Inspection on 27/01/10 for Afton Court

This inspection was carried out on 27th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Afton Court 09/06/10

Afton Court 17/12/08

Afton Court 18/12/06

Afton Court 25/01/06

Afton Court 20/04/05

Afton Court 17/01/05

Afton Court 04/08/04

Afton Court 04/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Afton Court 66-72 Marshall Avenue Bridlington East Riding Of Yorks YO15 2DS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Angela Tew     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Afton Court 66-72 Marshall Avenue Bridlington East Riding Of Yorks YO15 2DS 01262606888 01262677999 aftoncourtltd@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Afton Court Limited Name of registered manager (if applicable) Mrs Samantha Jane Berry-Dagnall Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Afton Court consists of four adapted terraced houses close to the centre of the seaside town of Bridlington. The home is registered to provide personal care and accommodation for up to 41 older people who may also have dementia. It is conveniently located for all local amenities and facilities including public transport. The home can provide on-street parking permits for visitors. Single and shared bedrooms all have en suite facilities of a wash-hand basin and toilet. Some rooms also have a bath or shower. There is also a self-contained ground floor flat suitable for a married couple. A vertical passenger lift provides access to all three floors. There is a choice of lounges and dining areas. A large private and well maintained courtyard provides a safe area for people living there and the outside space is very easy to access. The Care Homes for Older People Page 4 of 33 Over 65 41 41 0 0 1 7 1 2 2 0 0 8 Brief description of the care home Statement of Purpose and service user guide, as well as the latest inspection report completed by the Commission for Social Care Inspection are made available in the home, for people to read. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This site visit took place over one day and took a total of 8 hours. A regulation inspector visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home, staff members and health and social care professionals. The Annual Quality Assurance Assessment was returned to the CQC prior to the visit taking place. It had been completed to an adequate standard. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be Care Homes for Older People Page 6 of 33 taken. Some people currently living in the home were spoken to about the support they receive and what it is like to live in the home, some of their comments have been included in this report. Three files of people living in the home and four staff personnel files were looked at during the site visit. A tour of the building was undertaken and a number of records were looked at to ensure that the home is well maintained. The medication procedure and the way that incidents are reported was looked at and the manager was given feedback at the end of the visit. The manager told us that the current fees charged are £362.50 to £410.80. Additional charges are also made for items like chiropody, hairdressing, beautician services as well as individual items like newspapers and toiletries. A one to one service is offered at a fee, where staff can support people to meet specific needs. We also checked how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. We would like to thank the people who live in the home, staff and management for their hospitality during the visit, and also thank the people who had discussions with us. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? A lot of work had been done by the manager in updating the plans of care and identified risks and some new forms had been introduced, that make the care planning process more centred around the person and their wishes. The home has a medication policy and procedure and overall this is adhered to, ensuring that people receive their medication in a safe way. New systems for monitoring the medication system have been introduced and these appear to be working. People who live in the home are enabled to take part in activities, they are encouraged to maintain outside links with family and friends and the menu offered is of a good standard. Since the last inspection the home has increased the number of hours allocated for staff to undertake activities with people. People told us that they liked living in the home and that their bedrooms were comfortable and some comments included; I picked my wallpaper and colours. People living in the home and staff spoke highly of the manager and commented, I Care Homes for Older People Page 8 of 33 can go to Sammi at any time, she is always there, the manager is very nice and listens to any concerns, I like the manager and all of the staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 33 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to visit the home before deciding to move in. The preadmission assessment ensures that individual care needs can be met at the home and the person receives information and help, to enable them to choose whether Afton Court is the right place for them. Evidence: We looked at three care files confirming that a pre-assessment is undertaken before people are offered a place. The manager said, I visit the person and try to gain as much information before we offer them a place here. All of the care files looked at contained a comprehensive needs assessment that had been undertaken by the placing authority. Since the last inspection the paperwork had been reviewed and assessments contained signatures and a date of completion. People told us that had visited the home before coming to live there. One person said, I came to visit a few times and met everyone here. On the day of the visit a Care Homes for Older People Page 12 of 33 Evidence: prospective resident was having a trial visit and was accompanied by their health care worker, who commented, I have brought this person on several visits and the staff have been very supportive, trying to engage with them and the person is slowly integrating. I think the overall care is good. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in general have their health care needs met and the care plans cover a range of identified needs including how to manage some areas of risk. However, restriction on freedom and choice is not always covered and risk management plans do not specify the level of risk and whether this has been agreed with other professionals. Evidence: We looked at sample of files which belonged to people living in the home. We saw that a lot of work had been done by the manager in updating the plans of care and identified risks and some new forms had been introduced. We saw that each person had a care plan that covered mobility, strengths and needs, safety, personal care, intimate care, diet and nutrition, emotional care and support, communication, leisure activities, night care and health related conditions. The manager told us that she had been developing the care plans since the last inspection and has involved the person receiving care in the development of the care plans. She said, this includes discussions with the person, their social worker, family and the mental health team. The information is collated and the care plan created, but Care Homes for Older People Page 14 of 33 Evidence: we continue to gather information and review this on a regular basis. It was clear that the care plans had been further developed and were more about the person and their likes and dislikes. However, some did not describe in full what the actual need was or associated risks. For example, one care plan stated the person was a diabetic and a suitable diet was required, this did not go onto say what would be suitable. Another care plan stated that mental stimulation was required, again it did not go onto describe how this would be achieved. One plan stated that a person was unable to communicate by speech, but did not go onto to say how staff would communicate on a daily basis. Currently the staff record onto the daily notes that personal care has been given, however it does not specify what part of the care plan has been implemented and there is no way that the management could monitor this. During the visit it was observed that several people remained seated in their wheelchairs for a considerable time without being moved into a more comfortable chair. It was also noted that belts were used to keep the person in the wheelchair. The manager explained that this was not the usual practice and she would speak to the senior staff about it. She did say, the belts are used for posture support and not as a restriction. A discussion was held about the use of any form of restriction and that this should be agreed with others involved in providing care and this be done with the best interests of the person in mind. The manager told us that the management of difficult behaviour had improved and showed us some updated plans. Although these had improved since the previous inspection and covered a variety of areas including verbal, physical and sexual behaviours, again they did not describe in detail how the risk was to be managed. For example, one person was displaying aggressive behaviour, however the plan did not say what the signs, symptoms and triggers were and what intervention is required by the staff. The home does use a variety of assessments to identify risk including falls, challenging behaviour and environmental issues. In general the health care needs of people living in Afton Court are met. It was clear from looking at written records that people have access to a variety of health support including regular optical, dental, chiropody and general appointments. The manager told us, we employ a private physio-therapist who attends to the needs of our residents. She also advises me on any other needs the residents may have and equipment needed. Records showed us that falls are monitored and if a pattern emerges then the home will make a referral to the falls team for support and advice. The home has a medication policy and procedure and overall this is adhered to, ensuring that people receive their medication in a safe way. The manager told us that Care Homes for Older People Page 15 of 33 Evidence: since the previous inspection the home had received a visit from the Primary Care Trust (PCT) and Boots pharmacist, who offered advice and recommendations to improve the medication system. The manager said, we had an inspection by the PCT and they gave us lots of information to into our policy, they suggested we obtained a controlled drugs cabinet. The reports made by the PCT and Boots were seen and it was clear that the home had implemented the recommendations. The manager told us that a new system had been introduced and she has employed on person who looks after the medication ordering, booking in and returns. We looked at several records for medication and the standard of recording was good. The medication procedure is monitored on a daily basis and written evidence to confirm this were seen. The stock matched with what was recorded on the medication administration