe place to live and work in. What has improved since the last inspection? Since the last inspection in March 2007 improvements have been made at the home. The level and amount of training has improved. Staff have received training to help them move and handle people safely, some staff have received training to help them meet the needs of the people with dementia and to understand how to care for them properly. Sixteen staff have received first aid training and the number of staff with National Vocational Qualification (NVQ) level 2 in care has increased, this means the staff have been trained to care for elderly people. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 7 Members of staff are being supervised and trained so they are more aware of maintaining people’s privacy and dignity. The amount and variety of activities offered in the home has improved and the manager is trying to provide more trips out of the home, which some people have requested. The management of unpleasant odours on the Butterfly unit have improved and some new furnishings and redecoration has taken place in the home. Work has been done on care planning and some improvement has been made so that staff have the written information they need to help them care for people in the home. Overall staffing levels have increased since the last inspection, however this should be continually monitored to make sure there are enough staff on duty. This will help ensure everyone’s care needs are met. What they could do better: Work is still needed to ensure care plans provide staff with clear and specific detail to enable them to give individualised care. Staff must make sure that if someone is admitted to the home in an emergency they obtain all the information necessary to meet that persons needs and staff must make sure there is a full care plan in place for that person within 24 hours. People’s cultural and spiritual needs should be discussed and recorded so that staff know what to do to meet these needs. The management of medications must improve. All medications entering the home must be accounts for and correctly administered. Although improvements were noted there is still an odour problem on the Butterfly unit and the lighting on the corridor area in this part of the home was poor. Action should be taken to address these issues to improve the environment for the people living on this unit. The home still lacks an effective quality assurance system. This allows people to be consulted about the services provided. Where quality or service issues are identified an action plan should be developed by the home to address the issues and in so doing make positive improvements. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 9 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 Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are properly assessed prior to moving into the home to ensure that their needs can be met. EVIDENCE: Surveys received from people who live at the home generally indicate that they receive enough information about the home prior to them moving in. One person wrote, “My wife made the decision with the help of my daughter”. Some people living at Aden House had decided to stay permanently at the home following a short stay. The manager explained that people’s needs are assessed prior to them being offered a place at the home. The purpose of the assessment is to make sure that the home will be able to meet the person’s needs. Community Care Assessments were seen in place for those people who are funded by the Local Authority or the Health Authority. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 11 The manager and nursing staff undertake pre-admission assessments of most people before they are admitted to the home and completed a pre-admission assessment form. These forms were seen on people’s care files. Since the last inspection in March 2007 staff have received training to help make sure they have the skills needed to meet the care needs of people admitted to the home. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and10 . People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s care plans outline the level of support and care each person requires. Medication systems need work to ensure they are safe. Caring staff acknowledges people’s right to privacy and dignity. EVIDENCE: Surveys asked people living at the home if they receive the care and support they need. Six people responded “always”, three responded “usually”. Those people who spoke with the inspector during this visit gave positive feedback about their life at Aden House. They said they were happy living at the home and that the staff were kind and helpful. Relatives’ surveys asked if the care home meets the needs of their friend/relative. One relative responded “always”. Four relatives responded “usually” and one responded sometimes. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 13 Five people’s care documentation was examined in detail. Work has been carried out on care planning and staff have received training to help them write good clear care plans which provide staff with all the information needed to care for people properly. Improvements have been made. However some of the care plans audited during this visit still lacked specific detail. For example the care plan of people needing continence aids did not specify which continence aid was to be used for the individual. A requirement about this has been made in this report. The home has admitted some people in an emergency. The care records of one person admitted from hospital as an emergency were not complete. It is a recommendation of this report that staff obtain all the information about a person admitted in an emergency and complete a detailed care plan within 24 hours of admission. This is to ensure they have the information to meet the person’s health and welfare needs properly. Care plans showed little information about people’s cultural and religious differences. It is recommended in this report that peoples cultural and religious needs are discussed with them and a record made of the discussion and any specific needs or wishes. Care plans and risk assessments are in place and these are reviewed at least monthly. There is evidence that people have access to doctors and other community health care professionals to help meet their health and welfare needs, and that access to NHS (National Health Services) services are supported. A survey received from people’s doctors and one from a health care professional indicated there are some communication problems between the home and the doctor’s surgery. The surveys confirmed that doctors are able to see their patients in private, but there is not always a senior member of staff available to discuss people’s care with. These issues were discussed with the manager. At the last inspections the management of medications was not safe and not all the medications entering the home could be accounted for. Training has been provided for staff and two days before this visit a new system for administering medications had been introduced. A sample of medications was audited and although some improvements have been made three discrepancies were found and one drug error identified. Action was immediately taken to address the drug error. It remains a requirement of this report that medications be safely stored, administered recorded and destroyed. It was suggested to the manager that she increase Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 14 the frequency of medication audits to monitor the implementation of the new medications system. Observations throughout the day confirmed that staff are polite and courteous with people living at the home, their relatives and any other visitors to the home. People said that staff are always kind and will do anything for them. Visitors said they are always made to feel welcome, offered a drink and some relatives regularly stay at the home for a meal. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. Meals provided are generally good, varied and served in a pleasant environment. EVIDENCE: Surveys sent to the home asked people if there are activities arranged by the home that they can take part in. Five responded ‘always’, one said “usually”, one “sometimes” and one person responded ‘never’. One person wrote, “There are activities on a daily basis and I enjoy taking part.” During the visit, some people were reading or watching the TV or listening to the radio. Some people preferred to spend time in their room; others were sitting in the lounge or garden. In the morning a game of bingo took place and in the afternoon some people were painting, others took part in a quiz and made preparation for an “almost new sale” planned later in the year. Staff and people living in the home had Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 16 also made preparations to have a fund raising stall at the local Emley Show. Unfortunately the show had been cancelled due to the recent wet weather. Two relatives said in their surveys that they felt more stimulation and activities could be offered, particularly trips out. Another relative said that activities had improved since the new activity gentleman had started working at the home. Comments were discussed with the manager who advised that the home had accessed a local bus and that they hoped to offer more short local trips out of the home. Everyone one confirmed in surveys and in person that visitors are always welcomed at the home. Relative surveys asked if the care home helps their relative or friend keep in touch with them. Five responded, ‘usually’, one said the question was not applicable in their case. Two people did not respond to the question. Surveys also asked relatives if they are kept up to date with important issues affecting their relative/friend. Four responded ‘always’, one said ‘usually’, and one “sometimes”. The home has a community feel and several of the people living in the home are from the close local area. Aden House has links with the local church who visit regularly. Comments about the food were generally positive. The lunch served on the day of the visit was hot, tasty and very nice. One survey said that meals could be served hotter. This was discussed with the manager and people in the home. The people spoken to said that they hadn’t experienced this problem, but that if it occurred they would ask for the meal to be heated. They were sure this would be done as the home has a microwave. A four weekly menu is offered and variety if offered at every meal. Aden House Nursing Home DS0000001105.V342561.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living in the home are protected from abuse and they can be confident that their complaints will be listened to and acted upon. EVIDENCE: Responses received from people living at the home indicate that they know how to make a complaint and who to speak to when they are not happy about something. People spoken with on the day of the visit told the inspector, if they were not happy about something, they would speak to the manager. People said that Mrs Shaw, the manager is very approachable. The complaints procedure is displayed in the front entrance of the home. It is also available in the home’s Statement of Purpose. The manager keeps a log of any complaints received and there was evidence that people’s concerns had been taken seriously and the appropriate action had been taken to resolve the matter wherever possible. Six of the seven surveys returned by relatives indicate they know how to make a complaint. The manager said she welcomes people’s views about the home and feels her door is open and she is available to talk to people at anytime. One relative commented, “Any problems have been discussed with the staff and we have always come to an amicable arrangement”. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 18 In order to ensure that people are properly protected against the risk of abuse and neglect, all staff must be suitably trained so they are able to identify and report poor practice including abuse. The manager explained that, apart from recently appointed staff, everyone working in the home has received training about protecting vulnerable people in care. Records confirmed this. A date has been arranged for all new staff to take part in this training. Aden House Nursing Home DS0000001105.V342561.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home offers people a homely, comfortable and clean environment. EVIDENCE: Surveys asked people living at the home if it is clean and fresh. Six responded ‘always’, two “usually” and one person did not respond to this question. Comments received from relatives include, “The home is clean and welcoming to visitors” and “The home is clean and warm”. At the last inspection it was an area of concern that there was a severe unpleasant odour in the Butterfly unit. At this visit the problem had be addressed. The unit was fresher, however the odour had not been removed completely and it remains a recommendation of this report that action be taken to remove it completely. It was also noted that the lighting on the Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 20 corridor was dim and poor. It is recommended the lighting on the corridors of the Butterfly unit be improved. People’s rooms are generally homely and there is good evidence to show people are encouraged to personalise their rooms with pictures, photos and small items of furniture. Generally the home was clean and tidy. The manager discussed plans to build a conservatory lounge in the Butterfly unit to improve the facilities in this area of the home. Aden House Nursing Home DS0000001105.V342561.