CARE HOMES FOR OLDER PEOPLE
Airedale Nursing Home 44 Park Avenue Bedford Bedfordshire MK40 2NF Lead Inspector
Katrina Derbyshire Unannounced Inspection 31st August 2006 11:15 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 Airedale Nursing Home DS0000017660.V310154.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. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Airedale Nursing Home Address 44 Park Avenue Bedford Bedfordshire MK40 2NF 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) 01234 218571 01234 215097 airedalenursing@btconnect.com The Airedale Nursing Home Mrs. Jean Nichol Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35), Terminally ill (5), of places Terminally ill over 65 years of age (5) Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To limit the number of persons to be admitted under the category of terminal illness within the home. To limit the number of persons to be admitted in the age range between 45 and 65 years within the home in the category of PD. 5th December 2005 Date of last inspection Brief Description of the Service: Airedale is a care home offering nursing care situated in the centre of Bedford overlooking Bedford Park. The home has been slowly extended over a number of years and is currently registered for 35 older people with nursing needs four of whom can be between 40 and 65years of age with conditions similar to those already accommodated. Accommodation is provided in single and double rooms, all with wash hand basins; many of the rooms have en-suite toilets and some have en-suite showers. Care is provided at ground floor and first floor levels; stairs or one of the two lifts access the different levels. There are three separate communal rooms plus small reception areas, developed in the hall spaces throughout the home. The garden has been designed as a sensory garden and has full wheelchair access. The home is within walking distance of any bus that stops in Bedford town centre and is on the route of some local bus services. There is limited off-road parking and unrestricted parking on the road outside the home. The fees for this home vary from £600.00 per week, to £754.00 per week, depending on the funding source and assessed need of the resident. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 31st August 2006. The manager Mrs. Jean Nichol was present throughout the inspection. During the inspection all areas of the home were visited and the inspector spent time with many of the residents’ in the sitting areas of the home. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and relatives were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
The standard of cleanliness at this home is very good, all areas are nicely decorated and care and attention is paid to providing the residents with a homely environment to live in. One relative said, “ It is a pleasure to come into the home. It is always clean and maintained to the very highest standards inside and out”. The home is also very good at making sure that they keep up-to-date with changes in the way they should care for the residents known as ‘best practice’. One example of this is the use of the Malnutrition Universal Screening tool. In using this it makes sure residents receive not just a sufficient quantity of food and drink, but a diet that provides the necessary nutrients making sure that each resident receives the diet that they need to maintain a good level of health. Also when a resident or relative makes a complaint the home are good at looking into the concerns that have been raised, finding out what happened, changing things so it won’t happen again and letting the person who made the complaint know what they have done. Records of all concerns that have been made are kept at the home and these show that the home have always Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 6 responded to everyone, this means residents know that they will be listened to by the home and their views will be acted upon. Many of the residents and relatives also feel that the staff at the home are very helpful and kind, one said “ the staff are exceptional”. Residents feel comfortable asking for help when they need to, another resident said “ l do feel like this is my home and it’s the staff that have done that”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Airedale Nursing Home DS0000017660.V310154.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 Airedale Nursing Home DS0000017660.V310154.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of assessment of residents prior to their admission is good and ensures the home has sufficient information to make an informed decision on whether they are able to meet the needs of residents and provide the care and support that they require. EVIDENCE: Within the care records of residents evidence of pre admission/admission assessments was seen and gave sufficient information to describe the needs of the resident. The pro-forma in use detailed personal care, physical well-being, sight, hearing, communication, mental state, cognition, social interests and cultural needs. Intermediate care is not offered at the home. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care planning provides sufficient guidance to staff so that they have all the required information to ensure residents receive continuity of care relating to their healthcare needs. EVIDENCE: The care records seen showed documentary evidence of the involvement of residents in planning their care. Care plans were sufficient in detail and made clear the level of support to be provided by staff to meet the residents assessed needs. Staff through discussions demonstrated that they were aware of the care to be provided to residents, which reflected the entries contained within the care plans. Records showed that residents had access to medical services if required, appropriate aids were available and advice is sought from Healthcare specialists in the care of residents. There was evidence of nutritional screening prior to or after admission on each file, if a resident need a diabetic/specialist diet this is provide. The incidences
Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 11 of pressure sores and their treatment were appropriately maintained and documentary evidence of this was seen. All residents are registered with a General Practitioner and access to dental, chiropody and community health services had been accessed on behalf of the residents by the home. The receipt, recording, current storage and handling of medication are appropriately carried out. Controlled Drugs are administered by two appropriately trained staff and recorded in a Controlled Drugs Register. Observation of the personal support to residents by staff to be sensitive and respectful. It was noted that all staff knocked on resident’s doors before entering and used only a preferred form of address. Resident and relative comment cards received by the Commission for Social Care Inspection indicated that residents believed their privacy was respected and Relative/Visitor comment cards all indicated that they could meet their family member in private. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems and support to residents in maintaining personal relationships is good, and enhances the resident’s standard of life. EVIDENCE: Feedback from residents and relatives through comment cards showed that the home provided sufficient support to residents, in supporting them to maintain close relationships with family and friends. One relative said “ I visit everyday that is never a problem” another said of the support provided by the home “ Airedale is the best you could find”. Menus are displayed in the home and show that a varied diet is available that includes fruit and vegetables. Nutritional risk assessments are undertaken and information relating to these were seen in the care records of residents. Many of the residents when spoken to regarding the meals in the home said that they were satisfied with the meals at the home. Activities available in the home are advertised for the residents to see and included music, board games and trips out. A record of activities was seen.
Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 13 However the inclusion of resident’s social needs and how staff should support them needs to be made within the care records of residents. Residents confirmed they are able to bring personal possessions into the home and evidence of this was seen in residents’ rooms. Residents said that they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system in place with some evidence that resident’s feel that their views are listened to and acted upon. EVIDENCE: The homes complaints procedure gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of residents and that all complaints must be responded to. Within the homes statement of purpose a summary of how to complain had been included for residents and their relatives. Several residents confirmed that they knew how to complain and would not hesitate in doing so. A complaint received was noted to have been investigated and Social Services had been involved in this matter. The home had provided all information needed and had written evidence to support this. The home also had in place a policy for the protection of vulnerable adults; the local policy in this subject area was also in place. Reporting procedures were clear if an alleged incident of abuse was to be made and staff records showed evidence that they had been trained in this area. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Systems in place for hygiene and the control of infection in the home is good and ensures the environment is clean for the residents to live in. EVIDENCE: The grounds are attractive and well maintained and accessible to residents and their families. Documentary evidence was seen to show that at this time the home met all fire and environmental health requirements. Individual rooms of residents contained items, which assisted in the personalising of the rooms. The décor and furnishings and fittings were of a good standard, domestic and well maintained and the home was seen to be very clean and tidy throughout. The home was seen to be clean and free from offensive odours. Policies are in place regarding infection control and staff were seen to be using protective
Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 16 clothing. The home had a laundry area, with the walls and floor easily cleanable. Industrial washing machines and dryers are available. The disposal of clinical waste is through a contractual agreement. Hand washing facilities are sited in the areas where infected material/clinical waste is handled. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The training of staff in the care of residents is sufficient to ensure they have a satisfactory level of knowledge to provide care in accordance with current best practice guidance. EVIDENCE: Comments from residents on this inspection included that the staff were kind, competent and caring and that they felt there were sufficient numbers on duty to meet their needs. Relatives comments received in the main also reported that they felt there to be enough staff to provide care to the residents. Sample checks of staff files were undertaken to look at recruitment practices it was noted all files contained application forms, references and photographic evidence of identity. In addition evidence was seen that a criminal records bureau check had also been undertaken on all staff. Staff had undertaken a variety of training and through discussion they confirmed that the home had supported them in doing so. Training records were noted to be clear and information relating to this is within the homes statement of purpose. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems at this home for managing health and safety are good protecting the residents through reducing risks in this area. EVIDENCE: The Home Manager has many years experience, which is directly relevant to the role of manager in the home and in addition is a Registered General Nurse, and holds the Registered Managers award. Interaction observed between her and the residents and staff was supportive and caring. Staff informed the inspector that the Home Manager was very supportive to them and provided sufficient and effective management and leadership. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 19 The home had a Health and Safety policy. There was evidence within the training records that staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the residents care files. Records kept by the home include fire prevention and training, equipment checks, moving and handling risk assessment, food hygiene, infection control and COSHH. The home had undertaken a review in which they had sought the views of residents on the standard of care at the home. They now need to develop an action plan relating to the views received and demonstrate how they have used the information to influence the running of the home. The management of monies held on behalf of some residents showed that a robust system was in place that provided a clear audit trail. Balances seen were correct and receipts of all expenditure are maintained and available for inspection. Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 12, 13 & 15 Requirement A plan of care must be in place to make clear the individual social and cultural needs of the residents. The home must show how the views of residents influence the running of the home, and report on and make available this information to residents. Timescale for action 30/11/06 2. OP33 24 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Airedale Nursing Home DS0000017660.V310154.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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