CARE HOMES FOR OLDER PEOPLE
Airedale Nursing Home 44 Park Avenue Bedford Bedfordshire MK40 2NF Lead Inspector
Sally Snelson Unannounced Inspection 5th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 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.V267354.R01.S.doc Version 5.0 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 The Airedale Nursing Home Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (35), Physical disability over 65 years of age (35) Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Specialist Nursing Care (this may include persons with a Mental illness, who may also have a physical disability) 4 adults (40 -65 years) Date of last inspection 8th June 2005 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. The 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. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Airedale was unannounced and took place on 5th December 2005 from 10.00am. The manager, Mrs Nicholls was present throughout the majority of the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the services provided. The process considers the home’s capacity to meet regulatory requirements and minimum standards of practice. This inspection was the second of year and focused on the core standards not inspected as part of the last inspection and any progress towards the recommendations made at that inspection. Therefore this report should be read in conjunction with that of 8th June 2005. What the service does well:
The home had a welcoming and friendly atmosphere The majority of the staff team had worked at the home for sometime and were well acquainted with individual service user’s needs and the home’s operational systems. The home provides a good standard of care to service users based on comprehensive pre-admission assessments and regular reviews. Service users or their families are encouraged to visit the home before admission. A comprehensive service user guide ensures that they have sufficient information to make an informed choice. Staff treat service users with respect and all attempts are made to maintain their privacy and dignity. The relationship between staff and service users is relaxed and warm. The home provides a bright and comfortable living environment with individually decorated bedrooms. The home is well-managed and service users have confidence in the way the home is managed. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 6 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 7 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.V267354.R01.S.doc Version 5.0 Page 8 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): 3,5,6. A thorough pre-admission assessment ensured that only those service users, whose needs could be met by the staff team, would be admitted to Airedale. EVIDENCE: Service users files and documentation confirmed that prior to admission to the home a nurse, often the manager, would visit the service user. The manager reported that pre-admission assessments frequently happened in the hospital and on occasions it had been difficult collecting the necessary information. The manager was also aware of the need to ensure that the necessary equipment to care for the needs of the service users was in place in the home before the admission could take place. It was noted that service users with a primary diagnosis of a terminal illness were assessed and admitted to the home without this being a category of registration. The manager believed that this had been agreed with the previous registration authority and therefore the certificate will be amended with the manager’s agreement. However it is the registered persons
Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 9 responsibility to ensure that the certificate accurately reflects the conditions of the service users in the home. Service users spoken to had some information about the home before they moved in as a representative on their behalf had made a visit. Airedale did not offer intermediate care at the time of the inspection. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 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): 9 The safe storage and administration of medication ensured that service users were receiving medication correctly. EVIDENCE: During the inspection a medication round was in progress. Two staff were administering the medication as a nurse was supervising a student, undergoing adaptation training to convert her nursing qualification from her country of origin to that of this country. It was noted that the nurse acting as the mentor reminded her student to lock the trolley when it was unattended. Observation of the medication and the medication records confirmed that none of the service users were self-medicating. Medication was ordered, received into the home, and administered correctly. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 11 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 Service users were satisfied with the variety of activities in the home. EVIDENCE: At the start of the inspection there were few service users using the communal areas. Staff reported that was because the hairdresser was due to visit. When the hairdresser arrived she had a list of those service users who liked to have their hair done regularly and checked with them individually if they felt up to having it done that day. A number of the service users expressed their appreciation of this service and the way they felt after having their hair done. During a tour of the home it was apparent that a number of the service users had suffered with a chesty cold and were staying in their bedrooms because of it. One of the service users who had a visitor with young children was using the smaller lounge in which to entertain them. Service users spoke about the plans for Christmas and were looking forward to the seasonal entertainment. One service users told the inspector that she was happy to remain in her room unless there was a game of bingo. Although there was not a busy activity programme service users reported being happy with what was provided. Staff were helping service users individually with activities such as writing cards, reading letters or doing crosswords.
Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 12 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 Appropriate arrangements were in place to enable service users or their representatives to complain. The adult protection policy and the associated staff training would enable the home to deal with adult protection issues should they arise. EVIDENCE: The manager informed the inspector that no complaints had been received by the home over the last year. Following discussion it was apparent that only some minor concerns had been received by the home. These had not been recorded as they had not been considered complaints at the time and they had been dealt with immediately. The home’s complaints policy was inspected and found to meet the national minimum standards. Interviews with service users revealed that they currently had no complaints however they were confident that if they did they would approach management. One of the qualified nurses had trained as a trainer and was responsible for ensuring that all the staff had the relevant Protection Of Vulnerable Adults (POVA) training. She explained that the POVA training was part of the staff induction and also an on-going training for all the staff. The POVA policy was available for all staff in the office on the ground floor. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 13 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): EVIDENCE: These standards were not inspected as part of this inspection. Staff stated that since the last inspection they had tried to encourage the use of the dining room at mealtimes. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 14 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): 29 Robust recruitment procedures ensured that suitable staff were employed which protected the service users. EVIDENCE: Two staff files were inspected. There was documentation on file confirming evidence of identification and eligibility to work. Criminal Record Bureau checks were available for staff and those employed most recently also had POVA checks. The files also contained photographs, two references with at least one from the last place of work. The office administrator confirmed that where staff had previously worked in a position involving children or vulnerable adults, written confirmation must be sought for their reason for leaving. The files were well kept and stored securely by the office administrator. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 15 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): 38 Service users have confidence in the manager and they way the home is run. The home took seriously all maintenance checks and ensured they were kept up-to-date. EVIDENCE: The premises were inspected by the fire service 16.11.05 and there were no identified problems. During the tour of the home and while inspecting files it was apparent that staff had attended all the mandatory health and safety training and kept themselves updated with video training followed by questionnaires. Electrical equipment was regularly checked and routine checks were made on the lifts, hoists etc. Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 16 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Airedale Nursing Home DS0000017660.V267354.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 12 Requirement The manager must ensure that the registration certificate reflects the categories of care provided to the service users accommodated. Timescale for action 01/01/06 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.V267354.R01.S.doc Version 5.0 Page 18 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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