records. However, some medication did not have the date of opening written on to it, including calogen, conotrane cream and lactulose. It was noted that some prescribed creams were left out in peoples bedrooms. The home has a medication room that is kept locked at all times. There are two medication trolleys secured to the wall and there. The home has obtained a controlled drugs cabinet and has a CD register which was up to date and accurate. The manager confirmed that two people always sign and witness the administering of controlled drugs. There is a medication refrigerator and the temperature is taken and recorded on a daily basis. The manager said, one person orders the medication and checks the prescriptions are correct before they are dispensed from the pharmacy. People told us that their privacy is respected and staff were observed knocking before entering rooms and speaking to people in a way that would promote their dignity. Some comments received from people living in the home included, I really like it here, the staff are very nice, the girls are all friendly. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are enabled to take part in activities, they are encouraged to maintain outside links with family and friends and the menu offered is of a good standard. Evidence: The manager told us that since the previous inspection the activities programme has been further developed and a care assistant has been given the role of co-ordinating activities and outings. The manager said, two hours per day are offered and this is included in the staff rota, so staff know when it is their turn to undertake activities. People living in the home told us that activities do occur and are usually on a daily basis. During the visit it was observed that an outside group called Motivation and Co were delivering an activity that involved singing, moving to music and memory games. People appeared to enjoy the singing and the majority of them joined in. The manager said, Motivation and Co visit every two weeks and we also have live entertainers each month. We have developed a sensory room for people to enjoy and one staff member is currently resourcing more equipment. Usually the people who have limited mobility and communication enjoy the sensory room. Care Homes for Older People Page 17 of 33 Evidence: People are supported and encouraged to maintain links with their family and friends. Several people go out into the local community either with their family or independently. Overall choice is promoted for people living in the home and they told us that they can get up and go to bed when they choose to, take a bath or have some private time when they want to. However, as mentioned earlier in the report some people have their choice restricted by the use of belts on wheelchairs. A requirement was made in that section of the report for the home to ensure that this is being done with the persons best interests and in conjunction with other people involved in providing care. People told us that the food offered was of a good standard and some comments were, excellent meals, the food is of a good standard, really nice food and we get lots. The manager told us that there is a four weekly menu and that people are consulted on a daily basis about what they would like to eat. She said, the home is flexible and food preferences are discussed everyday and there is a service user meeting every six weeks. There are three options for lunch available and a sweets trolley with a variety of choice for dessert. The cook told us that people are consulted everyday about what they would like to eat and the menu is put out on view on a daily basis. She said, the main meal is served at lunch time and it is a lighter option for tea, usually something like omelet or burger. A cooked breakfast is available everyday. Special dietary needs are recorded in the care pans, however the information is not held in the kitchen. The cook said, I know what special diets people require including sugar free options or those who require their food blended. The food on offer looked well presented and inviting. Also the meals that had to be blended were presented separately. People were observed being assisted by staff and this was carried out in a sensitive manner. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Afton Court and their families can be sure that complaints are taken seriously and staff are alert to any signs of abuse. However, not all incidents have been referred to the safeguarding team and not all staff have undertaken safeguarding training. Evidence: The home has a complaints procedure and it was confirmed from speaking to people using the service that complaints are listened to and acted upon. People told us that, if there is a problem it is sorted fairly quickly, I would see one of the staff or the manager. The manager told us that she would speak to the complainant and record the concern and following any investigation the outcome would be relayed back to the person making the complaint. People get a copy of the service users guide either before or after they go to live at Afton Court. This guide gives information about how people can complain, who to, and how long they can expect to wait before they will get a response following any investigation. The home has a policy and procedure for the prevention of abuse. Some staff have undertaken training in this area. Since the last inspection there has been one safeguarding referral made to the Local Authority Safeguarding team and this is currently being investigated by the safeguarding team and involves an alleged sexual Care