CARE HOMES FOR OLDER PEOPLE
Airedale Nursing Home 44 Park Avenue Bedford MK40 2NF Lead Inspector
Sally Snelson Unannounced 8th June 2005 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 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 I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Airedale Nursing Home Address 44 Park Avenue Bedford MK40 2NF Telephone number Fax number Email 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 Airedale Nursing Home Jean Nicholls Care Home with Nursing 35 Category(ies) of PD(E) Physical Disability over 65 - 35 registration, with number OP Old Age - 35 of places MD(E) Mental disorder over 65 - 4 DE(E) Dementia over 65 - 35 Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Specialist Nursing Care my be provided for a service user who Hs mental health problems and a physical disability as long as there are no more than 4 service users with a mental disorder at any one time. No more than 4 service users between the age of 40 and 65 years can be accommodated.. Date of last inspection 11.01.05 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 I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of Airedale took place between 10.00am and 14.30 hrs on 8th June 2005. The main focus of this short inspection was to review the progress of the requirements made as part of the last inspection and to discuss future plans for the home with the owner and the manager. During the inspection the inspector sampled care files, spoke to service users, visitors and staff and observed care practices. What the service does well:
Airedale is well maintained, clean, tidy and free from any unpleasant smells. The owners ensure that the home is well decorated and individualised. Each of the service users bedrooms is furnished with co-ordinating bed linen and curtains. Service users can bring from home, small pieces of furniture or ornaments, to personalise their bedrooms. The inspector met a number of visitors all who praised the care that their relative or friend was receiving at Airedale. Staff greeted visitors and it was apparent that they would be able to discuss any concerns or problems with the staff. One visitor spoken to visited the home at least three times a week and stayed for the majority of the day. She said that she frequently had her lunch at the home and that the food was very good and always hot. She said, ‘In many ways I wish I could live here as well but at the moment I can still manage at home. I will be coming in here when I cant manage’ Airedale had a core group of staff that had worked at the home for a number of years. Nurses from abroad, that were going through or had been through a training programme were supported by the manager and other trained staff. The manager expected very high standards before she would pass a trainee. The home had introduced a system for documenting care that was very efficient. It ensured that all the care needs of the service users were documented and that staff were aware of what was expected of them in order to provide good care.
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 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 I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 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 standard(s) 2,3,4,and 6 Service users are assessed prior to admission to ensure that the qualifications and experiences of the staff team can met their needs. EVIDENCE: The care file tracked indicated that the manager had assessed the service user prior to admission. The manager confirmed that the needs of the service user and the qualification and experience of the staff had been considered when making the decision whether Airedale could meet the needs of the service user. This was supported by the comprehensive pre-admission assessments seen in the care files. Since the last inspection a social worker had contacted the inspector with concerns that the home was experiencing some difficulties meeting all the assessed needs of one of the service users. There was documented evidence that the manager and the social worker had tried to make alternative arrangements but were unable to identify a more suitable placement. It was agreed that the placement was in the service user’s best interest because he was happy and settled. A new service user commented that she did not look around the home, but her son had done so on her behalf. She said he came back to me and said ‘trust
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 9 me, they will look after you’. She went on to say that he always got things right and therefore she knew that she would settle in Airedale Nursing Home. Contracts had been reviewed in the past and updated to ensure that they included all the necessary information. Contracts were stored in files that were separate to the care plans, but retained within the same office. Airedale did not offer intermediate care. Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10 Clear and precise care planning ensured that all the care needs of the service users were met and that staff had all the necessary information to care for the service users. EVIDENCE: The home had a care planning system that ensured detailed health and social care was documented; the system was easy for staff to refer to. The care plans sampled had been reviewed monthly and updated as care needs changed. It was also apparent that service users and/or their relatives had read and agreed the care plan. All of the service users had been allocated a General Practitioner (G.P.). Because the home was in the centre of Bedford it was served by a number of G.P. practices and enabled many of the service users to retain their family G.P. when moving into Airedale. The home had a good relationship with visiting professionals including the MacMillan service, the tissue viability nurses and the community nurses who assessed all of the service users for the health funding they were entitled to. One of the service users spoke to the inspector about the ‘maggot therapy’ that had been suggested to heal a necrotic ulcer.
