CARE HOMES FOR OLDER PEOPLE
Alandale 9 The Drove Whitfield Dover Kent CT16 3JB Lead Inspector
June Davies Key Unannounced Inspection 10th April 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 Alandale DS0000023343.V333823.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. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Alandale Address 9 The Drove Whitfield Dover Kent CT16 3JB 01304 824904 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) ALANDALERESIDENTIALHOME@NTLWORLD.COM Mr Paul Maple Mr Paul Maple Care Home 29 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (28) of places Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residential care for people with a learning disability is restricted to 1 person whose d.o.b is 20.10.1940. 8th November 2005 Date of last inspection Brief Description of the Service: Alandale, is a large extended detached property. Currently Registered to provide accommodation for twenty-nine Older people, the Home offers a pleasant and spacious environment to live in. Located in a semi-rural setting on the outskirts of the village of Whitfield, the Home is within 5minutes walk of the local pub and 10 minutes walk to the shops in the village, limited parking is provided outside the Home, although street parking is available on the main road. Access to rail transport, is some distance away, a bus service is available in the village. There are 25 single rooms, and 2 double rooms situated over two floors, access to all areas of the Home is provided by the use of a stair lift. Each bedroom has a private wash-hand basin and call bell, a cordless telephone is available to service users to make and receive calls in private. The owner/manager takes an active role in the day-to-day running of the Home, and employs a ‘care’ manager. In addition to care staff, the home employs ancillary staff, to provide cooking, cleaning, and maintenance duties. The Home has a range of communal areas available to its residents including a smokers’ lounge, dining area, and a choice of several large and small lounge areas, the Home also benefits from the addition of a conservatory. The Home has an enclosed well-maintained garden laid to lawn with a raised pond located to the rear of the Home. Fees £314.95 to 411.79 per week. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection took place over a period of 7 hours, the inspector has used evidence from pre-inspection questionnaire, documents held within Alandale, discussion with registered provider and acting manager, together with the views of many clients living in the home, and the staff. A tour of the home was also carried out by the inspector on the day of this visit. What the service does well:
Pre-admission assessments and care plans give good evidence to staff as to how they are able to meet the assessed care needs of the clients. The links with health care professionals is good, and evidence through care plans and discussion with clients showed that the acting manager and staff have developed good relationships with district nurses, and general practitioners. Medication is well administered in the home, and there was good evidence of clients being given the opportunity through risk assessment to manage their own medication. The clients in the home spoke well of the staff and confirmed that staff always respect their privacy and dignity. The activities on offer in the home are good, and together with a monthly outing all the clients said their was plenty to do. On the day of this key inspection good conversations were taking place in the communal lounges between clients. Visitors are welcome into the home at any time, and one visitor said ‘I am always made welcome.’ All clients are assisted by the staff to maintain their independence for as long as possible and the inspector witnessed good evidence of this within the home. All clients reported that the food in the home was good, they were given plenty of choice, and that all the food was fresh. The home has a reviewed complaints policy and procedure in place that gives clear guidelines as to how a complaint can be made. Policies and procedure for the protection of vulnerable adults are good, and many of the staff have received training in this area, with further training being booked for this year. The home is very well maintained, with good standards of decoration, furnishings and maintenance. The whole home is domestic in character, and has a welcoming atmosphere. The standard of cleanliness and hygiene in the home is excellent. Staffing levels are good and staff are offered good development and mandatory training. The recruitment practices are good and all staff are well vetted prior to starting work in the home. Both the registered provider and the acting manager, work hard to create a friendly home that is well managed. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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 Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Clients move into the home knowing their personal, physical and social care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three pre-admission assessments were viewed on the day of this inspection, all contained detailed information covering personal, health and social care needs, and contained sufficient information on which to base a care plan. The home does not offer intermediate care. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. Clients know that their personal and social needs are reflected in their individual plans and that potential risks are managed. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure client’s medication needs are met. Clients are addressed by their preferred names and staff respect all clients rights to privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were viewed and were found to be based on completed preadmission assessments. The information provided for each client care plan gives staff sufficient information as to the individual care required. There was evidence that clients are involved in the drawing up of their care plans, and where this was not feasible, relatives have signed on the client’s behalf. Each care plan showed evidence that reviews take place each month, and any changes are accurately recorded. Care plans did contain risk assessments,
Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 10 but while the risk was recognised there were no indication of steps that staff could take to reduce the risk. On daily records, it was noticed that were clients require personal hygiene care, this was not specific and just recorded as ‘all personal care given.’ The three care plans viewed showed that the home has good working relationships with all health care professionals, and any concerns regarding a clients health is reported immediately to their general practitioner. Evidence available in care plans good contact with district nurses, continence nurse, dentist, chiropodist and opticians. Medication is administered via the monthly monitored dosage system. A check on medication and MAR sheets was carried out on this visit. All MAR sheets had been properly completed, medication agreed with the amounts in the blister packs. There were good policies and procedures in place for the administration of medication and for self-medicating clients. All selfmedicating clients had been risk assessed and these risk assessments are reviewed on a monthly basis. The list of staff trained to administer medication was out of date and this was pointed out to the acting manager, who will attend to this immediately. One client has been prescribed a controlled drug and while this had been doubly signed on the MAR sheet, the home does not have a controlled drugs register, and the registered provider will ensure that this register is purchased within the next few days. All clients spoken to during this key inspection stated how well the staff respected their privacy and dignity. One client said ‘staff make sure that the door is shut when helping me with washing and dressing, and they always knock when my bedroom door is shut.’ Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clients are able to retain as much independence as possible. Clients themselves were able to say how the management of the home and the staff assisted them to remain as independent as possible. Evidence is available to show that the home offers a wide range of activities, and a mini bus is hired once a month to take clients for trips into the countryside or to visit places of interest. One client said, ‘there is always something to do.’ Another client who was not able to communicate showed the inspector some beautiful craftwork that they had done and this would not have been possible without the thoughtfulness of the staff in the home. The visiting policy and procedure states that clients can have visitors at any time and there were no restrictions on visiting the home. Clients are able to entertain their visitors in the privacy of their own bedrooms or in a communal lounge, as they choose. Clients themselves stated that they had frequent visitors, who were able to visit at any time. One clients said, ‘I am able to entertain my son in the privacy of my own bedroom, when he visits.’ Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 12 Two clients are able to manage their own financial affairs, while other clients have chosen a relative or representative to manage their financial affairs for them. There is a leaflet pinned to the notice board in the main entrance hall giving both clients and their relative’s information on how they could access advocacy services. Each client is able to bring small items of furniture, ornaments and pictures into the home with them. Once client had been able to bring her small dog into the home with her, and this has proved to be very beneficial to other clients in the home. A copy of four weeks menus were sent with the pre-inspection questionnaire, and these menus showed that clients were offered a varied and nutritious diet. On the day of the visit the cook confirmed that all fruit, vegetables, meat and fish are purchased fresh. Clients are offered a wide choice for breakfast, lunch, high tea and supper, with hot or cold drinks being available throughout the day. The cook is able to cater for specialised diets, but only caters for diabetic diets at the present time. None of the clients require liquidised diets. One client said, ‘the food here is very good it is all so fresh and nicely presented, much better than the previous home I was in.’ All clients said they liked the food in the home. The inspector noted that all the dining tables looked very attractive with white table linen, napkins, place mats and small vases of flower on each table. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Clients know that any concerns or complaints they have will be listened to and acted upon. Staff have a good knowledge and understanding of adult protection issues, which protects the clients from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure is comprehensive, and gave clear information on how a complaint should be made and the response time in dealing with the complaint. No complaints had been made since the last inspection. Discussion with the manager showed that she is quite clear as to how a complaint should be recorded, investigated and responded to. Two clients stated, ‘yes I would know how to make a complaint if I needed to, I would know who to make the complaint to.’ The policies and procedures for the prevention of abuse and whistle blowing were seen and have been reviewed. Staff spoken to said ‘they would be able to raise any concerns regarding abuse with management. A recommendation made at a previous inspection regarding implementing behaviour management guidelines for clients had been adhered to and there was a comprehensive guideline in place for staff to observe. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. The standard of the environment within the home is excellent providing clients with an attractive, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a homely atmosphere and there is an excellent standard of cleanliness throughout. All areas of the home were very well decorated and furnished. At the present time the registered provider is in the process of having an extension build on to the home, and this has caused minimal inconvenience to the clients in the home, there has been no invasion to the present building until the last stages of the extension. This extension will provide a further four bedrooms with en suite facilities and a larger sun lounge, which will lead onto an enclosed courtyard, with built up fish pond. This extension will also provide the home with a shaft lift. The registered provider has an ongoing programme of maintenance, redecoration and renewal. A
Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 15 maintenance person is employed to carry out day-to-day repairs. The inspector noted during a tour of the building that all communal bathrooms are domestic in character and while providing the necessary moving and handling equipment, and being spotlessly clean were not institutionalised. Throughout the home there was evidence of good risk assessments, which provided a safe environment for the clients. Letters were available from the Environmental Health Officer to show that the home complies with environmental health requirements and a recent letter from the Fire Safety Officer, stating he was happy with the registered providers fire risk assessment of the home. One visitor commented, ‘this is a lovely home which is well maintained and provides a lovely environment for the clients who live here’. Several of the residents spoken to said, ‘we love living here, the home is so comfortable.’ The home is spotlessly clean with no offensive odours. A domestic on duty on the day of this inspection said, ‘I like the home to be clean and nice for the clients.’ The laundry is sited away from the kitchen area. The laundry floor is tiled. Two industrial washing machines have the appropriate sluicing and disinfecting programmes. The home has policies and procedures and contracts in place for dealing with clinical waste. All staff are provided with disposable gloves and plastic aprons, and these were evident throughout the building. There were several areas throughout the home where care staff could wash their hands and these facilities were provided with liquid soap and paper hand towels. Alandale DS0000023343.V333823.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. There is a good provision of staff on duty at all times to meet the assessed needs both physical and social for the clients in the home. The home is working towards ensure that staff have a NVQ qualification to enable them to have a greater understanding of the needs of older people Recruitment practices in the home are good, with all staff being appropriately vetted to ensure that clients are not placed at risk. Induction of new staff is improving to ensure that staff have a clear understanding of their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four weeks rotas were sent with the pre-inspection questionnaire. Rotas showed that there is sufficient staff on duty throughout the day to meet the assessed needs of the clients. Staff spoken to on the day of the key inspection verified this. The cook verified that she also carries out care duties, but confirmed that she now has two uniforms one for cooking and one for caring, and this was also observed later in the day, when the cook took over care duties in a different uniform. Clients themselves stated that there are, always plenty of staff on duty to meet their needs. Two clients said, ‘in the afternoon staff have time to sit and talk with us.’ Another client said, ‘they always respond to my call bell, I never had to wait long.’
Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 17 Out of nineteen care staff five staff have a NVQ qualification, and a further six staff are in the process of gaining their NVQ. The inspector viewed three personnel files; all files contained an application form, two forms of identification, CRB check and a statement of terms and conditions of employment. All files had a checklist at the front, and this confirmed that new staff are given a GSCC code of conduct booklet at the start of their employment. The inspector did note that the application form did not request a full employment history and this was discussed with the acting manager who will ensure that the application form is reviewed to ensure that all future staff give a full employment history. All staff receive induction training, but this needs to be reviewed to ensure that large chunks of the induction are not signed off on the same day. Through discussion with the registered provider a new induction programme has been introduced for new staff, and in future management will ensure that staff complete one unit before moving on to the next unit. This new induction programme is in line with the Skills for Care induction package. Both staff personnel files and the training matrix show that staff have completed all health and safety mandatory training, together with other mandatory and job related training. Staff confirmed that they have all the training they require. At the present time further adult protection training is being booked. Alandale DS0000023343.V333823.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The registered provider and acting manager have a clear development plan and vision for the home, but this still needs to be developed and communicated to the clients. Records relating to the safekeeping of valuables and expenditures made on clients behalf is well maintained, and clients know that monies and valuables are safe. While generally health and safety in the home is good, an improvement does need to be made to make sure that clients are safe at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has gained her NVQ level 4 and RMA and is in the process of applying to be registered manager of Alandale. Over the past few years she has updated her skills by undertaking periodic training. There are clear
Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 19 lines of accountability within the home, and the acting manager works closely with the registered provider, to make sure the home runs smoothly and meets the needs and choices of the clients. Staff reported that they are able to approach management in the home with issues that concern them, and that the home is openly managed. Through discussion with the registered provider and the acting manager is was clear that both are aware of the improvements that need to be made, and both are doing a good job in prioritising these improvements to make sure that the clients have a high standard of care. While some systems are in place for quality assurance, further checks need to be developed to gain the views of stakeholders, to make sure that a complete health and safety check of the building is carried out at regular intervals, and that regular monitoring of systems used in the home is carried out and recorded. All meetings should be minuted and recorded. The acting manager does not hold personal allowances for clients. The home does make purchases on the clients’ behalf, receipts are kept expenditure is recorded in each individuals account book and the clients or their relatives are billed at the end of each month for expenditure made. Some clients do request the acting manager looks after their valuables and small amount of money, and this was seen by the inspector to be appropriately recorded for each client, and that these valuables and monies are securely locked away. Health and Safety systems in the home are good with the majority of staff have completed all aspects of health and safety training, and regularly reviewed health and safety policies and procedures in place. The inspector viewed up to date maintenance certificates for all appliances used in the home. The inspector did note that while making a tour of the building that none of the wheelchairs had foot rests in place and a requirement has been made for this to be remedied, to prevent an accident to any of the clients using the wheelchairs. The EHO accident book showed clear reporting of all accidents in the home. Alandale DS0000023343.V333823.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 4 13 3 14 3 15 4 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 3 X 3 Alandale DS0000023343.V333823.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 OP33 Regulation 24(1)(a) (b), (2)(3) Requirement A full quality assurance system needs to be implemented to make sure views of stakeholders, health and safety check of the internal rooms and external area of the home is made at regular intervals, and that monitoring of systems used in the home are recorded. All wheelchairs must have footrests in place at all times, to minimise the risk of accident to clients using the wheelchairs. Timescale for action 23/07/07 2. OP38 23(4)(5) Sched. 4 (12)(d)(e) (14)(15) 18/06/07 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. Refer to Standard OP7 Good Practice Recommendations Risk assessments should have clear steps that staff can take to reduce the level of risk to the clients. Where personal care is given, this must be explicit, and to
DS0000023343.V333823.R01.S.doc Version 5.2 Page 22 Alandale record ‘all personal care given’ is not helpful or adequate. 2. OP29 Application forms need to be reviewed to ensure that all new applicants give a full employment history, and any gaps are fully explored and reasons recorded. Induction programmes should not be signed off en block, and staff should complete one unit at a time. 3. OP30 Alandale DS0000023343.V333823.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
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