Inspection on 19/07/06 for Albemarle

This inspection was carried out on 19th July 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Albemarle 15/11/07

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 Deirdre Nash Unannounced Inspection 19th July 2006 11:45 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.V303685.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.V303685.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.V303685.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2006 Brief Description of the Service: Albemarle is a care home providing personal care and accommodation for 24 older people aged 65 years and over. The home is located in Leamington, 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. Fees for 2006/7 are £480 to £525 per week. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all of the information that we have received about this home and kept on our records over the past twelve months. The home has had some contact with us during that time to keep us informed of residents well being. We sent the home a questionnaire in May to fill in and bring us up to date with facts and figures about the home. We did not receive it back although the manager says that she filled it in and returned it to us in good time. The Inspector called on the home without notice at noon mid week, spoke with some of the residents, spoke to staff, spoke to the manager and the owner, looked around the home and looked at records. The care of a sample of four particular residents was ‘tracked’ this way in order to see if the home is providing a service that meets the national minimum standards. What the service does well: What has improved since the last inspection? The manager now makes sure that when new staff are appointed the home has all the information about them necessary to be confident that they are suitable to work with vulnerable people before they start work. Any complaints received by the home are now fully recorded in a central logbook. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 6 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. Albemarle DS0000004202.V303685.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 Albemarle DS0000004202.V303685.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that the needs of service users are assessed before she offers them a place in the home. Residents move into a home that can properly look after them. EVIDENCE: The manager reports that up dated copies of the Statement of Purpose and Service User Guide are given to families/prospective service users. The home now needs to make sure that these contain the extra information required by the amendment to the Care Homes Regulations 2001 that come into force this month and also on 1st September 2006. The care files of a sample of four residents were looked at including the most recent admission to the home. All but one, a resident who has been in the home for some years, had a written assessment of needs. Three staff spoken to confirmed that they had, on the day before undertaken some dementia awareness training and were able to describe how their care of Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 9 their residents who have dementia or confusion will benefit from it. The manager reports that 12 staff attended this training. Although the home is registered for up to three people with dementia, many more residents do have or develop some confusion so this is important and relevant training. There was no evidence of any contracts or written terms and conditions for care and accommodation in resident’s files. A requirement is made to improve this so that everyone is clear about what has been agreed. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. Residents have written individual plans for their social and health care. Residents receive good quality care from a team committed to their well being. EVIDENCE: Four care files were looked at and each contained a service user plan with evidence that the manager or deputy reviews it monthly. The plans show how the assessed needs of residents are to be met and include how the home helps residents to get the routine and specialist healthcare that they need. One residents notes showed some episodes of challenging behaviour that had affected other residents. There was no written risk assessment or risk management strategy for this to direct staff in their approach. A requirement is made below under the standard on ‘protection’ but reference is made to it here because it is an example of how the home could further improve its service user plans by including the resident and /or their relatives and other Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 11 professionals that may be involved with their care in formulating and agreeing care plans. This is a good practice recommendation. Administration of medication was observed at lunchtime. Medication is properly stored, administered and recorded including the controlled drugs which ensures that residents receive appropriate medication. The manager reports that all staff who administer medication have undertaken a four module distance learning course through a local college and that this training has reduced errors. Residents asked confirm that staff carry out personal care sensitively and competently. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. Staff address the well being of each resident as an individual and meals and mealtimes make a positive contribution to this. Residents enjoy a fulfilling lifestyle within the limitations of their condition and needs and are not treated as a group. EVIDENCE: The Inspector saw many residents occupied with something and visitors coming and going through the day. The garden was laid out with tables and chairs and a big sunshade. All afternoon staff were heard asking residents to make the small choices of everyday living. Residents spoken to confirm what was written in individual’s records that regular activities are offered and one resident said she runs the lottery syndicate for the home. The owner reports plans to extend the communal space at the rear of house and this would also provide a space for concerts and gatherings. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 13 One resident said ‘. Its nice, you can have a chat and a laugh with the staff and they come ‘round at night because they know I have trouble sleeping and ask me if I want a cup of tea’. Lunch was fresh, well served and unhurried. Sorbet and ice cream were served, as the day was so hot. Staff offered residents drinks all afternoon in line with the ‘heat wave’ risk management plan put in place by the manager. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The outcome for this group is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously but there are no written procedures for responding to any suspicions or allegations of abuse. Residents are not safeguarded by clear policy and procedures. EVIDENCE: The Commission for Social Care Inspection has received no complaints about this home since the last inspection. The home records complaints/concerns and ‘issues’ in individual care files and in a central log book. One complaint had been made since the last inspection by a relative and it was properly written up describing the response that the manager made. Residents spoken to confirmed that the manager and owner would deal with any concerns or complaints seriously. The home has made no progress since the last inspection on Protection Of Vulnerable Adults (POVA) policy and a requirement has remained outstanding for this since the last inspection. This must be done or the Commission may take enforcement action to improve the framework in the home for responding to any suspicion or allegation of abuse. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 15 Referred to above, ‘Issues’ recorded in one care file during 2005 described some adverse episodes from one resident that involved another resident and how staff responded. There was no risk assessment or agreed management strategy on record in this residents care plan to guide their response to this challenging behaviour. The other resident did not get the extra protection afforded by this incident being reported ‘out’ of the home to social services and to us. This highlights the absence of up to date knowledge and practice around adult protection and the home needs to catch up. A requirement is made to improve this to give residents the best possible protection. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. The house is large, well decorated and has accessible gardens. Residents have a comfortable home. EVIDENCE: The day of inspection was a very hot day and windows were open around the house and blinds closed to keep out strong sunlight where necessary. The garden doors were open but residents said it was too hot to sit out even under shade. The rear dining room was not useable under the heat wave risk assessment and this meant that the front dining room was cramped and difficult for residents and staff to get around with mobility aids. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 17 The Inspector saw one near mishap while staff were moving a resident between chairs. A requirement is made below under safe working practices to improve this. Plans to build a very large conservatory on the end of rear of house are reported by the owner. This would greatly increase the communal amenities. It is difficult to find the way through to this area from the front of house and the manager needs to think of ways to effectively ‘sign post’ this route for confused residents other wise they won’t get the benefit of it. The Manager reports that bedrooms redecorated since last inspection have been done in neutral tones to make sure they don’t further handicap already cognitively impaired and confused residents. A requirement is made to make sure the new extension décor/layout/ access maximises independence and minimises confusion. The Inspector has sent some information on how to go about this. Although it was the hottest day for decades the house smelled nice and the residents were well groomed. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. Staff have been recruited to work in the home in line with current good practice that safeguards residents. A trained, well-motivated team work towards common goals. Residents are well looked after with a professional approach to their care. EVIDENCE: Inspection of a sample day on the staffing roster shows the home to be well staffed and has a strong management presence from two deputies. Comments from residents show that night staff actively engage with residents during the night. Staff were seen making records before they went off duty at 2pm on the day of inspection and the records are well written, clear and useful. The manager reports that over 50 of care staff hold NVQ in Care at level 2 and four more are being put forward for the college programme in September. This is very positive. Twelve staff had undertaken some dementia awareness training the day before the inspection and a discussion with three of them showed that they had learned from the course more about how to understand and help their residents with dementia and some confusion. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 19 Staff confirmed that they are all to attend refresher manual handling training in October this year. A sample of two personnel files of recent recruits showed that the home has all the documents and proofs necessary about workers to protect residents from unsuitable people and this is an improvement from previous inspections where there were gaps in information. The staff group is generally very stable and when it needs to recruit the home is attracting qualified social care staff. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33, 35, 36, 37, 38 The outcome for this group is good. This judgement has been made using available evidence including a visit to this service. There is effective management and leadership in the home and the owners have invested in improvements. Fire safety checks are not rigorous. Residents, staff and visitors are being put at risk from any faults in equipment going unnoticed. EVIDENCE: The manager is registered with us, qualified in social care and management and well supported by two deputy managers. There is a clear structure of accountability with also a lead care assistant assigned to each shift in rotation. The manager reports that the home does not manage money for any resident. The owner is in the home most days and financial investment in the fabric of the home is ongoing. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 21 No concrete progress on quality assurance has been made, the manager reports that work is in progress but this needs to be completed now. Residents and others who have an interest in the home should be asked their views on the quality of its service. There has been no progress on formal staff supervision; this was a requirement from last inspection and needs to be done. This will further improve team work and the professionalism of the staff. A sample check on fire extinguishers and bath seats show regular safety inspection and maintenance. A deputy manager reports that the fire risk assessment for the house is work in progress, this must be completed now and incorporate the plans for the new extension. Inspection of fire safety test records show significant recent gaps in testing of fire alarm and emergency lights. The last Fire Officers report of February 2005 raised this as a shortfall and the home has slipped back again. There is a fire safety policy for the home that includes regular fire drills but there was no evidence of any drills taking place. This puts residents, staff and visitors to the home at risk and must be improved. The manager was given 48 hours to test the fire alarm and emergency lights and to carry out a fire drill. An immediate and ongoing requirement is made. Manual handling practice needs to improve. Referred to above, there was a ‘near miss’ accident in the dining room at lunchtime while a resident was being transferred from one chair to another. There is a manual handling risk assessment in this residents care file but it is not sufficiently detailed. Also, risk assessments are not being linked to each other. For example the heat wave risk assessment undertaken for each resident determined that the rear dining room was not safe for residents to eat in but the resultant crowding in the front dining room had not been accounted for and managed as safely as it could be. Staff talked about how they should safely handle the resident referred to above but could not say from where they got that information. This suggests that care plans, including risk assessments are not being read. Staff were also seen turning dining chairs towards the tables with residents sitting in them. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 22 This can damage the backs of staff and cannot be comfortable for residents and should not be done. Requirements are made to improve this. Staff are updating their manual handling training in October. All records seen were well written and properly kept and one resident asked said that she felt comfortable about asking to see anything that was written about her. Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 x x 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 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 2 x 3 2 3 2 Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP18 Regulation 13 Requirement The registered person must ensure that a written policy and procedure is produced to respond to suspicions or allegations of abuse of residents and that staff are made familiar with it. (Compliance date of 01/05/06 not met) The registered person must ensure that staff have at least six individual professional supervision sessions each year with their manager. (Compliance date of 01/05/06 not met). The registered person must ensure that each resident has a copy of a written statement of terms and conditions for their care and accommodation. The registered person must ensure that any incident that adversely affects the well being of a resident is reported to the CSCI and where appropriate to social services. The registered person must DS0000004202.V303685.R01.S.doc Timescale for action 01/09/06 2 OP36 18 01/09/06 3 OP2 17 01/10/06 4 OP18 13 01/08/06 5 Albemarle OP19 12 01/09/06 Page 25 Version 5.2 6 OP33 24 7 OP38 23 8 OP38 23 9 OP38 13 ensure that plans for the new communal room supports people with dementia and helps to maximise their independence and minimise confusion. The registered person must ensure that a system for reviewing and improving the quality of care provided by the home is established and maintained and that reports on this are made available to residents and to the CSCI. The registered person must ensure that a fire safety risk assessment is completed for the house and that the proposed new extension to the ground floor is taken into account. The registered person must ensure that the fire alarm system and the emergency lights are tested and then regularly tested at the appropriate intervals and that a fire drill is carried out and thereafter at regular appropriate intervals. IMMEDIATE The registered person must ensure that staff do not move residents unless the move is assessed and that manual handling risk assessments contain the detail necessary to instruct staff and that staff read the risk assessments. 01/10/06 01/09/06 21/07/06 01/09/06 Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 26 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 OP6 Good Practice Recommendations The manager should involve relatives and other professionals in agreeing care plans and risk management strategies for residents who may have some behaviour that challenges staff and other residents. The manager should take opportunities to make the interior décor in the home less likely to disable residents with confusion and other cognitive impairment. 2. OP20 Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Albemarle DS0000004202.V303685.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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