Homes for Older People Page 19 of 33 Evidence: assault on a person living in the home. However, during discussion with the manager it was clear that a second incident had occurred whereby a staff member had administered medication to two residents from the same package. At the time of this incident the current manager who is also the owner was not managing the home, she assures CQC that any incidents of such a nature will be reported appropriately including safeguarding referrals if they required. The manager did display a good understanding of the safeguarding procedure and from discussion it was evident that she is aware of what constitutes abuse. She said, I have undertaken the safeguarding training course for managers and the Mental Capacity Act and some of the staff have also done the safeguarding training, but we are awaiting dates for others to complete this. Each person has a locked facility in their room, to ensure their personal possessions and money are safe. The home has procedures in place to ensure that people have access to their finances, however the home is currently insured for up to £500 in cash and the safe currently holds well over that amount. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is clean, hygienic, comfortable and homely. However, some parts of the building would benefit from refurbishment and redecoration and some carpets may pose a trip hazard. The temperature of the water in communal areas is too hot and may pose a risk of scalding and one bathroom is out of order, which may mean people cannot bathe when they choose to. Evidence: During the visit a tour of the building was undertaken and the standard of accommodation and cleanliness was adequate. However, some part of the home is looking old and worn and in need of redecoration and refurbishment. The manager told us that there is a development plan in place and 14 of the 38 bedrooms have been refurbished and also had ensuite facilities put in. She said, we plan to refurbish the remaining bedrooms, but currently we are not at full capacity and we do not have the resources to complete this just yet. The maintenance book was seen and it was clear the work is prioritised and the handyman is then asked to complete the tasks. The home has two bathroom/shower rooms, however one has been out of order for sometime. The manager told us that they had been waiting for a part. She said, I will see to it immediately. Although the main bathroom/shower rooms had water restrictor valves fitted that ensured the water distributed at a safe temperature, the taps in the communal toilets did not and these were found to be distributing water at Care Homes for Older People Page 21 of 33 Evidence: high temperatures. That may pose a risk to people of scalding. Again the manager assured CQC that this would be dealt with immediately. The home was using portable heaters in communal areas, however these were free standing and were very hot. All of the communal toilets had hand washing and drying facilities. Following the inspection CQC received confirmation from the manager that water restrictors are currently being fitted to all water outlets and the portable heaters were no longer in use. On the ground floor there are a number of different communal rooms and people can choose where they sit. The dining room is spacious and the tables laid with flowers. There is a conservatory and outside a secure and safe patio garden, with fish ponds, seating areas and flowers. The home has a sensory room/hairdressing salon in place and it was clear from records that this facility is used by people living in the home. People told us that they liked living in the home and that their bedrooms were comfortable and some comments included; I picked my wallpaper and colours. The furniture is new and it is very nice, I like my room. Individual rooms looked at were homely and comfortable and contained peoples personal possessions. However, two rooms looked at did have a strong smell of urine and one had faeces on the carpet. The front door to the home has several locks fitted including two deadlocks making it difficult to open quickly. The fire department has inspected the home recently and made a recommendation that the home installs an electromagnetic locking device to all final exit doors that are linked to the fire alarm system with the provision of an override and fail safe facility. The home has not actioned this recommendation as yet. The home has a no smoking policy and currently there are two people living in the home who smoke. They are expected to go outside to have a cigarette, however, there is no outside shelter for people to use and they have no protection from the elements. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where staff are supportive and caring. However, staffing levels may not always be sufficient to meet peoples needs. The home employs staff before the full disclosure is received and this may put people at risk of receiving support from unsuitable staff. Evidence: The manager told us the home employs 17 care staff. However, only 3 have obtained NVQ level 2 in care. She said, we like the staff to work here for at least 6-12 months before they commence the NVQ training, as they might leave. Staff members were spoken to and although they could describe the basic needs of people living in the home, they were not so clear about specific need such as difficult to manage behaviours or what was stated in the persons care and risk management plan. During the visit staff were observed to be patient, calm and supportive when dealing with people. It would appear that they have developed