Inspection on 28/06/07 for Ailsa House Residential Care Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ailsa House Residential Care Home 18/12/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Ailsa House Residential Care Home 64-66 Genesta Road Westcliff On Sea Essex SS0 8DB Lead Inspector Kathryn Moss Unannounced Inspection 28th June 2007 09:30 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 Ailsa House Residential Care Home DS0000069501.V344615.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. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ailsa House Residential Care Home Address 64-66 Genesta Road Westcliff On Sea Essex SS0 8DB 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) 01702 336473 Dr Ram Kishore Tandon Mrs Barbara Ellis Care Home 18 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (17) of places Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New registration – see details below. Brief Description of the Service: Ailsa House is an established private care home that has recently been sold to new owners; the new registered provider is Dr Ram Kishore Tandon. Previous staffing and care arrangements currently remain unchanged and the former deputy manager, Mrs Barbara Ellis, is now the registered manager for the home. Ailsa House provides personal care and accommodation for 18 older people. It caters for people with low to moderate dependency needs and although it does not routinely provide care for people suffering with dementia, it has one registered place for an existing person who has dementia. Ailsa House is a large traditional house, in keeping with other properties in the area, and is located in a residential area of Westcliff on Sea. It is close to public transport, sea front and local amenities. The home has twelve single bedrooms and three shared rooms situated on the ground and first floor, many with private en-suite facilities, and each with a call bell facility and a TV point. The home has a passenger shaft lift between the ground and first floor. Staff facilities and offices are on the second floor. The home is nicely decorated and has a homely atmosphere. There is a garden to the rear of the house with a separate patio area. Residents living at the home are able to access facilities in the local community and leisure interests are encouraged with support from staff and relatives. A conservatory built to the side of the property is used as a day care facility for up to ten clients. This is not a registered facility and is run separately to the home, although residents in the home can join in activities with the day care clients and day care clients are able to mingle with the residents when they are invited. The most recent inspection report was available in the entrance hall of the home, with copies of the homes Statement of Purpose and Service User Guide. The current fees for the home range between £379.47 and £493.50. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was carried out on the 28th June 2007 and lasted eight hours. The inspection included: • • • • • • Discussion with the manager and registered provider Inspection of communal areas and a sample of bedrooms and bathrooms Inspection of laundry facilities Inspection of a sample of records and policies Conversations with 2 staff and with 4 residents Feedback questionnaires from 8 residents and 10 relatives. This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. notifications from the home, complaints, internal monitoring reports, improvement plans, etc.). Some information submitted by the home prior to the recent change of registered provider (e.g. pre-inspection questionnaire, service user and relatives’ surveys) has also been referred to in the report because it remains relevant to the staffing and care management practices in the home. For this reason, issues outstanding from the last inspection of the home (carried out on the 1.8.06) were also reviewed on this visit and have been referred to in the report. Outcomes relating to 25 Standards were inspected: there were 4 requirements resulting from this inspection, and 9 good practice recommendations have been made. The manager, registered provider and staff were welcoming, helpful and constructive throughout the inspection. The home provides a consistent level of care and support, with positive feedback from residents and relatives. What the service does well: Ailsa House has a small but stable and dedicated staff team, who provide good levels of care. Good levels of staff training ensure that staff have the knowledge and skills to do their job: all residents consulted felt that they received the care and support they needed, and were positive about the care staff. Comments received as part of feedback from residents and visitors included: ‘the staff are very caring and helpful’, ‘we have only to ask for something and it gets done immediately’, and ‘I think the standards of care are excellent and the carers are wonderful with the residents’. Staff are commended on this. The home provides a good quality of life for residents. It provides a warm and homely environment, in a pleasant residential location close to the seafront. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 6 Many residents commended domestic staff for always keeping the home clean, and it is generally well maintained. Feedback from residents about meals and activities was very positive, and the use of part of the premises as a Day Centre enables residents to meet other people and to join in with some of the Day Centre activities. What has improved since the last inspection? What they could do better: Although the home provides good care, some issues relating to care plans and medication practices have affected the overall outcome judgement for Health and Personal Care practices in the home on this occasion. Care plans provide evidence that the home understands what support each person needs, and ensure that staff have clear guidance on how to meet each person’s individual needs. The home’s care plans do not contain sufficient detail of the action required by staff, and had not improved since the last inspection; they therefore need development. Although previous requirements relating to medication administration practices had been addressed, some aspects of medication practices still remained unsatisfactory and require further action. Medication practices need to be well maintained, as poor practice in this area can potentially put residents’ health and welfare at risk. Rigorous recruitment practices are essential for the safety and protection of residents, and the home’s recruitment records did not provide sufficient evidence to demonstrate that all the required checks had been carried out on staff before they started work. This needs to be addressed with some urgency, as similar issues were identified at the last inspection. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 7 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. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 8 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 Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 9 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): 1, 3 and 4 People who use 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. The home’s admission processes ensure that residents can be confidant that the home can meet their needs. EVIDENCE: Ailsa House was recently registered to new owners, and a revised Statement of Purpose was submitted as part of that registration. A copy of the home’s Service User Guide (i.e. information about the home) was seen in the office, and had been updated to reflect the new manager and new ownership. A copy was available in the hallway of the home, and it was good to also see a copy in each person’s bedroom. All eight residents who completed feedback questionnaires as part of this inspection felt that they had received enough information about the home to decide if it was the right place for them; several also said that they had been able to visit the home before moving in. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 10 All eight confirmed that they had a contract relating to their residence in the home. Prior to the inspection, the home had submitted evidence that they had revised their Pre-Admission Assessment form, which now demonstrates that they assess all relevant needs and issues before offering a prospective resident a place in the home. A completed copy of this form was seen on one resident’s file. The manager confirmed that the home takes referrals from private individuals and also from social services, and always completes their own assessment before deciding whether they can meet a person’s needs. Evidence was submitted of a letter the home now sends out confirming that they feel they can meet someone’s needs and can offer them a place in the home. The manager showed good understanding of the needs of people living in the home, and staff receive training appropriate to the range of needs that the home aims to meet. Residents completing feedback questionnaires all felt that they received the care and support they needed, and relatives were all satisfied with the overall care provided. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 11 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 People who use 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. Residents’ health care needs are well met within the home. However, resident’s welfare is not adequately safeguarded and supported by the home’s care and medication records. EVIDENCE: From observations during the inspection, and from feedback received from residents and relatives, Ailsa House provides a good standard of personal and healthcare support to people living in the home. One relative commented on the way the staff had looked after a resident when they were unwell, saying that ‘the care and attention they gave them day and night was excellent’. Records describing and evidencing the care provided had not changed since the last inspection. Care documentation was largely on pre-printed formats, Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 12 including an ‘Assessment and Care Plan’ form that covered most areas of need (including social and religious needs), but had very little space to record the action required by staff to assist the person. In the care plans inspected, one person’s needs had changed significantly since the care plan was developed: although some amendments had been made, the form lacked space to adequately describe their new needs. For example, their skin integrity still showed as ‘good’ although they were now at quite high risk of developing pressure areas. The pressure area care being provided by staff was not detailed in the care plan, although some information was included in a risk assessment. The manager confirmed that the improvements to care plans required of the home at the last inspection had not yet been implemented, but was able to demonstrate that new formats were being considered. She was encouraged to ensure that care plans are person-centred (individualised) and contain sufficient detail as to how staff should meet each individual need. Records also included handling assessments and a risk assessment form that covered a range of risks (e.g. falls, transfers, pressure sores, etc.). This form did not enable a sufficiently detailed assessment of each risk (e.g. for risk of pressure areas), although it contained some useful information on the action being taken to minimise risks. The home is encouraged to develop more detailed risk assessments for key health and care issues (e.g. nutrition, risk of pressure areas, continence, etc.). The home was observed to be providing appropriate