Inspection on 15/11/07 for Albemarle

This inspection was carried out on 15th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Albemarle 19/07/06

Albemarle 20/03/06

Albemarle 29/09/05

Albemarle 02/11/04

Albemarle 25/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Albemarle 50 Kenilworth Road Leamington Spa Warwickshire CV32 6JW Lead Inspector Patricia Flanaghan Unannounced Inspection 15th November 2007 11:30 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 Albemarle DS0000004202.V354974.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. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Albemarle Address 50 Kenilworth Road Leamington Spa Warwickshire CV32 6JW 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) 01926 425629 01926 315627 The Albemarle Rest Home Limited Ms Sonia Penelope Meade Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (24) of places Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2006 Brief Description of the Service: Albemarle is a care home providing personal care and accommodation for 24 older people. The home is located in Leamington Spa, close to shops, pubs, the post office and other amenities. The home provides 24 single rooms, 20 of these are en-suite. Nine bedrooms are on the ground floor; seven of these have en-suite facilities. There are six bedrooms on the first floor, all have en-suite facilities and there are a further eight bedrooms on the mezzanine floor, six of these have en-suite facilities. All floors are accessible by use of a chairlift and stairs. The home has a large garden to the rear of the property, which is well maintained and easily accessible. There is ample parking at the front of the house. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place on Thursday 15 November 2007 between the hours of 11:30am and 6:00pm. To enable us complete the inspection process, we requested further information relating to staff recruitment, which was promptly forwarded to us. The registered manager was on duty along with four care assistants, the cook and a domestic. The registered provider was also available throughout most of the inspection. The manager advised that 24 people were living at Albemarle at the time of the visit. Three residents were ‘case tracked’, this involves finding out about the individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences. Looking at their care files, looking at their environment, and discussions with staff on duty. We also reviewed staff training records to ensure training is provided to meet peoples’ needs. The inspection process consisted of discussions with the registered provider, manager, staff and people who use the service. Records examined during this inspection included, complaints, care, staff recruitment, training, social activity records, staff duty rotas, and health and safety and medication records. Notification of incidents received by us from the Albemarle and any other information received were also considered as part of the inspection process. The inspection visit enabled the inspector to see people in their usual surroundings and see the interaction between staff and residents. Annual Quality Assurance Assessment (AQAA) documentation was sent to the Home for completion and information recorded in this document was reviewed during the inspection process. Seven residents and two by relatives completed feedback questionnaires. Comments made are included in the main body of this report. A complaint had been received by us, which was looked into at this visit. It was alleged that people were left unattended for long periods of time and staff morale was low. These issues were looked into and are detailed under the corresponding outcome areas. No regulations were found to have been breached. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 6 What the service does well: The atmosphere at Albemarle was relaxed and friendly, residents were at ease in their surroundings and in the company of staff. Fixtures and fittings are reasonably well maintained and furnishings give a homely feeling. Residents stated that they are happy at the home and gave positive feedback as follows: • • • “I am very happy here” “I live like I would in my own home” “The food is very good, you couldn’t ask for better” Staff commented that they work well as a team, have the equipment needed to be able to do their job and have regular training updates. Comments received from residents and relatives in completed questionnaires returned to us include: • • “Staff are always friendly, polite and there to help as necessary” The staff are very concerned that I am comfortable and that my needs are met.” What has improved since the last inspection? Most of the requirements identified at the last inspection have been addressed. The manager is aware of the action to take to address outstanding issues and work has started on these. A new conservatory has been built at the home providing more communal space for residents. Some areas of the home have been refurbished. The registered provider said that refurbishment is undertaken on an ‘as needed’ basis. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 7 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. Albemarle DS0000004202.V354974.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 Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People receive a full assessment identifying their needs and abilities. This ensures that the home can meet their needs and care can be planned before the resident moves in to Albemarle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A discussion was held with the manager regarding the pre-admission process. The manager or deputy undertake pre-admission assessments and find out as much information as possible from the potential resident or their relative. The manager confirmed that they would visit the person in their own homes or hospital to undertake the assessment if this was necessary. They encourage everyone to have a look around the home before they agree to move in. Information about the home is discussed and questions are asked about the Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 10 resident’s health and well being. The two care files seen, including that of a recently admitted resident contained pre-admission assessment documentation which demonstrated that sufficient information is gathered about the resident to ensure that the home would be able to meet their needs. One resident confirmed that she had visited the home with a relative and had all of the information she needed before any decision was made about moving in. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Each person has a plan of care and access to health care services so that their health and personal care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations during the key inspection visit found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. Garments were clean and well maintained. Three people were identified for ‘case tracking’. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 12 Each person had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment and was developed as staff got to know the individual’s strengths and limitations. Care plans were available for the identified needs of each person and supplied staff with the information needed to make sure the person’s needs were met safely and appropriately. Evidence was available to confirm that people living in the home have access to other health professionals such as GP, district nurse, dentist, community psychiatric nurse and optician. We received a complaint, which alleged that staff often left residents unattended for long periods of time. We discussed this with the management, staff and residents. We found that no regulations have been breached. Comments received from residents and staff include: • • “Albemarle provides the level of care that my relative requires.” “The staff are very concerned that I am comfortable and that my needs are met.” The systems for the management of medicines in the home were examined. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in a locked trolley that is kept in a locked room dedicated to medicine storage. Audits of the medicines of two people were correct indicating that medicines had been administered as prescribed. The home does not store excess medication. Arrangements are in place with the pharmacy to safely collect and dispose of medicines that are no longer required. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. People were not left unsupervised for any length of time; this increases the opportunities for residents to interact with staff and for staff to respond to the Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 13 psychological needs of people who become agitated or distressed. For example, one person was observed to become distressed and anxious, a staff member immediately responded and gave gentle reassurance to relieve the person’s anxiety. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests, which enhances their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with said social activities are undertaken in the home. On arrival at the home we saw people enjoying armchair aerobics provided by an outside entertainer. Care staff also provide the social activities as part of their shift. The home maintains files containing details of who has participated with activities and if they enjoyed them. This assists the home in monitoring if peoples personal preferences are being met. A resident commented: • “There is plenty to do if you want, there is a really nice atmosphere, everyone gets on well” Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 15 On the day of the inspection some people said that they enjoyed watching television and reading books and newspapers rather than participating in organised activities. Residents were observed ‘coming and going’ throughout the day, choosing how and where to spend their time. There was a happy atmosphere in the home. This gives the people living in the home some choice over what happens in their lives. People are encouraged to maintain links with their family and friends. Visitors were observed coming in to the home on the say of the inspection and were made welcome by staff. Visitors confirmed that they could visit at any time. A relative stated in their completed questionnaire: • “I visit most days and I’m always made welcome.” Care records confirmed residents’ religious needs. The manager and people spoken with confirmed that the home receives visits from representatives of local churches. We did not dine with residents but observed the lunchtime meal being served. The atmosphere in the dining room was relaxed with residents chatting to each other during their meal. People said they enjoyed their meal. Menus and records of food provided show that choice is available. The kitchen was seen to be clean, organised and well managed. At the time of the most recent Environmental Health Officer’s (EHO) inspection, matters were generally satisfactory. A requirement was made to improve the ventilation in the kitchen and the registered provider and the EHO are seeking to reach a satisfactory outcome on this. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. Staff respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. People spoken with on the day said they would raise concerns with any member of staff, as necessary. Comments received from residents and relatives include: • • • “I have no worries at all.” “I have never needed to complain, care is always first class” “I think it highly unlikely I will have to make a complaint” We have received a complaint since the last inspection and this is referred to under the appropriate sections of this report. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 17 There have been no adult protection issues at the home. The abuse policy was reviewed and it was noted that this had been updated since the last key inspection visit, but should be further reviewed, as it does not contain full instructions for staff regarding the action to take if abuse is suspected. . It was not evident that the reporting procedure is openly on display in the home so that senior staff can access this promptly when needing to make any referrals, for example at weekends when the manager may not be readily available. Staff spoken to were aware of their responsibilities in respect of making referrals so that appropriate investigations could take place to safeguard residents. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26 Quality in this outcome area is good. The home provides comfortable surroundings that are reasonably maintained and clean. This should increase the experience of quality of life for people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal areas were comfortably furnished and residents appeared at ease in their surroundings. Three lounge areas, including a newly built conservatory, are available on the ground floor. One lounge offers a quiet area where residents and their visitors can sit in private. There is a separate dining room where people are encouraged to dine to enable socialising where possible. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 19 Bedrooms were clean and there were no unpleasant odours. People have the opportunity to bring their own personal items to decorate or furnish their rooms, promoting individuality and ownership. People said that the home is always clean and well maintained. A resident commented, “I am very happy and comfortable here.” The bathrooms and toilets are easily accessible to people. Facilities were clean and everything required for personal hygiene was available. There is a large landscaped garden to the rear of the home, which has been maintained to a high standard and can be accessed by residents when they wish. The home has systems in place for the management of dirty laundry and the disposal of waste. Systems are in place to manage the control of infection. The standard of cleanliness in the home is good. There were no concerns about cleanliness or hygiene identified during the inspection Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 39 Quality in this outcome area is good. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Recruitment procedures are not always followed consistently to ensure the protection of residents from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff within the home were observed to be friendly, caring and supportive to residents and there were many positive comments made about the staff both during the inspection and within comment cards received from residents and their relatives. • • “All the staff are very good, very nice” “The girls are marvellous, always smiling and willing to go the extra mile” On the day of the inspection visit there were 4/5 care staff on duty throughout the day, with the manager being supernumerary. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 21 Three staff files were examined. Staff files evidenced that rigorous staff recruitment checks necessary to ensure the protection of residents had not always been carried out before staff were confirmed in post. One of the files examined showed that a Criminal Records Bureau (CRB) disclosure had been applied for, but had not yet been received. Another file showed that a CRB from a previous employer had been accepted and a new check had not been applied for. CRBs are not portable, therefore a new CRB must be obtained. The manager has since confirmed that these had been requested for the identified staff members. A recently employed member of staff told us that she had undertaken a sixweek induction period at the home. She said staff receive good support from the providers and management and that there is a “very fair system” in the home. The AQAA completed by the manager prior to the inspection indicated that 11 of the 19 permanent care staff either have, or are working towards a National Vocational Qualification (NVQ) at Level 2 in Care. We saw evidence that training courses in Dementia Care, Palliative Care and Infection Control had been booked for staff members with a local college. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The manager is competent and fit to be in charge of the home. Policies and procedures offer a sound framework and safeguard service users’ interests and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been in post for a number of years and has the necessary experience and training required to undertake the role. She has an in-depth knowledge of the care needs of those that live at the home. She was observed using an open, consistent and friendly approach to people living at Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 23 the home, visitors and staff. Staff spoken with provided positive comments about the management style and the support they receive. The manager is supported by a Deputy Manager who has achieved the NVQ level 3 in care and said she wishes to commence the NVQ level 4 in care. We received a complaint, which alleged that staff morale in the home was low. Staff spoken with said they felt there was a good team spirit and that the providers and management were “fair” in their dealings with staff. We found no regulations had been breached. Currently quality assurance is done on an informal basis mainly because of the size of the home and the fact that the registered provider and management provide a very hands on role. Some surveys completed by people living in the home were seen. This is an area that the home must develop to ensure the views of all interested parties, including visitors, staff and other interested stakeholders in the community, for example, GPs and District Nurses are sought on how the home is achieving goals for people living there. An audit of the management of the peoples personal allowance management was carried out and a robust system was evidenced. Health and safety of the staff and residents is well managed. Required checks on the fire system, emergency lighting and hot water are undertaken. All equipment is serviced regularly. Staff undertake health and safety, moving and handling, fire, food hygiene and first aid training on a regular basis. Policies and procedures to do with conduct and management of the home, together with all risk assessment procedures are in place. Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 24 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 25 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. 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 Refer to Standard OP18 Good Practice Recommendations The Adult Protection Policy must be further updated to include details of who should be contacted if abuse is suspected i.e. social services, commission for social care inspection etc and some mention of whether disciplinary action will be taken if abuse is substantiated. Recruitment procedures in the home must be followed to ensure a robust and consistent approach to staff recruitment and employment practices. This will ensure that people who use the service have their health, safety and welfare protected. A Quality Assurance Programme should be further developed to monitor and audit the services provided at the home. This will ensure that the home is run in the best interests of the residents 2 OP29 3 OP33 Albemarle DS0000004202.V354974.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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