very good relationships and the atmosphere was relaxed. It was noted that staff respect the person and their privacy. Staff spoke to people living in the home in a way that was encouraging and enabling to the person. People living in the home told us, the staff are lovely, the Care Homes for Older People Page 23 of 33 Evidence: girls work very hard, I really like it here,the girls are all friendly. Social and health care professionals spoke highly of the staff group and some comments included, they adopt an holistic approach with all their clients, all of the staff work well and are accepting of all advice given, Afton Court in my experience is very homely, caring and efficient, the manager and staff are very professional and have each clients best interests at heart, they are very person centred in their approach towards the people they care for, my experience of working with them has been very positive and I have no concerns with any areas of their practice. People living in the home and staff told us that there are not always enough staff on duty. Some comments included, I would like more time to spend talking to staff, I would like more freedom to do more things, I think we could do with more staff, at the weekend it is bad, care needs are fully met, but not always promptly. Social and health care professionals told us, carers work very hard and try their best, but Afton Court needs more carers to cope with peoples social and health care needs due to the layout of the building, sometimes they appear not to have many staff on duty. The manager told us that she felt the staffing levels were sufficient and the home currently offers a total of 571 care hours. The minimum the residential forum recommends for the current amount of people living in the home and their level of need is 591 care hours. Therefore, the staffing levels require reviewing and looking at to ensure that there are sufficient staff on duty to undertake the various tasks required of them and as the number of people living in the home increases. The manager told us that there is a training plan in place and this meets the Skills for Care requirement. The manager said, we offer an in-house induction programme that meets the common induction standards and all new staff must undertake this. Two staff files and the training plan for the year were looked at confirming that the majority of essential training had taken place, however some staff have not undertaken training in relation to safeguarding, moving and handling and infection control. The manager said that some staff are awaiting dates from East Riding Council for their training. There were appropriate checks in place that would deem the person appropriate to work in the home. However, the manager told us that staff are usually employed using a Protection of Vulnerable Adult (POVA) 1st check, prior to the full Criminal Records Bureau (CRB) check being received back. Current guidance states that this must only be undertaken in exceptional circumstances and not for every new staff member. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is generally run in the best interests of the people living there, essential maintenance and checks are not being carried out often enough to make sure peoples health and welfare are always being protected. Evidence: The owner of Afton Court and has recently returned to the home to manage it as the previous manager left. She is registered with CQC and has experience of working within a residential care setting. The manager told us, I have commenced a degree course in dementia care and am hoping to find this useful for the people we support. I have undertaken dementia awareness and have a place booked for nutritional needs. People living in the home and staff spoke highly of the manager and commented, I can go to Sammi at any time, she is always there, the manager is very nice and listens to any concerns, I like the manager and all of the staff. The home does seek the views of people using the service and surveys are given to them on a yearly basis. Surveys are sent out to health and social care professionals Care Homes for Older People Page 25 of 33 Evidence: and families and the manager told us, we do not currently send surveys to GPs or staff members. The home holds regular resident meetings and people are able to express their opinions within that arena. The home also receives thank you cards from people who have used the service. These were seen and were very complimentary about the home. The manager told us that she has given the task of medication audits to a senior carer to ensure that mistakes are corrected and procedures updated quickly. A carer has been given the responsibility of co-ordinating the quality assurance system, however this is in its infancy and requires further development. Although the home listens to the views of people involved in the service, the information is not currently formulated into a report that would identify any shortfalls and action require. The building is adequately maintained and the manager told us that all of the appropriate maintenance certificates are in place. However, as mentioned earlier in the environment section of the report some parts of the building would benefit from refurbishment and redecoration and some carpets may pose a trip hazard. The temperature of the water in communal areas is too hot and may pose a risk of scalding and one bathroom is out of order, which may mean people cannot bathe when they choose to. The fire department has inspected the home recently and made a recommendation that the home installs an electromagnetic locking