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 11 This was due to start in the near future and would require regular visits from a specialist nurse. Throughout the inspection it was noted that staff spoke politely to service users and would stop and speak whenever possible. Service users commented that they had told staff how they wished to be addressed and did not feel that their dignity was compromised at any time. A service user said that ‘the little nurses from abroad are particularly kind to me.’ Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 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 standard(s) 13,14,15 A varied menu enables service users to choose wholesome well-cooked food. The activities provided reflect the needs and interests of many of the service users. EVIDENCE: The inspector witnessed lunchtime. It was noted that the service users enjoyed their meal and that staff helped those who required it in a sensitive unhurried way. Some of the service users had their meal in the garden; some in their bedrooms and others remained in the lounge. As observed during previous visits none of the service users choose to use the dining room. The manager confirmed this was the service users choice and it was documented in their care plans. One of the carers had taken on the responsibility for organising activities for those that wished to take part. It was a hot day and the activity, a game of bingo, took place under a gazebo in the garden. The carer who had taken on this role had a lot of ideas for social activities. An occupational therapist visited the home weekly to encourage the service users to move to music. It was noted that visitors were welcomed into the home and spent time with other service users not just the person they had come to visit.
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 13 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 standard(s) EVIDENCE: These standards were not assessed as part of this inspection. Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 26 The size of the home and the décor gave the environment a ‘homely’ feel. A regular maintenance programme ensured that all areas of the home were fresh at all times. EVIDENCE: The home is in the centre of Bedford which means there is easy access for visitors from the town and from local villages. The building is maintained to a high quality. The home is clean and well decorated throughout. The home has a large lounge that opens onto an attractive sensory garden. In the garden were two gazebos; one was static and the other was in place for the summer months only. The gazebos allowed the garden to be used even when it was warm but wet, or, when it was necessary to be shaded from the sun. Adjacent to the main lounge was a quiet lounge; there was also a dining room. Over the last year the home had reduced the number of shared rooms and now has only four shared and 27 single rooms. All of the rooms were individually furnished with a number having en-suite facilities.
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 15 In the past a service users survey had suggested that the majority of the service users preferred, and felt more confident, using a shower rather than a bath. The management had therefore made some changes and the home now had nine showers and only one assisted bath. As part of the changes made during the last year the laundry had been moved to the second floor; this was working well and the laundry staff were more than satisfied with the facilities. Service users commented that their clothes were washed, ironed and returned to them promptly. Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The training history and needs of each individual member of staff is recorded. A skills gap analysis matrix of training needs assists in planning future training and ensures that the home has all the skills necessary to meet service users needs. EVIDENCE: The manager ensures that there is always sufficient suitably qualified staff on duty and that the home does not have to rely on agency staff. It was noted that for some periods during the inspection, a member of staff did not supervise service users sitting in the lounge. This may have been partly due to the number of the service users who choose to remain in their bedrooms and required support there and because the inspector spent time in the lounge talking to the service users. The home had a comprehensive training programme. The inspector was given information of individual staff training but did not see how a programme that ensured all mandatory training was updated was formulated. Recruitment policies and practices were not looked at as part of this inspection. Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 and 35 The manager had a clear vision for the home. This vision was shared with the staff team. EVIDENCE: Staff were enthusiastic about the support and the direction they received from the manager, Mrs Nichol. One member of staff commented, “she is strict but fair because she wants everything to be good”. The continuation of an effective review processes ensured that service users and their families were able to comment on the care that Airedale was providing. The inspector noted that the majority of the comments were positive and that many of the families reported being satisfied with the care plans they had seen in respect of their relative. Staff meetings took place regularly. A meeting was due to take place the evening of the inspection. The manager stated that she had noted some areas
Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 18 that staff needed to be reminded about, for example if a drink was spilt it was the duty if the nurse or carer to clean it up as it happened and not leave it for the cleaner. The staff meetings were followed by a shared meal with various members of staff taking it in turn to prepare food, often from their country of origin. Staff on duty stated that they were looking forward to the meeting. Staff at the home did not take total responsibility for any of the service users money. Small amounts of money for newspapers, hairdressing or other sundries could be held by the home on behalf of the service user. Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x 3 x x x Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 20 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 Regulation Requirement Timescale for action 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 20 Good Practice Recommendations The service users should be encouraged to take meals sitting at a table in the dining room.. . Airedale Nursing Home I51 S17660 Airedale V231891 080605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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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