Inspection on 06/03/07 for Aden House Nursing Home

This inspection was carried out on 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aden House Nursing Home 31/07/07

Aden House Nursing Home 22/06/06

Aden House Nursing Home 08/09/05

Aden House Nursing Home 18/05/05

Aden House Nursing Home 14/12/04

Aden House Nursing Home 14/04/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Aden House Nursing Home Long Lane Clayton West Huddersfield West Yorkshire HD8 9PR Lead Inspector Sally McSharry Key Unannounced Inspection 6th March 2007 09:00 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 Aden House Nursing Home DS0000001105.V326618.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.V326618.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 Vacant position 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.V326618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Day care - 15 To provide care for one named service user who is under 60 years Service users admitted to the home under category PD are over the age of 50 years but under 65 years. Service users who are admitted to the dementia care units are over 65 years of age and require only personal care 3rd October 2006 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 service users 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 service users, 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 service users can sit out if they so wish. The provider informed the Commission for Social Care Inspection on 06/03/07 that fees range from £354.72 to £502.47 per week. Additional charges include hairdressing, personal newspapers, private chiropody and a charge of £5.35 per hour made to escort service users 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.V326618.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 carried out to the home by two inspectors on the 6th March 2007. The inspectors arrived at the home at 09:00 am and left the home at 5:00 pm. The last key inspection, which was carried out in June 2006, identified some areas of serious concern, and since August the Commission has carried out a further additional random visit. That visit took place on the 3rd October 2007 and was carried out to monitor the improvements made at the home following the poor inspection in August. Both the random visit carried out in October and this key inspection shows the home has made some progress in addressing the issues identified. Since August last year a new acting manager, Ms Alyson Shaw, has been appointed to the home. Service users were generally very complimentary about the proposed manager, relatives told one of the inspectors that they had seen an improvement in the home since the new manager took over. During this visit the inspectors spoke to some of the service users, a visiting relative, some of the staff and the home’s management. The inspectors read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the building and observed lunch being served. Prior to the inspection twenty service user questionnaires were sent to Aden House to obtain service users’ views about living at the home. Two completed questionnaires were returned. Some service users in the home are very frail and may have difficulty completing a questionnaire. There were fifty five service users resident in the home on the day of this visit. Relative surveys were sent out to twenty of the service users’ relatives or friends. Two GP practices attend the home and questionnaires were sent to them and three questionnaires were sent to other health care professionals who visit the home. When the inspector wrote this report seven of the relatives had responded, one response had been received from a GP and one from a health care professional. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the provider, minutes of residents meetings and a pre inspection questionnaire completed by the provider and manager. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 6 The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: What has improved since the last inspection? The level of social activities has improved in the home. Some service users thought they were very good. A new activities organiser has been employed and started work at the home two weeks ago. However not all service users and relatives felt their needs were being met and a further recommendation has been made in this report. The acting manager is encouraging staff to take part in National Vocational Qualification (NVQ) training. She is also ensuring staff receive mandatory training sessions. However requirements have been made in this report about specific training required. Regular staff supervision and appraisals are now beginning to take place. The new acting manager seems to be settling into her new role well. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 7 Quality assurance has been introduced at the home and should be progressed and developed further to ensure service users and relatives are involved in the developing and improving the service. What they could do better: The registered provider and manager must take care before service users are admitted to Aden House to ensure that the staff who are to care for the service users have had the necessary training; and have the experience and skills to meet all the service users’ health and welfare needs. Care plan and risk assessment documentation needs to be more detailed and provide staff with full details of individual service users needs and clearly explain how those needs are to be safely met in the home. Staff must be trained to write and maintain care plans and risk assessments. Daily records should be more detailed. The information on wound charts should be accurate and specific to ensure staff can monitor improvements or deterioration clearly. Information in oral assessments should be specific and staff must ensure they obtain specialist treatment for services requiring a dentist rather than leaving this to relatives. The standard of medication management, administration and records must be improved to ensure service users receive the correct medications at all times. Staff must be trained and competent to administer medications. Staff must be trained to maintain service users’ privacy and dignity, taking care that comments made to service users could not be miss understood or possibly offensive. Activities should be individualised and all service users must have access to activities to suit their needs. Service users on the Butterfly unit should be offered hot and cold drinks during the morning and not just a cold drink. Care must be taken to provide assistance and encouragement to those service users who need help with their meals and accurate records must be kept to show what has been offered and what the service user has managed to eat. Generally staff must be trained and skilled to meet the needs of all the service users in the home, training needed includes dementia care, first aid, management of challenging behaviour, restraint techniques and palliative care; as well as training and a knowledge of common illnesses and aliments in the elderly. National Vocational Qualification training should also progress, with the aim of having 50 of care staff with NVQ level 2. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 8 The severe unpleasant odour on the corridor and in the Butterfly Unit must be addressed urgently. The results of quality assurance surveys carried out by Aden House Ltd. Should be summarised and made public along with an action plan advising the steps to be taken to address any issues identified. Care should be taken to ensure correct movement and handling practice is used in the home and that movement and handling training includes a practical session in which staff can practice the techniques. 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.V326618.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.V326618.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 and 6. No service user moves into the home with out having had their needs assessed. Further staff training is needed to ensure the staff team have the skills to meet all the service users needs. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and a relative confirmed when spoken to and in questionnaires that they had information about the home before they came to live there and that their needs had been assessed before admission to the home. The sample of case records audited showed that service users admitted to the home recently had been assessed prior to admission. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 11 The acting manager advised that prospective service users and relatives are welcome to visit or have a short stay at the home before making the decision to stay there permanently. During the visit the inspectors discussed with members of staff the training they had received to help them care for service users. Some members of staff who worked in the Butterfly Unit (the residential unit for service users with dementia) had not had any dementia care training. This must be addressed. Before a service user is admitted to the home care must be taken to ensure members of staff working in the home have the skills needed to meet all the service users needs. The home has admitted service users with a diverse range of needs and from a variety of cultural backgrounds, mainly from the local area. Aden House does not currently provide intermediate care. Aden House Nursing Home DS0000001105.V326618.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 and 10. Not all service users’ health, personal and social care needs are set out in an individual plan of care. Risk assessments are carried out and monitored but some lack detail. Service users are able to make decisions about their lives with the support of staff. Medications are not being managed safely. Service users are not always treated with respect, their privacy and dignity is maintained by the staff in the home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 13 At the last key inspection in June 2006 care records were found to be of a poor standard. Work was carried out and when care records were reassessed in a random visit to the home in October 2006 the standard had improved. However these improvements have not been maintained. Care records failed to identify all service users’ needs. One service user had significant behavioural problems; these had not been identified in a care plan. Where care plans have been developed they lacked detail. A need is identified in the care plan such as the individual service user’s social care needs. It identifies what the service user’s interests are but then fails to advise staff how those needs are to be met in the home. Similarly risk assessments are in place however they lack detail and do not address all the risks. These issues must be addressed. Care plans must be detailed and identify all a service users health and welfare needs. Care plans should be individualised to reflect the individual service user’s likes, preferences and wishes. Care plans must tell staff in detail exactly how the service user’s individual needs are to be met in Aden House. Risk assessments must be thorough and detailed. They must identify all risks to a service user and how those risks are to be managed, minimised and where possible eliminated. To ensure the standard of care planning and risk assessing improves and is maintained staff in the home must be trained to develop and maintain care plans and risk assessments properly. Daily records remain poor and lack detail. Therefore the recommendation made in the last report that daily records reflect the actual care provided each day, remains a recommendation of this report. Care records show that some health care needs have been inappropriately managed or have not been addressed in the home. Care records relating to the management of one service user’s pressure ulcers were inadequate and failed to show that these had been correctly managed. Another service user had complained of toothache and a sore mouth. The home failed to obtain suitable treatment and instead referred the matter to the service user’s relative. The home uses a dressings form to monitor and record the management of wounds or pressure ulcers. This form is not specific and asks staff to assess the wound as, small, medium or large. This system is not accurate and should be changed. Staff should measure and record the actual size of the wound each time it is dressed. This is a good practice recommendation of this report. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 14 Care plans relating to service users’ social interests are frequently headed, “work and play”. As service users no longer work and reference to playing is demeaning this title should be replaced by something more appropriate. These are serious incidents and show a lack of care and bad practice. These issues must be addressed to ensure at all times service users receive appropriate care and treatment. The registered provider and manager must at all times ensure that the staff on duty have the experience and skills needed to care for the service users. This has already been made a requirement of this report. Feedback from service users during the visit and in returned questionnaires was generally positive. Service users felt staff were kind and caring and would do anything for them. However two out of the seven questionnaires returned by relatives or friends raised serious concerns about general care in the home. The questionnaires returned by a GP and a health care professional also raised concern about the care skills and communication skills of some staff in the home. The management of medications in the home were identified as poor during the key inspection in June. When reassessed in October standards had improved. However during this visit further issues were identified. When a sample of medications was audited six tablets were missing and could not be fully accounted for. Some service users were prescribed sedation to be given when required. Records showed these were being given three times a day, however there was no written evidence to justify why the medications was being given so frequently or that staff were monitoring possible side effects as they had been requested to by the Community psychiatric nurse. Paracetamol had been given twice in a day, however staff had not recorded the times that it had been administered and therefore it was not possible to see if it had been Four hourly as recommended. Staff had used the “code” system inappropriately on the medications administration sheet. On one sheet they had used the same code “O” to indicate “open bowels” and “out of stock”. These issues must be addressed. 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. When staff administer “when required” medications they must be able to justify the reason for administering the medication. Suitable “codes” must be used on the medication administration sheets. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 15 Generally service users and relatives comments about staff in the home were positive. Several made comment that this had improved since the new acting manager had been appointed. When the inspectors observed members of staff interacting with service users they felt that staff were kind and well meaning and had a good knowledge of individual service users. However some staff discussed issues, which were private to individual service users in a communal area. Staff were also heard to use local terms of endearment to service users, such as “ sweetheart”; and one member of staff said to a service user “ sit down or I’ll smack your bottom”. Although these comments were made in a lighthearted way care should be taken as some service users might be offended by such comments. Therefore staff must be trained and supervised to ensure they maintain service user’s privacy and ensure they always treat service users with respect. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 16 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. Service users’ social, cultural, religious and recreational needs are not being fully being met; they are helped to maintain contact with their families and the local community. Service users are able to exercise some choice and control over their lives. Meals provided are varied. Meals are served in a pleasant environment. Care must be taken to ensure that service users who need support receive the assistance they require. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some service users and relatives said at the visit and commented in questionnaires that activities in the home have improved. One relative said Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 17 that activities were very good and that service users could chose to join in if they wanted. Other service users spoke of crafts and games being provided. However three relatives in their questionnaires said that service users did not receive sufficient or suitable activities, particularly those service users less able to join in group activities. During the visit some service users said they were bored and one said they would like more activities and that they get fed up of “bingo”. At this visit the inspectors met the new activities organiser who is to work full time and plans to work some weekends. During the morning the activities organiser was talking to service users and looking at books, which stimulates reminiscence about life in the local area. One service user asked to go out for a breath of fresh air and the activities organiser took her out in a wheelchair, which she really enjoyed. In the afternoon some service users enjoyed playing bingo. Now an activities organiser has been recruited, it is recommended that the activities provided in the home be reviewed with input from service users to ensure the activities being offered meet all the service users’ needs and preferences. Relatives and friends said at the visit and in returned questionnaires that they are always welcomed into the home. Those service users who are able leave the home are encouraged to go out with their relatives. Members of the local community visit the home and a monthly church service is held at Aden House. Service users confirmed that they do have choice over their lives in the home. They are generally able to choose when they get up in a morning and go to bed at night, what they wear and where they spend the day. Activities are offered but service users are able to choose whether to join in or not. During this visit service users on the Butterfly unit were only offered a cold drink mid morning. Service users should be given the choice of a hot or cold drink. Comments received about the meals provided were all very positive. Some service users felt the meals were good and that there was always a choice available. The lunch being service at the time of the visit offered choice, looked and smelt appetising. Service users commented on how nice it was. One relative also commented on the good standard of meals offered. One relative commented that some service users who need assistance and encouragement with meals and help to eat their meals were not always given the time and encouragement required. During this visit staff were seen to help service users. However when the inspector checked the records of a service user who needed assistance, the records were not always completed fully. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 18 On some days records showed three main meals, nourishing drinks and fluids had been offered and a record of what the service user had been able to take, was made. However on other days records were either incomplete or showed that insufficient meals or drinks had been offered. Care must be taken to ensure that service users who need assistance and encouragement with meals are given the necessary assistance and time by staff. Records must accurately reflect what has been offered and what the service user has been able to take. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 19 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. Service users and their relatives and friends are confident to make complaints and that these will be listened to and taken seriously. Service users are not being fully protected from abuse and poor care, because some staff have not been trained to meet their needs safely. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last key inspection some service users and relatives felt if they raised concerns these would not be addressed. Service users and relatives during this visit and in returned questionnaires generally indicated that they were aware of the complaints procedure and would know how to make a complaint and that this would be addressed. The manager keeps a record of complaints made, the investigation carried out and the outcome of the complaint and any action taken. There have been three complaints made since the last inspection. Two have been upheld and action taken, one remains under investigation. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 20 All staff have received training in relation to abuse and the protection of vulnerable adults. However during this visit the inspectors identified that some staff particularly on the Butterfly Unit (unit providing personal care to service users with dementia) have not been trained in dementia care and first aid. Staff have not received training in how to manage challenging behaviour and have not received training about how to safely restrain service users or advise on “break away techniques”. All these skills are currently needed in the home and the registered provider and manager must ensure staff are trained and skilled in these areas to help prevent possible poor practice and injury to service users and staff members. This must be addressed as a matter of urgency. This is a requirement of this report. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 21 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 20. Service users live in a safe, well-maintained environment. The home is clean however there is a severe unpleasant odour in some areas. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence that the home has had some redecoration since the last inspection, however some rooms are showing wear and tear. Generally bedrooms were clean, carpets vacuumed, tidy and odour free. However the corridor and lounge area on the Butterfly unit had a severe unpleasant odour. Several relatives also mentioned this in their returned questionnaires. One service user said during the visit, that they “didn’t want to stop in this hole, Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 22 even the chairs stink”. The inspectors felt that on the day of this visit that was a fair comment. Some of the chairs on the unit are shabby and worn and should be replaced. These issues must be addressed. It is not acceptable for service users to live in an area with such an unpleasant odour. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 23 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. Suitable numbers of staff are employed. The staff receive induction and basic foundation training but require further training to ensure they have the skills required to care for the service users. Staff recruitment policies and records protect service users. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last key inspection in June 2006 there were concerns raised about the number of staff on duty. Since then staffing levels have been reviewed and increased. The new acting manager has made efforts to recruit new staff and several new staff have started at the home. The one drawback of this is that it takes time for new staff to be trained, gain experience and develop skills and this is reflected in the requirements already made about staff training in this report. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 24 Some service users advised that staff sickness sometimes leads to a shortage of staff in the home. Records show that where every possible agency staff are used to fill vacancies and where able the manager uses the same agency member of staff to help consistency. NVQ training is now encouraged and promoted and although the home currently only has 14 of its care staff trained to National Vocational Qualification (NVQ) level 2, a further 16 staff are currently under taking NVQ training and three more are waiting to sign up to the course. It remains a recommendation of this report that the home has 50 of its care staff trained to NVQ level 2 or above. General training is provided but mainly focuses on mandatory training such as movement and handling, fire, abuse and adult protection and basic food hygiene. Training must be developed in the home to ensure staff have the skills required to care for the service users in the home. Training such as dementia care, managing challenging behaviour, restraint and “ break away” techniques, first aid, palliative care, nutrition, oral care, foot care, catheter care and maintaining service users privacy and dignity must also be provided, as well as training about common illnesses and conditions in the elderly. The recruitment and training records of five members of staff were audited. Recruitment records were complete and included all the required references and checks. This helps to protect service users from staff who might be unsuitable to work with vulnerable adults. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Service users live in a home with an experienced and competent acting manager. The home is beginning to be run in the best interest of service users. Service users financial interests are safe guarded. The health, safety and welfare of service users and staff could be more fully promoted and protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 26 EVIDENCE: Since the last inspection, a new manager has been proposed to run the home. Ms Shaw has worked in the home before and has managed another home in the Aden House group before. She appears to have settled into her new role well. Members of staff, service users and relatives reported Ms Shaw to be approachable and that the atmosphere in the home has improved. Ms Shaw has a realistic view of the home and although improvements have been made is aware that much work is still required to improve and maintain standards. Ms Shaw advised that she has submitted an application to the Commission for Social Care Inspection to become the registered manager and she has already obtained the Registered Managers Award. Since the last key inspection, a quality assurance manager has been appointed by Aden House Ltd. Quality assurance questionnaires have been sent out to service users and relatives. The results of these questionnaires are currently being summarised. This information must to be printed out and made available in the home. Along with an action plan addressing the issues raised or identified. A service user and relative meeting has been held, although attendance was poor. The Commission for Social Care Inspection would encourage further meetings to enable service users and their relatives to become actively involved in the future of the home. On a monthly basis, Aden House Ltd produces a management report monitoring the service and identifying any issues to be addressed. The home acts as appointee for one service user, collecting their pension and personal monies. The records clearly show the service user receives their personal allowance. Some service users have small amounts of spending money held by the home. A sample of these records and monies was audited during this visit. Records are clear and show how money has been spent on the service users’ behalf. All money checked was correct and corresponded to the records held. There is a planned maintenance programme in place in the home, with records to show maintenance checks and tests have been carried out. The fire alarm system is checked weekly and records clearly record this. During the visit one of the inspectors witnessed some poor movement and handling techniques; where a movement and handling belt was used to lift a Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 27 service user. This was discussed with the acting manager. The movement and handling practice of staff in the home must be closely monitored to ensure correct procedures are practiced. Care should be taken to ensure movement and handling training includes practical sessions to help staff practice procedures correctly. Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) (d) Requirement Timescale for action 31/03/07 2. OP7 15 (1) The registered provider and manager must be sure that the staff in the home have the skills needed to care for service users before they offer the service user a place in the home. Care plans must be detailed and 30/04/07 identify all a service users health and welfare needs. Care plans must be individualised to reflect the individual service user’s likes, preferences and wishes. Care plans must tell staff in detail exactly what to do to meet the service user’s individual needs in Aden House. 3. OP8 13 Risk assessments must be thorough and detailed. They must identify all risk to a service user and how those risks are to be managed, minimised and where possible eliminated. Giving staff clear and precise guidance on how to do this. 30/04/07 Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 30 4. OP9 13 (2) & 17 (1) (a) At all time 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. When staff administer “when required” medications they must be able to justify the reason for administering the medication. Suitable “codes” must be used on the medication administration sheets. 30/04/07 5. OP10 12(4) Staff must be trained and supervised to ensure they maintain service user’s privacy and ensure they always treat service users with respect and maintain their dignity. Care must be taken to ensure that service users who need assistance and encouragement with meals are given the necessary assistance and time by staff. Records must accurately reflect what has been offered and what the service user has been able to take. 30/04/07 6. OP15 12(1) & 16(2) 31/03/07 7. OP18 12 (1) (5) & 13 (6) Staff must have the skills needed 30/04/07 to care for the service users in Aden House. Staff must have dementia care training; First aid training; Training in the management of challenging behaviour; Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 31 8. OP25 23 (1) (a) 9. OP30 18 (1) Restraint and “break away” training; To ensure the service users are cared for appropriately and safely and to ensure staff safety. Action must be taken to eliminate the severe unpleasant odour in the corridor and lounge on the Butterfly unit. To ensure the standard of care planning and risk assessing improves and is maintained staff in the home must be trained to develop and maintain care plans and risk assessments properly. 30/04/07 30/04/07 10. OP30 18(1) The training programme must be 30/04/07 reviewed and staff must be trained and have the skills to care for all service users in the home, taking into account the their specific needs and illnesses. The movement and handling practice of staff in the home must be closely monitored to ensure correct procedures are used. Care should be taken to ensure movement and handling training includes practical sessions to help staff practice procedures correctly. 30/04/07 11. OP38 13(5) Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations Daily records should be more detailed and accurately reflect the care given each day. Staff should measure and record the exact size of any wound every time they redress the area. So that everyone can clearly see if the lesion is getting bigger or smaller. Information on oral assessments should be specific and should not be passed to relatives unless this is a specific request of the service user’s. It is recommended that the activities provided in the home be reviewed with input from service users to ensure the activities being offered meet all the service users’ needs and preferences. During this visit service users on the Butterfly unit were only offered a cold drink mid morning. Service users should be given the choice of a hot or cold drink. Chairs which are worn and smell unpleasant should be replaced. Work should continue to increase the amount of staff with the NVQ level 2 awards. The results of these quality assurance questionnaires are currently being summarised. This information must to be printed out and made available in the home. Along with an action plan addressing the issues raised or identified. 3. OP8 4. OP12 5. OP14 6. 7. 8. OP19 OP28 OP33 Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Aden House Nursing Home DS0000001105.V326618.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!