care to a person who was at risk of developing pressure areas, with pressure relief equipment in place (e.g. mattress and cushion). Daily notes were recorded on each shift and provided clear and relevant information on people’s well being. The home also kept a record of contact with healthcare professionals (e.g. GP, District Nurse, optician, etc.), and residents consulted felt that they received the medical support they needed. Staff reported that they found local GPs supportive, and that district nurses visited the home when needed. Continence promotion was not specifically discussed on this inspection. Four residents were spoken to during the inspection, and all were very positive about staff, finding them kind and courteous, gentle and polite. They were happy with the way staff provided their care, and staff were observed to treat people respectfully. Shared bedrooms did not contain privacy curtains, except around the wash basins: the manager stated that after the last inspection they had offered a privacy curtain to residents in shared rooms, but none had wanted one; this was confirmed by two residents spoken to. It is recommended that privacy curtains be fitted in shared rooms next time rooms are refurbished, or if there is a change of occupants. The home’s medication administration policy was not specifically reviewed on this inspection. The home had safe medication storage facilities, but did not have a Controlled Drugs cabinet that meet the requirements of the relevant legislation. The manager stated that they rarely had any controlled drugs in Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 13 the home: although one person was prescribed Temazepam, the current pharmacist had advised the home that this did not need to be stored as a controlled drug. The manager was advised that as good practice Schedule 3 Controlled Drugs (e.g. Temazepam) should be stored and recorded as a controlled drug, and the home should obtain appropriate facilities for this. Other medication was appropriately stored; bottles of liquid medication were not dated on opening, and this is recommended. Medication Administration Records (MAR) were printed by pharmacist; where staff had recorded additional medication details onto the MAR these entries were clearly written, signed and dated. Medication received into the home was recorded on the MAR, but not supplies carried over from the previous month: staff reported that most unused medication is returned to the pharmacist at the end of each month, and the home had implemented a monthly audit form for each person that recorded any tablets left-over. However, current stocks of one medication checked during the inspection did not tally with the home’s records of medication received that month, medication administered, and medication carried over from a previous month recorded on the monthly audit form. The home must ensure that recording systems enable all tablets received by the home to be accounted for. The manager was advised that recording tablets carried over from previous months on the current MAR would provide a clearer audit trail. Records of medication administered were generally well maintained, although there was inconsistent practice in relation to recording some ‘as and when required’ medication, with some staff leaving blank spaces and others using codes to indicate when medication was not required. Since the last inspection the home had established a system for recording medication returned to the pharmacist at the end of each month. No residents were self-administering their own medication, apart from one person who was administering their own eye drops and an ointment. The manager stated that they had assessed that the person was able to manage this task appropriately, but there was no specific record or risk assessment regarding this. The manager reported that staff receive regular medication training through courses provided by the pharmacist, and through training provided by a qualified nurse. The manager has previously completed a distance-learning course in the Safe Handling of Medicines through a local college, and observes new staff carry out medication rounds before they do this on their own. There is not currently any evidence that an assessment of competence has been carried out, and this should be recorded. Although many of the medication issues identified at the last inspection had been addressed, the home needs to take further action to improve the consistency of medication recording practices. The new manager showed a clear understanding of the medication issues raised, and at the end of the inspection was already taking action to address some of these. This was good to see. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use 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. The home provides a good lifestyle that offers choice and meets peoples’ social and recreational needs. EVIDENCE: Residents spoken to during the inspection were happy with current routines in the home, were clear that that they could say what time they wanted to get up or go to bed, and felt able to spend their day how and where they liked. The home has two lounges, and the TV is usually only on in one of the lounges: people spoken to were happy with this, with those who chose to sit in the TV lounge being positive about being able to watch the programmes they wanted (seen watching the news and Wimbledon on the day of the inspection), whilst those in the other lounge said they preferred to listen to music. One person reported that ‘we do what we like; we have only to ask for something and it gets done immediately’. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 15 The home operates a Day Centre in part of the premises. Residents are able to join in with the activities of the Day Centre group, and the home’s care staff spend time with residents’ in the lounges: on the morning of the inspection staff were observed doing nail care and playing a ball game with residents. Two residents spoken to confirmed that there were activities they could join in with if they wished, were aware they could go into the day centre and play games if they wanted, and reported that there is regular outside entertainment that they can attend. Another person stated that they preferred watching TV, and had Sky TV installed in their bedroom. Care records viewed contained individual activities records showing any activities participated in each day: this provided a useful record of levels of engagement and interaction. Visitors can come and go when they wish, and those consulted reported that they felt welcomed in the home and could visit their relative in private. The home’s visitors’ book showed evidence of regular visitors at all times of day. A communion service is held in the home every two weeks, and a catholic priest visits one person. Three residents attend a local church on a Friday, and people from the church visit the home at various times of year (e.g. Christmas and Easter). Trips out of the home were not specifically discussed, although the manager reported that the Day Care minibus can be used by the home. Rooms viewed were well personalised, showing that people were able to bring their own possessions into the home. A Key Worker system was in place in the home, and each person’s bedroom contained a clear sign with the name and photo of their key worker: this was a good idea, and clearly helped people to remember who their key worker was. The manager stated that the home has access to a local advocacy service, and one person currently receives support from an independent advocate to continue to manage their finances. All eight residents who completed feedback questionnaires said that they ‘always’ or ‘usually’ liked the meals at the home. Those spoken to during the inspection were positive about the meals, thought the cook was a good cook, and said there was variety and choice. They reported that menus were periodically changed, and that they are asked what they want and felt that suggestions got acted on. The minutes of a recent Residents’ Meeting showed that two people had asked for kippers at teatime, and the manager confirmed that this was being arranged. Menus showed good range of meals, with choices at each meal. The home’s dining room provided a pleasant environment for meals: tables were laid with tablecloths, and laminated menus were on each table. It was good to see a bowl of fruit in the dining room, and to observe residents helping themselves to this; residents spoken to confirmed this is filled up daily. The main meal looked and smelt appetising. Where residents needed support with eating this was being given: it was noted that a carer was standing beside someone to provide assistance, and the manager was advised to ensure that staff sit down alongside people when providing assistance. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 16 One resident commented on the short time gap between meals, with breakfast starting at 8am, lunch at 12pm and teatime at 4pm. Although residents confirmed that snacks are available in the evenings if they want them, this did mean there was a long gap between teatime and breakfast the next day. This was discussed with the manager, and it was recommended that residents be consulted on this, and meal times reviewed if necessary. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use 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. Practices in the home ensure that residents feel safe and are confidant that any concerns will be taken seriously. EVIDENCE: Details of the home’s Complaints’ procedure is included in the Service User Guide, and a copy is displayed in the home. The manager stated that the home has a complaints record book, but could not find this at the time of the inspection; she stated that this had not been used for sometime, as they had had no complaints for several years. What constitutes a complaint was discussed with the manager, who is encouraged to record all complaints, even those that might be considered more minor ‘concerns’ that are dealt with on a day-to-day basis. Residents spoken to during the inspection all felt able to raise any concerns and were confident these would be dealt with. All four people spoken to felt able to speak to the manager, and said they found her approachable and supportive. One person had been living in the home for many years, and stated that on the couple of occasions when they had raised concerns these had been dealt with to their satisfaction. Relatives who completed feedback questionnaires said that they were aware of the home’s complaints’ procedure; Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 18 residents’ feedback questionnaires confirmed that they all knew how to make a complaint. The manager was observed to appropriately deal with a concern voiced by a resident during the inspection, listening sympathetically and showing sensitivity in the approach they took to address this. The home has a variety of policies and procedures relating to the Protection of Vulnerable Adults (POVA), which include information on Whistle Blowing and the procedure the home would follow in the event of a suspicion or allegation of abuse (including referral to social services and police). A previous incident in the home was discussed with the manager, who showed appropriate understanding of the referral and investigation processes the home should follow to protect residents. The manager reported that most staff had completed POVA training within the last couple of years, through attending external workshops. Only a few staff had not done this training, but these staff had completed an induction that covered the Common Induction Standards (which include POVA). A carer spoken to confirmed this, and showed an understanding of what to do if they had any concerns (e.g. re reporting concerns to the manager), and an awareness of the concept of ‘institutional abuse’. The manager confirmed that the home has a DVD training pack that can be used to update staff; it was recommended that POVA training be regularly updated. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 People who use 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. Residents’ benefit from a well-maintained, comfortable, clean and hygienic environment. EVIDENCE: Ailsa House has two lounges and a separate dining room, and residents are accommodated in twelve single rooms (seven with ensuite toilets) and three double rooms (one with ensuite). The home’s dining room leads into a ‘conservatory’ lounge/diner that is used for the Day Care. The home has a small, secluded garden to rear, with an area of grass and a patio area with seating; at the front of the home there were attractive planted flower borders. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 20 The home’s two lounges were homely and comfortable, well lit, and with views out to the front of the home. A sample of bedrooms viewed were all in a reasonable state of decoration, and were clean and tidy. Some rooms were well personalised, and it was good to see that people were able to bring a wide range of personal possessions into the home, including furniture and music and TV equipment. Double rooms had some space constraints and did not offer much individual space, but contained sufficient furniture for people’s needs. Furniture and furnishings were sound but some were becoming worn through age (e.g. marked wood, threadbare upholstery, etc.), and may benefit from replacing. The home has a range of bathing facilities, including assisted baths and shower facilities. On the day of the inspection the home was clean and tidy, with no apparent hazards or unpleasant odours. Residents who were spoken to or completed feedback questionnaires all reported that the home is always kept clean, and were very positive about the main housekeeper. The laundry contained appropriate facilities. The new owner stated that the home’s washing machine is due to be replaced with a machine that provides specific sluice and temperature settings to meet infection control standards; this is commendable. It was good to see that the home’s risk assessments covered the management of soiled linen, and referred to the use of red bags. There is no specific sluice sink in the home, but the laundry area contains a porcelain sink and a metal sink, and was equipped with soap and hand towels. The manager confirmed that only a few commodes are used in the home, and described appropriate arrangements for cleaning these. Staff attend infection control training as part of their standard core training. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use 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. Staffing levels and skills meet the needs of residents and ensure they are in safe hands. However, records failed to adequately demonstrate that residents are protected by the home’s recruitment practices. EVIDENCE: Care staffing levels at Ailsa House are three staff throughout the day, and two staff on duty at night (one waking, one sleeping). A fourth carer is allocated each day to separately cover the Day Centre, so this does not affect the level of staff available to residents. At the time of this inspection there were eleven care staff employed at the home, and the manager confirmed that she also works in a care role when cover is needed. Residents consulted all felt there were generally sufficient staff on duty to meet their needs, and those spoken to said that they did not have to wait long when they called for assistance. The home has one dedicated cook, and a carer is allocated to provide the meals on the cooks’ days off; a housekeeper works Monday to Friday, and a carer provides some domestic support at weekends. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 22 The files of two staff were viewed for evidence of the home’s recruitment practices. Since the last inspection a new health declaration form had been introduced and was present on both files, which was good to see. The home had also introduced an employment checklist showing when key checks were carried out, enabling the home to monitor progress of applications. Both files contained completed application forms (with criminal declaration), photos and evidence of identification. It was noted that the home’s application form only requested five years’ employment history: this does not provide a full employment history. Additionally, the applicants had only given the start and finish year of their periods of employment, not the actual dates: this meant that it was not possible to ascertain whether there were any gaps in employment history, and there was no evidence that this had been checked. The manager was reminded that the Care Homes Regulations 2001 require that services obtain a full employment history on all applicants, and a written explanation of any gaps in employment history. This issue had also been raised on the last inspection. Both files contained two references including one from the last employer; a reference from an overseas referee had not been translated into English. In one file both references were dated several months prior to the applicant applying to the home, with an additional undated copy of one reference that the manager thought the referee had subsequently e-mailed to the home. The home often uses a recruitment agency to obtain staff, and the manager thought these references had been taken up by the agency when recruiting the carer. She was advised that references must be obtained at the time of recruitment to the service, and the home should not accept references