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are met by trained staff who have undergone a thorough recruitment process before they are allowed to work in the home. EVIDENCE: Comments from relatives about whether they feel the care staff have the right skills and experience to look after people properly include, “On my visits there I have been impressed by their dedication. To me they all seem caring and capable and are very kind to the residents”, and “ They are very attentive and considerate”. Two relatives commented that at times they felt the home was short staffed and that staff were very busy. The manager explained that her hours are supernumerary in addition to the to the required staffing levels. Staffing levels have been increased on the Butterfly unit from three care staff during the day to four. On the general unit there is one qualified nurse and seven care staff during the day. There is also a clinical leader. At night there is one qualified nurse and four care staff on duty. The home employs activity, catering and domestic staff as well. Although staffing levels have increased since the last visit the registered provider and manager must take not of relatives’ comments. It is a Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 22 recommendation of this report that staff levels are closely monitored to ensure there are always sufficient staff on duty to meet the needs of the people living in the home. NVQ training has improved and the home now has 33 of its care staff with NVQ level 2 or above. A further 19 care staff are working toward the award. Staff records showed that a significant amount of training has been provided in the last 5 months. All new staff undertake a detailed induction programme and specific training is provided to staff to help them meet the needs of the elderly people in the home some of whom have dementia. The staff who spoke with the inspectors confirmed that they had enjoyed the training and that it had help them do their job and understand the needs of the people they were caring for. A sample of five staff recruitment records was checked. These contained the required information, references and checks needed to help protect people from unsuitable staff. Aden House Nursing Home DS0000001105.V342561.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well managed and the health, safety and welfare of people living at the home, and staff, is promoted and protected. EVIDENCE: Mrs Shaw is an experienced manager who has achieved the registered managers award and has the NVQ level 4 award in care. Mrs Shaw has a clear view of the improvements she needs to make at the home and offers strong leadership to staff. Since Mrs Shaw took over as the manager of the home she has made significant step to improve standards and services provided. One relative commented in their survey, “ The manager is approachable” and one person in the home also confirmed this, complimenting Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 24 the manager on the work she has done, the long hours she works and her dedication. After the last two inspections it was made a requirement that the home implement an effective quality assurance and auditing system, to check that they are providing a good and effective service which takes into account the comments made by people living in the home and their relatives. Some steps have been taken to address this in that the company sent out questionnaires to relatives and people living in the home. However although some attempt has been made to summarise the result of these questionnaires there was no action plan available at the home to show how the issues identified are to be addressed. Therefore is again a requirement of this report that effective quality assurance be introduced in the home. The manager has recently introduced resident and relative meetings at the home and is working to address comments and information gained during these meetings, in particular comments made about further activities and trips out of the home. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Three people’s finances were checked during the visit and were found to be correct. When auditing the finances the inspector found it difficult to match up some receipts with the records and it was recommended that the receipts be numbered to make records clearer and audits easier. It was also recommended that the manager routinely audit records to monitor the system and check they are correct. Staff records show that members of staff are now starting to receive formal supervision. However new staff after an initial period of three months meet with the manager to discuss how they are settling into the home and how their induction programme is progressing. These meetings are not recorded and the inspectors suggested that the manager record these initial meetings on supervision records. There is evidence of routine maintenance and servicing of equipment in the home. The home carries out weekly fire safety checks and these are recorded. At the visit a requirement was made that all staff receive movement and handling training. Records showed and staff confirmed that this had been addressed. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 (1) Requirement Care plans must be detailed and identify all a people’s health and welfare needs. Care plans must be individualised to reflect the individual people’s likes, preferences and wishes. Care plans must tell staff in detail exactly what to do to meet the people’s individual needs in Aden House. Timescale 0f 30/04/07 not met. At all times the home must be able to account for all medications entering the home. All staff that are responsible for the administration of medications must be trained and competent to administer medication safely. Timescale 0f 30/04/07 not met. The registered provider must implement an effective quality monitoring system, which takes DS0000001105.V342561.R01.S.doc Timescale for action 31/12/07 2. OP9 13 (2) & 17 (1) (a) 31/10/07 3. OP33 24 (1-3) 31/12/07 Aden House Nursing Home Version 5.2 Page 27 into account the comments made by people living in the home, their representatives and other people who attend the home. The results of surveys and questionnaires must be made available in the home and an action plan developed to address any issues raised. This will help the registered provider ensure that the home is run in the best interests of the people living there. 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 OP7 Good Practice Recommendations It is a recommendation of this report that staff obtain all the information about a person admitted in an emergency and complete a detailed care plan within 24 hours of admission. This is to ensure they have the information to meet the person’s health and welfare needs properly. Peoples cultural and religious needs should be discussed with people and the discussion recorded. This will ensure the cultural and religious needs of all people are met in the home. Action should be taken to eliminate the unpleasant odour on the butterfly unit. Consideration should be given to providing a more suitable floor covering and thoroughly cleaning the floor beneath the carpet. Action should be taken to improve the lighting on the corridor area of the butterfly unit. It is a recommendation of this report that staff levels are closely monitored to ensure there are always sufficient staff on duty to meet the needs of the people living in the home. Work should continue to increase the amount of staff with the NVQ level 2 awards. It is recommended that the receipts relating to peoples personal money be numbered to make records clearer and DS0000001105.V342561.R01.S.doc Version 5.2 Page 28 2. OP12 3. OP25 4. 5. OP25 OP27 6. 7. OP28 OP35 Aden House Nursing Home audits easier. It was also recommended that the manager routinely audit records to monitor the system and check they are correct. Aden House Nursing Home DS0000001105.V342561.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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