device to all final exit doors that are linked to the fire alarm system with the provision of an override and fail safe facility. The home has not actioned this recommendation as yet. Although the majority of records looked at were up to date and signed by staff, some of the recording was judgemental and personal opinion rather than being impartial and factual. Some comments included, she is a demanding lady and does not like to kept waiting, he was very rude. The manager told us that staff meetings and supervision are occurring on a regular basis and written evidence was seen that supported this. Staff members told us that they received both informal and formal support from both the team leaders or manager. Staff said, there is always someone around, either a team leader or the manager, yes I receive support and supervision at least six times a year. From looking at written records it was clear that staff do not receive supervision as regular as they should. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 13 All hot water to which people 31/01/2009 living there have access to, should be monitored so that the registered person is satisfied that the risk of people being scalded by water that is too hot, is minimised. This will contribute to protecting people from harm. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 If restrictions are to be put in place then the decision must be made with other people involved in providing care, this must be subject to a mental capacity assessment and detailed risk management plan and agreed in a multi agency setting. This would ensure that people are involved in any decisions about their life and if a restriction is put in place this has been done in consultation with others involved in providing care and in the persons best interests. 10/05/2010 2 7 15 Care plans and the risks associated with difficult to manage behaviour must be clear, describe what is required, how often and by whom. 10/05/2010 Care Homes for Older People Page 28 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This would ensure that staff are clear about the needs, risks and how these are to be managed. 3 9 13 Prescribed medication including creams must be stored securely. To ensure that medication is stored safely. 4 18 12 The home must only hold money on the premises that they are insured for. To ensure that peoples finances are protected. 5 18 18 Staff must undertake essential training that would safeguard people living in the home. To ensure that people living in the home are protected from harm or abuse. 6 19 23 The home must be maintained to a safe standard, carpets must be fitted correctly and not pose a trip hazard. To ensure that people live in a well maintained and safe home. 7 21 23 All communal bathroom/shower rooms must be in working order. 10/03/2010 10/03/2010 11/05/2010 11/03/2010 10/05/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that there are sufficient bathrooms for the number of people and they can have a bath/shower when they choose to. 8 26 23 The home must be free from 10/05/2010 offensive odour. To ensure that people live in a safe, clean and hygienic home. 9 27 18 The staffing hours must be 10/05/2010 reviewed and increased as the numbers of people living in the home increases. To ensure that there are sufficient staff on duty at all times, and in particular for busy periods. 10 28 19 Staff must only be employed 10/05/2010 using a POVA 1st check in exceptional circumstances and not as a matter of course. To ensure that people live in the home are supported by staff who have been recruited safely. 11 30 18 An audit of the training is required to find out which essential training staff have not undertaken. 10/05/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the staff group are well trained and have the skills to deal with the people they support. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 9 A system should be introduced that would monitor the implementation of the care plan system. Medication that may deteriorate when opened should have the date of opening recorded onto it. To ensure that people receive medication safely. People who have special dietary needs should have these recorded and this be available to the catering staff. To ensure that they fully understand the range of dietary needs. The home should offer a smoking shelter to those who wish to smoke. This would ensure that people are not having to stand out in all weathers in order to have a cigarette. The home should review their fire risk assessment regarding locks on the front door and be able to demonstrate the safety of people living in the home is not compromised. To ensure that people live in a safe environment. 50 of care staff should achieve NVQ level 2 or above. To ensure that staff are well trained and knowledgeable about the people they offer support to. The quality assurance system should include the views of all people, including GPs and staff, the shortfalls identified and a written report prepared at the end of the yearly cycle. To ensure that the views of all stakeholders are sought and acted upon that would mean the quality of the service is monitored. 3 15 4 19 5 23 6 28 7 33 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 36 Staff should receive supervision a minimum of six times per year. To ensure that people living in the home receive support from staff who are monitored and supervised. Written recording about people living in the home must be factual, impartial and professional. 9 37 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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