previously obtained for other purposes. A similar issue was raised at the last inspection when the home was reminded that, when using agencies to recruit staff, the responsibility remains with the registered person to ensure that all information meets regulatory requirements. Files contained Criminal Records Bureau checks and POVAfirst checks: in both cases these were dated after the carer started work in the home. The new manager was aware that this issue had been raised at the last inspection, and was confidant that the home had been verbally notified of the outcome of each POVAfirst check prior to receiving the written confirmation and before staff started work; however no record of this had been made. The manager was advised that the home must provide clear evidence that all checks have been carried out before new staff start work. The new manager had not been directly involved in the recruitment of these staff: however, she showed good understanding of the various issues discussed and of the action required. The home has an induction programme that meets the Skills for Care standards (Common Induction Standards): an external trainer comes into the home to deliver and assess induction training, with staff completing a workbook covering the Common Induction Standards. The manager stated that all core training is updated annually (e.g. first aid, moving and handling, Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 23 fire safety, food hygiene, infection control): previously provided by external trainers, the new provider employs a trainer who will provide most of this training in future. A staff member who had been employed at the home for a few months confirmed that they had already completed induction training, moving and handling and fire safety training. Where English was not a person’s first language, it was good to see the home encouraging staff to develop their English language skills, and also providing them with appropriate support to ensure they benefited from training. Staff training records were well maintained, with certificates and individual training profiles kept on personal files, and a copy of each profile also kept in a central training file. Individual training profiles were typed and up-to-date, providing a clear record of the training subject, the trainer, and date: these showed a good range of relevant training regularly completed by staff. Eleven care staff are currently employed at the home. Six of these are foreign nationals who have nursing qualifications from their own country, and have completed the full Common Induction Standards when starting work in the home. Of the remaining five staff, two have completed NVQ level 2, and a further two hope to do this training. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 24 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 People who use 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. Residents’ benefit from the sound management of the home. Health and Safety practices in the home protect residents, and promote a safe environment. EVIDENCE: The home’s manager recently completed registration with the CSCI, and is currently undergoing training to achieve the Registered Manager’s Award (NVQ Level 4 in Management). She has experience of most areas of management within the home through her previous role as deputy manager at the home, where she has been employed for several years. Both staff and residents Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 25 spoken to were very positive about the manager, finding her approachable and supportive. The manager spends time around the home and is therefore able to monitor day-to-day practices and offer advice and support. Formal supervision processes were in place: the manager reported that they aim to carry out one-to-one supervisions every two months, and had a system in place to plan and arrange these supervisions. Individual supervision records were maintained, though not specifically inspected on this occasion. Two senior carers were due to carry out some of the supervisions; both manager and senior staff had recently completed a supervision training course, and reported that they had found this useful. Discussions with the new registered provider indicated that they also spent time in the home, were available to the manager for advice, and had positive ideas for the home’s future development. With regard to Quality Assurance processes, residents are asked for their views on the home informally on a daily basis and more formally through regular residents’ meetings and surveys of residents’ views. Residents spoken to felt they could raise suggestions and would be listened to. The home’s survey form had been revised since the last inspection, and has been used this year: residents who are unable to complete survey forms independently are generally assisted by the manager, and it was suggested that the home could explore whether someone more independent of the day-to-day running of the home could assist residents to complete quality assurance surveys. The manager confirmed that issues raised by residents’ surveys are addressed by the home, but no summary of the overall feedback and outcomes has been produced from previous surveys. The home is advised that a report should be produced on any review of care carried in the home, and made available to residents and to the CSCI. The home does not currently have any forms for seeking the views of other stakeholders (e.g. relatives, healthcare professionals involved with the home, etc.), and it is recommended this could be developed. The home does not have an annual development plan or formal auditing systems for monitoring practices in the home. However, a medication audit form had been introduced, and some practices were informally audited (e.g. care plan reviews, checks on residents’ monies, etc.). It is recommended that the home develop the home’s quality assurance processes further. The home has safe storage facilities for any residents’ monies looked after by the home. Only management staff have access to residents’ monies, which is kept in individual moneybags. Clear individual record sheets were maintained showing all transactions, with receipts kept. One person’s cash, receipts and records were checked, and balanced. The manager stated that all residents’ monies and records are checked weekly. The home’s health and safety policies were not reviewed on this occasion. As noted in the previous section, the home provides a good level of staff training, with core staff training updated annually and including training in relevant areas of health and safety. The home maintained a file of relevant risk assessments on safe working practices, which were well completed and Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 26 updated regularly. This included a fire risk assessment. No hazards were observed around the premises on the day of the inspection. Information submitted to the CSCI prior to the inspection showed that the equipment and utilities were appropriately maintained and serviced. The home carries out regular internal checks on fire alarms and emergency lighting, with records seen. Fire drills were carried out as part of annual fire training, with some additional drills with groups of staff. Records showed that only two drills had taken place in the last year, mainly as part of training: the new manager was advised to establish a system for ensuring that all staff attend periodic fire drills in addition to any training. Records of fire drills did not show the names of the staff attending, and this should be addressed The home maintained monthly checks on hot tap water temperatures to ensure they remained at a level that protected residents from risk of scalding. A sample of water was tested annually for Legionella, however the home did not have systems in place for ensuring that central hot water storage temperatures are maintained at over 60°C and should implement a way of checking this. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 27 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 3 X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 31/08/07 2 OP9 13 3 OP29 19 To ensure that residents receive the care they require, staff must have clear information on how to meet residents’ needs. Care plans must therefore contain sufficient detail of the action to be taken to meet each person’s health and welfare needs. This is a repeat requirement (last timescale 4.8.06). Medication storage, recording 31/07/07 and administration practices must protect residents. The home must therefore ensure that: 1. There are appropriate facilities for the storage of any controlled drugs; 2. Records of medication enable all stocks to be easily audited and accounted for; 3. There is evidence that a risk assessment has been completed for any person wishing to selfadminister their medication. 4. Bottles of liquid medication are dated when they are opened. To ensure the protection of 31/07/07 residents, the home must ensure that recruitment checks required DS0000069501.V344615.R01.S.doc Version 5.2 Ailsa House Residential Care Home Page 29 4 OP33 24 by Regulation are carried out before new staff start work. This particularly relates to ensuring a full employment history and written explanation of any gaps, obtaining current references, and evidence that a CRB or POVAfirst check has been obtained. This is a repeat requirement (last timescale 4.8.06). To demonstrate that the home ensures that it is run in the best interests of residents and responds to residents’ feedback, the home must produce a report on any review of the quality of care carried out in the home. 31/03/08 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 OP8 OP9 Good Practice Recommendations The home should ensure that the pressure area preventative care required by any individual is clearly detailed in their care plan. In relation to medication administration practices, it is strongly recommended that: 1. Medication carried over from a previous month be recorded on the MAR, to assist the ongoing audit of stocks 2. Staff follow consistent practice with regard to the recording of when PRN medication is not required; and 3. Training records include a clear assessment of staff competence to administer medication. It is recommended that the home seek the views and wishes of residents regarding current meal times. The home is encouraged to record all complaints, including concerns dealt with on a day-to-day basis. It is recommended that rooms be regularly audited, and any worn furniture or furnishings replaced. DS0000069501.V344615.R01.S.doc Version 5.2 Page 30 3 4 5 OP15 OP16 OP19 Ailsa House Residential Care Home 6 OP29 7 OP33 8 OP38 9 OP38 It is recommended that the home’s application form be revised, to request that applicants’ declare a full employment history. The home should ensure that an official translation is obtained for any references obtained in another language. The home should develop its quality assurance and monitoring processes (e.g. internal auditing processes, annual development plans, surveys of other stakeholders’ views, etc.). The manager should ensure that the frequency of fire drills enables all staff to attend drills that are not part of planned training, and should ensure that the names of the staff attending each fire drill are recorded. It is recommended that the home implement a system for regularly monitoring that central hot water storage temperatures are maintained at over 60°C, as part of the home’s processes for minimising risk of Legionella. Ailsa House Residential Care Home DS0000069501.V344615.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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